D.C. Fire and EMS Whole Blood Program Saving Lives in the Nation's Capital

In the evening of Wednesday April 10, 2024, Washington DC Fire and EMS paramedics transfused their first unit of low-titer (low levels of anti-A and anti-B antibodies) type-O whole blood into a patient as part of the agency’s new whole blood program. An adult male with gunshot wounds was treated by Medic 27, Paramedic Engine 10, and EMS 2 in Northeast Washington, after he met clinical criteria for receiving a prehospital transfusion.

“The patient actually survived,” said paramedic Lt. Holly O’Byrne, DC Fire and EMS whole blood coordinator. “Our very first patient actually was discharged to a skilled nursing facility and has since been discharged home.”

As of October 4, 2024, “we've treated 133 patients with 139 units,” O’Byrne told EMS World. “Six of our patients have received two units, so we know especially with penetrating trauma that upwards of 65% of those patients die. What I can tell you is overall 90% of our patients survive to discharge.”

“Our survival rate for patients with penetrating trauma that have received whole blood resuscitation in the field is typically greater than 90%, which is astounding when you think about it,” said David A. Vitberg. He is interim medical director for DC Fire and EMS, and the person who oversees the whole blood program. “The historical rates of mortality from penetrating trauma with hemorrhagic shock have been upwards of 60 to 70%—and we're seeing survival rates above 90%.”

When whole blood transfusions have been given to suitable patients in cardiac arrest, the DC Fire and EMS program has achieved a 77.2% survival rate. This is a substantial improvement over previous pre-transfusion patient outcomes, where death rates due to life-threatening hemorrhagic shock often exceeded 65%.

Announced by Washington DC Mayor Muriel Bowser in January 2024, the DC Fire and EMS Whole Blood Program is a collaborative partnership between DC Fire and EMS, the American Red Cross, George Washington University Hospital Blood Bank, and all of the district’s emergency departments and trauma centers. “This program is such a strong example of how you can improve outcomes when you get people the right care at the right time, and we’re grateful for the first responders who are making it a success,” said Mayor Muriel Bowser. “The Whole Blood Program is successful because we have teams of people, behind the scenes and responding to incidents, who innovate and work together to deliver the best care possible to our community.”

Whole blood transfusions are typically only administered in hospital settings. Less than 1% of all U.S. EMS agencies nationwide have adopted this life-saving technique. As a result, DC Fire and EMS is one of only 160 agencies in America to provide whole blood transfusions to eligible patients.

It makes sense to offer whole blood in the nation's capital city. “DC has had an exponential amount of penetrating trauma,” O’Bryne said. “The homicide rate was climbing and we knew we had to do something. People were dying in our city.”

In 2023, Washington DC suffered 274 homicides. That’s more homicides “than in any year since 1997, giving the District the fifth-highest murder rate among the nation’s biggest cities,” according to the Washington Post. “More than 90 percent of the killings through Dec. 27 were by gunfire, police said.”

To ensure that the DC Fire and EMS Whole Blood Program saves as many people as possible, program organizers reviewed crime statistics in the District and assigned blood supplies accordingly. “In the last six months, the placement of blood throughout the city has proven to be exactly where it needs to be,” said DC Fire and EMS Deputy Fire Chief Ryan Elborne. “Better yet, there is not a corner of the city that we can't have whole blood to within 10 minutes, which I think is pretty remarkable given our conditions in the city with traffic congestion.”

Being able to offer in-the-field blood transfusions has required some ambulance upgrades, staff training, and sophisticated real-time blood tracking on the part of DC Fire and EMS. But the lifesaving results have more than justified the effort. “This has been one of the most incredibly gratifying things I've ever done in my career, both in EMS and as a physician,” Vitberg said.

To learn more about the DC Fire and EMS Whole Blood Program, go to https://fems.dc.gov/page/whole-blood.