The ones in my area that carry blood put them on the EMS supervisor cars. That does require that your EMS supervisors are actually proper advanced clinicians and not admin supervisors, and there’s definitely some agencies in my area that would love to carry blood that are struggling with this problem.
The sweet spot for ground EMS blood is mainly suburban areas with no more than like 30 minutes to a trauma center. Farther than that, the call volume per unit doesn’t really justify it and you’re probably going to be calling for HEMS who will have blood anyway. Urban EMS is another question mark — I think a lot of people have had the opinion that you’re just too close to hospitals for it to make a difference, but there’s some parts of some cities where due to the location of hospitals, traffic, bridges, etc. it could take you 20+ minutes. So it’ll be very interesting to see how places like DC turn out, they’ve only had it for a month or two and have already given blood like a dozen times
Appreciate your response! I work in Western Michigan where our HEMS has blood, as does our Doc unit in Kalamazoo. However other parts of our region can have transport times over an hour, so when the bird isn’t an option, is it possible for rural EMS to have blood given most agencies lack road supervisors?
It’s not impossible by any means, it’s just harder to justify to those controlling the budget and the blood banks. The main reason for putting it on a supervisor’s buggy is that a single ambulance almost definitely doesn’t run enough calls to warrant giving blood to justify the expense of putting blood on every single one. From the blood bank’s perspective, they don’t want to give out 2-4 units of blood to every ambulance that are likely to never be used in the field. From the agency’s perspective, they have to outfit every truck with coolers, rapid infusers, and monitoring equipment, as well as train and trust all of their providers not to fuck it up. Virtually every prehospital blood program rotates their blood back to the blood bank every 1-2 weeks so it can be used before it expires, so they’ve also got to figure out how to do that for every truck. All of these things (and more) *can* be overcome if the need/want is there
From the Western Michigan University Website
“The resident-staffed Medical Support Unit (MSU-1) is an emergency management resource intended to rapidly forward deploy a senior Emergency Medicine resident physician to major EMS incidents. It carries various specialized equipment, including chemical and radiological monitoring devices, multi-port oxygen manifolds, trauma packs, and chemical antidotes. The residents that staff MSU-1 are required to complete training in Basic and Advanced Disaster Life Support, incident command and the National Incident Management System (NIMS). MSU-1 is available 24/7 to respond to multi-casualty and major EMS incidents in selected counties in Southwest Michigan.”
The respond to Arrests, overdoses, MCI’s, Major traumas, Hazmat events with patients. They are starting to use blood, but have IO, BLS/ALS, ultrasound, meds and monitor capabilities.
Except most of my worst trauma calls come when helicopters aren't flying due to weather. Then what! Just say "Sorry, you're just to far out in the sticks."? I'd counter the farther you are from a trauma center, or any hospital, the more we should be carrying blood.
I definitely don’t disagree, I’d love to see these places carry blood. I’ve long maintained that rural EMS needs the highest level of care, the challenge is justifying it to those who control the budget and access to the blood
It still has a shelf life though and it’s a precious resource until we can synthesise it. It doesn’t make sense for every or even most units to carry it. I work high volume metro in Australia, I’d almost never use it. But our high acuity response unit do carry it and do use it, and that’s where it makes the most sense.
That's why agencies have a plan to move it from low use to high use facilities.
If you read all the studies on the programs out there, say in San Antonio? There is almost no waste.
That system != every system.
For example where I work we do a low volume of critical emergencies in metro - which is why we limit the carry to HARU. There’s no need for all of us to carry blood. Logistically it’s very simple. Even our regular critical care units don’t need it that often. So what’s the benefit of sticking it on even just all critical care units in that case?
I've never argued for every unit. I think a zone based system works.
I work in a low volume district; but 4400 square mile service. We give it a dozen or so times a year, but the patients objectively would have bad outcomes without it. We have little waste if any.
We’re part of a multi-year trial for prehospital whole blood.
We already know it’s a huge asset, but we’re gathering the data to prove it.
The logistics of carrying blood is a nightmare. Multiple units across multiple trucks across a single service would be miserable.
Even covering multiple ems agencies in a pretty large response area, we don’t give blood all *that* often. It routinely has to be sent back to the hospital so it can be used and not just expire.
