Alexander County Emergency Medical Services (EMS) Director Jeffery Sigmon has announced that local paramedics with the department can now administer whole blood to traumatically injured patients.
Trauma is the leading cause of death for individuals up to the age of 45 years in the United States. Uncontrolled hemorrhage remains the number one cause of preventable death, according to the American Association for the Surgery of Trauma.
Sigmon and Major Kevin Richards, Alexander County EMS Training Officer, have been working on getting the whole blood capability in place for EMS since July 2022.
“With Alexander County located over an hour away from a Level One Trauma Center, our purpose is to provide a blood transfusion in the field to increase survivability,” Richards stated.
All Alexander County EMS ambulances are stocked with Tranexamic Acid (TXA), a medication which promotes blood clotting.
This week, EMS has begun placing whole blood in a special mini-Bio Fridge cooler on the EMS Quick Response Vehicle (QRV). The QRV is driven by a supervisor that has medical supplies but does not transport patients. The Bio Fridge was tested and certified by Atrium Health Wake Forest Baptist Hospital. A program known as Traceable Live provides continuous temperature monitoring of the blood to the smartphones carried by the EMS Director, Shift Supervisor, and Training Officer. It is critical for blood freshness to keep the units between 1° to 6°C.
Richards noted the QRV must remain running to power an inverter to run the Bio-Fridge, unless the QRV is plugged into a power outlet.
The QRV also carries a device called a QinFlow Warrior blood warmer, to heat the blood to body temperature for transfusion into the patient. The transfusion will be done with blood tubing, together with saline, in a setup with a forked, Y-shape tube. Saline is used to prime the IV line then whole blood administration begins.
When the first ambulance arrives on the scene of a traumatic blood loss patient, paramedics will administer TXA until the EMS Quick Response Vehicle (QRV) arrives with the whole blood product to begin transfusion.
Before this endeavor, paramedics could only give normal saline solution by intravenous (IV) to a patient.
“Normal saline will provide volume to a loss of blood,” Richards noted. “However, it does not provide oxygen carrying capabilities to the dying cells and organs. Along with attempting to stop the bleeding, previously paramedics would see trauma patients’ blood become thinner and thinner, until death occurred. With the capability of whole blood, along with TXA for clotting, we expect an increased survivability rate.”
“The development of a whole blood protocol came with careful consideration of the logistical challenges we faced as a service,” Richards said. “Attempts were made to work with our local hospitals on this endeavor. Unfortunately, general hospitals, such as the ones that surround us, cannot provide whole blood for field use as they are limited on how much they have on hand. Even with the medical helicopters that enter the county, not all of them carry blood.”
The whole blood that Alexander County EMS will use is from either O+ or O- blood donors, known as “universal donors” for their blood’s compatibility with other individuals having various blood types. The Red Cross notes that blood types are determined by the presence or absence of two antigens, A and B, on the surface of red blood cells. In addition to the A and B antigens, there is a protein called the Rh factor, which can be either present (+) or absent (–), creating the eight most common blood types (A+, A-, B+, B-, O+, O-, AB+, AB-). Whole blood is ideal for prehospital use as it is superior to crystalloids such as normal saline. Alexander County will be administering the same type of blood one would receive at a trauma center. The US military has been transfusing whole blood in the field with great success for several years.
The National Institute of Health explains that whole blood contains red blood cells, white blood cells, and platelets suspended in a protective yellow liquid known as plasma. About 55 percent of blood is plasma, and the remaining 45 percent is made up of red blood cells, white blood cells, and platelets. Plasma is about 92 percent water.
Alexander County EMS will source whole blood from Atrium Health Wake Forest Baptist Blood Bank. The blood bank at Baptist will ship the blood to the Atrium Health Wilkes Medical Center blood bank. The QRV will drive to Wilkes Medical Center to receive 2 units of blood every two weeks. These units of blood, if not needed, will be returned to the blood bank within 14 days, or five days prior to the expiration date of the blood, to receive a new shipment.
During times of whole blood shortages, the blood bank may substitute with 2 group O packed red blood cells and 2 group A plasma.
In the event of a mass casualty scenario, the Baptist Blood Bank can provide additional personnel and up to 20 units of red cells or whole blood to the scene.
“With blood being a valuable commodity, we plan to hold blood drives in the future,” Sigmon said. “Alexander Rescue Squad and local fire departments are interested in hosting blood drives to support the blood bank. When a blood drive occurs, I would like to encourage anyone who is willing to donate blood to please participate, as the blood you donate very well could come right back into Alexander County.”
With this new development in local EMS capability, Alexander becomes one of the few counties in North Carolina carrying whole blood.
Sigmon and Richards would like to thank James Caldwell from the NC Office of EMS, State Medical Director Dr. Tripp Winslow, Alexander County EMS Medical Director Dr. Joel Inman, Georgia Kontos and Christina Warren from the Baptist Hospital blood bank, and all the Alexander County Paramedics who have trained tirelessly.
“May this mission of whole blood administered in the field give someone a fighting chance,” Richards said.
“Prehospital blood administration is a cutting edge procedure that can save the lives of patients suffering from hemorrhagic shock prior to reaching a trauma center. We are very pleased with all the hard work our employees have put into our blood administration program and the effects it will have on the lives of critical patients in our county,” Sigmon concluded.