On Wednesday, the San Antonio Fire Department responded to a call from a man suffering major blood loss due to gastrointestinal bleeding.
The unidentified man’s blood pressure was dangerously low when paramedics arrived, but they saved his life by performing a blood transfusion en route to the hospital.
Since a citywide initiative launched Sept. 30 to provide blood transfusions inside ambulances to people who have suffered major blood loss, three area residents treated by paramedics survived, Fire Department officials said. First responders anticipate the initiative will save 250 lives in the region in one year.
“When you lose blood, you need blood, and every second counts,” said Dr. CJ Winckler, the fire department’s deputy medical director. “When you get down to the very basics of it, that’s what [medical first responders have] not been able to offer before.
“When paramedics [respond to a call] and realize someone needs blood, they can start the blood right there while transporting them to the closest medical trauma facility.”
The initiative is a joint effort among SAFD, the South Texas Blood and Tissue Center, University Hospital, Brooke Army Medical Center, and the South Texas Regional Advisory Council (STRAC), a network of hospitals and first responders who maintain the regional trauma and emergency healthcare system for San Antonio and the surrounding 22 counties.
The South Texas Blood and Tissue Center provides Type O whole blood, which anyone can receive, to SAFD, which keeps it in storage coolers in each of the department’s five medical officer vehicles and two special operations vehicles. The blood is heated by a portable fluid and blood warming device before being administered as first responders transport patients to either University Hospital or Brooke Army Medical Center, two of only 18 comprehensive Level I trauma facilities in the state.
San Antonio is the only urban area in the nation where first responders have the capacity to perform whole blood transfusions before a patient arrives at a hospital, said Randall Schaefer, research director at STRAC.
“The logistics involved in acquiring, tracking, storing, and maintaining blood involves a balance between donor supply and demand and cooperation between organizations to make sure that the blood is always being used” before it expires, Schaefer said.
In January 2018, rescue helicopters across South Texas began carrying whole blood for transfusions, an effort coordinated by STRAC to cover trauma victims across the region’s 26,000 square miles.
Based on the number of local residents arriving at San Antonio’s trauma centers needing an immediate blood transfusion, better outcomes could be achieved by immediately giving them whole blood, Schaefer said.
Whole blood is blood from which none of the components, such as plasma or platelets, have been removed. Standard practice is to give transfusion patients red blood cells, plasma, and platelets separately, typically at a 1:1:1 ratio.
The shift from using whole blood to blood components happened gradually in order to maximize blood banks’ limited resources, Schaefer said.
“Whole blood is a precious commodity and it depends on the [number] of donors willing to give it. While we would like to have whole blood in every ambulance in the region, it is not feasible.”
The program is funded by the City of San Antonio, which agreed to help cover the cost of whole blood acquired from the Blood and Tissue Center, and the U.S. Department of Defense, which covered the cost of the equipment. The City also has agreed to provide additional resources following any potential mass casualty situation in which many people need transfusions.
SAFD EMS Lt. William Bullock said the mechanical components required to perform a blood transfusion outside of a medical facility cost nearly $4,000.
“The machines make their money back,” Bullock said, by helping patients arrive at the hospital in better shape, saving medical and financial resources.
Not every blood-loss trauma will result in a transfusion on-site, Bullock said.
If a fire engine arrives at a scene and first responders determine a transfusion is necessary, they call medical special operations to bring blood to provide the transfusion; in cases where first responders know the severity of trauma ahead of time, a medic vehicle is likely only a few minutes behind the fire truck, Bullock said.
“Either way, we won’t delay the transport. If [first responders] have the person ready to go to the hospital before medics arrive,” they take the patient to the hospital, he said. “They do not wait for blood to arrive on site before taking the next step toward saving someone’s life.”
Paramedic Matt Bowers said while he has yet to perform a whole blood transfusion, he has responded to calls for which he was “extremely grateful” to have the option available.
Bowers was part of the medical team that responded to a triple shooting around 12:20 a.m. Monday outside the Pegasus nightclub north of downtown. In that incident, patients were taken to hospitals before a whole blood transfusion was necessary.
It was nice to have the blood on hand in that moment, even though it wasn’t needed, Bowers said. “It’s another tool in our tool belt.”