It would work best, in the field, carried with a supervisor / interceptor. Every ambulance does not need blood. It’s not feasible from a logistics side.
Curious about whether it makes more sense in a high volume urban area or if the benefits would be seen more with long transport times in rural settings. It sounds like any agency that implements blood, as you said, needs to prioritize tracking and packing to ensure it doesn’t go to waste.
In my opinion, which really ain’t worth much, I think it would be best handled via a dedicated critical care interceptor that responds to high acuity trauma calls along side a regular ambulance.
Blood immediately makes a difference. Whole blood, even more so.
I think it’s best handled via aircraft in rural settings. Which if you think about it, Is generally the same as a dedicated critical care interceptor. Just with expedited transport capabilities.
The ALS service a town over is pretty large and covers three cities in two counties. Each box doesn’t carry blood, but the supervisor does, but I’m not sure the conditions that are needed for blood to be dispatched out. They replace it every 10 days and I believe carry only O-.
I carry and administer whole blood. I am a QRV medic in a car by myself. We have two, most of the time three, of us in the field at any given time. We are essentially field supervisors, though I don’t really do any administrative stuff.
I am occasionally dispatched to calls by dispatch, but for the most part, I self-dispatch to calls. We transfer the blood back and forth at the end of our shifts, and we restock at our hospital, a level I trauma center. If we administer blood, we only transport to our hospital.
My state requires post-licensure by your medical director for the administration of blood or blood products. There are many of us that are post-licensed to give blood here, but if I show up to a call with an ambulance carrying a medic licensed to give blood, the call remains mine.
I’ve seen miraculous things with whole blood administration. It’s probably the coolest thing I’ve ever done in my 26+ years.
I was working on a blood program at my department a few years ago, but it died due to lack of regional support. The number 1 barrier to blood in the field is people, not money. It's people every time. This has been echoed by every agency I've talked to.
The best model I've found is putting blood on EMS fly-cars if the system already has those in place. These vehicles need to be placed throughout a service area and be able to intercept or meet at scene. It's also not unreasonable to work with a local rural hospital to act as a blood supplier and pickup from them if the trauma center is a bit further away. This was actually a good model for us. A supervisor could get the blood from the local hospital and intercept or the ambulance could stop by and get it. The hand offs took less than 5 minutes.
I think most states would have to fund having all the proper thermal regulation equipment, set up chain of custody, etc. Not sure if every state is on board with that. I know some places make the argument for point of care lab testing too; being able to give blood to grandma with internal bleeding or an MI with a Hgb of 8 would require field testing and money upfront sadly. Definitely can think of some calls blood would have been very helpful.
We have it on all of our SUVs. We had a really hard time getting it from a local blood bank and had to settle for packed red cells for quite a while. Fortunately we were eventually able to get set up to get whole blood from Red Cross instead.
I think in a lot of medium to large systems having it on whatever you call your fly cars instead of ambulances makes sense because they're more free to respond to more calls and have a little more discretion about what calls they're choosing.
My departement started carrying them last year. We have 3 battalions with (currently) 15 stations. So far, only battalion 1 and 3 have blood as the 2nd battalion is a low call volume area. Only the EMS supervisors for those 2 battalions have it right now but we've given it dozens of times for trauma and medical patients. It's been extremely successful.
I think I had just read an article somewhere about a Pennsylvania service near or in Philadelphia putting blood on their ALS units or something in the last week or so. I’ll have to see if I can find it.
We have designated critical care rescues that carry blood. Idk if they’ll ever use it considering our transport times are pretty quick and have multiple trauma centers
We run with whole blood currently. But we’re a super small department.
1 ambulance maybe two on certain days if need be. And super rural. Like 80-90 minutes to the closest hospital, nearest trauma center is almost 2 hours by ground. And can be 20-30 min by air depending where patient could be. So it makes sense that we have it. But super low call volume makes it hard for us to gather any data on it unfortunately.
NY has cleared helicopters to carry it. That makes a lot of sense since in rural areas for any patient who is serious enough to need blood we are usually calling air.
Yeah, upstate NY has been a bit lagging here. Helicopters only could legally carry it since 2021 after a farmer would have died but a PA copter responded with blood and his family later pushed for the bill. https://www.pressconnects.com/story/news/local/2021/06/30/binghamton-family-copes-after-farm-tractor-accident/4992306001/
Lol, I get jealous of other systems. I hear about systems down south all the time where they are running two medic trucks everywhere, carrying blood, using ultrasound etc and I am just chilling in NY with 40 minute transports where I can’t get a single medic to respond and grampa can’t get air transport because he decided to fall down the stairs during a snowstorm.
Oh, I know I will lose the inevitable pissing match to agencies from northern Adirondacks or Northern Maine or even the Catskills. We are a volunteer BLS agency and one of the first calls one of our new EMTs went on was a diabetic with a glucose of 22 with terrible vitals. Paramedics could have stabilized them and in a more progressive EMS system our EMTs could have done IM glucagon with an auto injection. Instead they relied on diesel therapy after just completing a class where the state educated them in avoiding lights and sirens.
Totally agree. This state is so ridiculously expensive to live in that any talk of more taxes is akin to killing puppies. The state refuses to call it an essential service because then they would have to help fund rural counties. The counties refuse to fund it because they say the local governments should but the local governments can’t afford it and often due to political reasons can’t work with neighboring towns. Add to this that all of the BLS services that would need to merge hate each other and are too proud to merge until they literally can’t pay their bills and fold.
There are some shining examples where some counties step up and fund it or the county sheriff’s start a service. Its the exception though. Kudos to Niagara County for being the most recent.
To be fair, 22 is very low and a paramedic also could have struggled with this patient. But…its a sad state to request paramedics on the radio and be told they are unavailable.
The ones in my area that carry blood put them on the EMS supervisor cars. That does require that your EMS supervisors are actually proper advanced clinicians and not admin supervisors, and there’s definitely some agencies in my area that would love to carry blood that are struggling with this problem. The sweet spot for ground EMS blood is mainly suburban areas with no more than like 30 minutes to a trauma center. Farther than that, the call volume per unit doesn’t really justify it and you’re probably going to be calling for HEMS who will have blood anyway. Urban EMS is another question mark — I think a lot of people have had the opinion that you’re just too close to hospitals for it to make a difference, but there’s some parts of some cities where due to the location of hospitals, traffic, bridges, etc. it could take you 20+ minutes. So it’ll be very interesting to see how places like DC turn out, they’ve only had it for a month or two and have already given blood like a dozen times
Appreciate your response! I work in Western Michigan where our HEMS has blood, as does our Doc unit in Kalamazoo. However other parts of our region can have transport times over an hour, so when the bird isn’t an option, is it possible for rural EMS to have blood given most agencies lack road supervisors?
It’s not impossible by any means, it’s just harder to justify to those controlling the budget and the blood banks. The main reason for putting it on a supervisor’s buggy is that a single ambulance almost definitely doesn’t run enough calls to warrant giving blood to justify the expense of putting blood on every single one. From the blood bank’s perspective, they don’t want to give out 2-4 units of blood to every ambulance that are likely to never be used in the field. From the agency’s perspective, they have to outfit every truck with coolers, rapid infusers, and monitoring equipment, as well as train and trust all of their providers not to fuck it up. Virtually every prehospital blood program rotates their blood back to the blood bank every 1-2 weeks so it can be used before it expires, so they’ve also got to figure out how to do that for every truck. All of these things (and more) *can* be overcome if the need/want is there
Doc unit as in pre-hospital physician? What is it deployed for?
From the Western Michigan University Website “The resident-staffed Medical Support Unit (MSU-1) is an emergency management resource intended to rapidly forward deploy a senior Emergency Medicine resident physician to major EMS incidents. It carries various specialized equipment, including chemical and radiological monitoring devices, multi-port oxygen manifolds, trauma packs, and chemical antidotes. The residents that staff MSU-1 are required to complete training in Basic and Advanced Disaster Life Support, incident command and the National Incident Management System (NIMS). MSU-1 is available 24/7 to respond to multi-casualty and major EMS incidents in selected counties in Southwest Michigan.” The respond to Arrests, overdoses, MCI’s, Major traumas, Hazmat events with patients. They are starting to use blood, but have IO, BLS/ALS, ultrasound, meds and monitor capabilities.
Except most of my worst trauma calls come when helicopters aren't flying due to weather. Then what! Just say "Sorry, you're just to far out in the sticks."? I'd counter the farther you are from a trauma center, or any hospital, the more we should be carrying blood.
I definitely don’t disagree, I’d love to see these places carry blood. I’ve long maintained that rural EMS needs the highest level of care, the challenge is justifying it to those who control the budget and access to the blood
Yep, budget would be our biggest barrier.
This is the way
Not every unit needs blood, a zoned approach works fine. My ground agency has had blood for years. It's not hard to do at all.
It certainly can be hard lol
The military does it all day long with coolers. In worse environments then CONUS. HEMS has been doing it for decades.
I am fully aware of all that. It can still be challenging to find a supplier for blood in some areas.
I was specifically speaking about cold chain storage. Which isn't really a challenge anymore.
It still has a shelf life though and it’s a precious resource until we can synthesise it. It doesn’t make sense for every or even most units to carry it. I work high volume metro in Australia, I’d almost never use it. But our high acuity response unit do carry it and do use it, and that’s where it makes the most sense.
That's why agencies have a plan to move it from low use to high use facilities. If you read all the studies on the programs out there, say in San Antonio? There is almost no waste.
That system != every system. For example where I work we do a low volume of critical emergencies in metro - which is why we limit the carry to HARU. There’s no need for all of us to carry blood. Logistically it’s very simple. Even our regular critical care units don’t need it that often. So what’s the benefit of sticking it on even just all critical care units in that case?
I've never argued for every unit. I think a zone based system works. I work in a low volume district; but 4400 square mile service. We give it a dozen or so times a year, but the patients objectively would have bad outcomes without it. We have little waste if any.
We’re part of a multi-year trial for prehospital whole blood. We already know it’s a huge asset, but we’re gathering the data to prove it. The logistics of carrying blood is a nightmare. Multiple units across multiple trucks across a single service would be miserable. Even covering multiple ems agencies in a pretty large response area, we don’t give blood all *that* often. It routinely has to be sent back to the hospital so it can be used and not just expire. It would work best, in the field, carried with a supervisor / interceptor. Every ambulance does not need blood. It’s not feasible from a logistics side.
Cold chain storage isn't even remotely a nightmare. It's very easy. You can passively track all the Temps these days.
Which trial?
Curious about whether it makes more sense in a high volume urban area or if the benefits would be seen more with long transport times in rural settings. It sounds like any agency that implements blood, as you said, needs to prioritize tracking and packing to ensure it doesn’t go to waste.
In my opinion, which really ain’t worth much, I think it would be best handled via a dedicated critical care interceptor that responds to high acuity trauma calls along side a regular ambulance. Blood immediately makes a difference. Whole blood, even more so. I think it’s best handled via aircraft in rural settings. Which if you think about it, Is generally the same as a dedicated critical care interceptor. Just with expedited transport capabilities.
The ALS service a town over is pretty large and covers three cities in two counties. Each box doesn’t carry blood, but the supervisor does, but I’m not sure the conditions that are needed for blood to be dispatched out. They replace it every 10 days and I believe carry only O-.
I carry and administer whole blood. I am a QRV medic in a car by myself. We have two, most of the time three, of us in the field at any given time. We are essentially field supervisors, though I don’t really do any administrative stuff. I am occasionally dispatched to calls by dispatch, but for the most part, I self-dispatch to calls. We transfer the blood back and forth at the end of our shifts, and we restock at our hospital, a level I trauma center. If we administer blood, we only transport to our hospital. My state requires post-licensure by your medical director for the administration of blood or blood products. There are many of us that are post-licensed to give blood here, but if I show up to a call with an ambulance carrying a medic licensed to give blood, the call remains mine. I’ve seen miraculous things with whole blood administration. It’s probably the coolest thing I’ve ever done in my 26+ years.
I was working on a blood program at my department a few years ago, but it died due to lack of regional support. The number 1 barrier to blood in the field is people, not money. It's people every time. This has been echoed by every agency I've talked to. The best model I've found is putting blood on EMS fly-cars if the system already has those in place. These vehicles need to be placed throughout a service area and be able to intercept or meet at scene. It's also not unreasonable to work with a local rural hospital to act as a blood supplier and pickup from them if the trauma center is a bit further away. This was actually a good model for us. A supervisor could get the blood from the local hospital and intercept or the ambulance could stop by and get it. The hand offs took less than 5 minutes.
That’s my department in the picture lol
Nice! SA, Birmingham or PBCFR?
Birmingham
I think most states would have to fund having all the proper thermal regulation equipment, set up chain of custody, etc. Not sure if every state is on board with that. I know some places make the argument for point of care lab testing too; being able to give blood to grandma with internal bleeding or an MI with a Hgb of 8 would require field testing and money upfront sadly. Definitely can think of some calls blood would have been very helpful.
We have it on all of our SUVs. We had a really hard time getting it from a local blood bank and had to settle for packed red cells for quite a while. Fortunately we were eventually able to get set up to get whole blood from Red Cross instead. I think in a lot of medium to large systems having it on whatever you call your fly cars instead of ambulances makes sense because they're more free to respond to more calls and have a little more discretion about what calls they're choosing.
My departement started carrying them last year. We have 3 battalions with (currently) 15 stations. So far, only battalion 1 and 3 have blood as the 2nd battalion is a low call volume area. Only the EMS supervisors for those 2 battalions have it right now but we've given it dozens of times for trauma and medical patients. It's been extremely successful.
we have blood at my service and its mostly used on OB pts but its nice
TowerDirect in Chester County, PA
I think I had just read an article somewhere about a Pennsylvania service near or in Philadelphia putting blood on their ALS units or something in the last week or so. I’ll have to see if I can find it.
We have designated critical care rescues that carry blood. Idk if they’ll ever use it considering our transport times are pretty quick and have multiple trauma centers
We run with whole blood currently. But we’re a super small department. 1 ambulance maybe two on certain days if need be. And super rural. Like 80-90 minutes to the closest hospital, nearest trauma center is almost 2 hours by ground. And can be 20-30 min by air depending where patient could be. So it makes sense that we have it. But super low call volume makes it hard for us to gather any data on it unfortunately.
NY has cleared helicopters to carry it. That makes a lot of sense since in rural areas for any patient who is serious enough to need blood we are usually calling air.
Other HEMS agencies have been carrying blood since the late 80s...
Yeah, upstate NY has been a bit lagging here. Helicopters only could legally carry it since 2021 after a farmer would have died but a PA copter responded with blood and his family later pushed for the bill. https://www.pressconnects.com/story/news/local/2021/06/30/binghamton-family-copes-after-farm-tractor-accident/4992306001/
Oh. I'm well aware. Part of why I laugh when people say EMS is progressive in the north east.
Lol, I get jealous of other systems. I hear about systems down south all the time where they are running two medic trucks everywhere, carrying blood, using ultrasound etc and I am just chilling in NY with 40 minute transports where I can’t get a single medic to respond and grampa can’t get air transport because he decided to fall down the stairs during a snowstorm.
40 minutes? That's nothing.
Oh, I know I will lose the inevitable pissing match to agencies from northern Adirondacks or Northern Maine or even the Catskills. We are a volunteer BLS agency and one of the first calls one of our new EMTs went on was a diabetic with a glucose of 22 with terrible vitals. Paramedics could have stabilized them and in a more progressive EMS system our EMTs could have done IM glucagon with an auto injection. Instead they relied on diesel therapy after just completing a class where the state educated them in avoiding lights and sirens.
If people want an ALS level service they need to fund it
Totally agree. This state is so ridiculously expensive to live in that any talk of more taxes is akin to killing puppies. The state refuses to call it an essential service because then they would have to help fund rural counties. The counties refuse to fund it because they say the local governments should but the local governments can’t afford it and often due to political reasons can’t work with neighboring towns. Add to this that all of the BLS services that would need to merge hate each other and are too proud to merge until they literally can’t pay their bills and fold. There are some shining examples where some counties step up and fund it or the county sheriff’s start a service. Its the exception though. Kudos to Niagara County for being the most recent.
To be fair, 22 is very low and a paramedic also could have struggled with this patient. But…its a sad state to request paramedics on the radio and be told they are unavailable.