N.C. EMS Agencies Roll Out Blood Transfusion Service

MORGANTON, NC—Many trauma patients die from blood loss in the first 30 minutes after injury before they can get to a hospital for treatment. The solution is to provide blood to paramedics to they can perform blood transfusions in the field.

Over the past six months, UNC Health Blue Ridge has collaborated with Burke County EMS, McDowell County EMS, and Caldwell County EMS to do just that.

Few counties in North Carolina have this service, and none in the immediate region. This unique partnership means residents with traumatic blood loss can get help in the field faster.

"Many of the patients can't get to a hospital and EMS is the primary care provider," said Brian Mahaffey, MBA, RN, CEN, trauma program manager, UNC Health Blue Ridge. "We want to give some more resources to EMS. One thing, in particular, is blood transfusions in the field."

Blue Ridge, EMS directors and the hospital's blood bank have been working collaboratively to work out protocols, training, and logistics for providing paramedics with whole blood. In early December, paramedics began training and plan to roll out the service later this month.

"This has been a long-term goal for Caldwell County to have blood on our trucks and it has always been a logistical nightmare," said Jonathan Cook, Caldwell County EMS Division chief. "The idea was brought up at a quarterly EMS directors meeting held here at Blue Ridge. Blue Ridge just figured out how to do this for us. We truly appreciate it."

UNC Blue Ridge has agreed to provide units of blood products along with coolers and temperature monitors to EMS. These coolers have sensors that monitor the temperature every 10 minutes. They are Bluetooth enabled to send alerts if the temperature climbs. The blood needs to be kept between 2 and 6 degrees Celsius, roughly 35 to 43 degrees Fahrenheit. So there is not an excessive waste of valuable blood, the UNC Health Blue Ridge blood bank will exchange units that are not administered.

"This is a huge step in the right direction for EMS," said Blake Cochran, Caldwell County EMS, training coordinator. "We realize there are multiple things that save lives—you can have the best paramedics, the best providers, best interventions, but two interventions really make a difference—hemorrhage control and getting blood volume back."

The new service will help with both and could save more than 50 lives a year. "When we worked with the agencies to determine the need, between all three departments, we estimated we would utilize this blood for patients approximately 60 times a year," said Leonora Mahoney, BSN, RN, director of Emergency Services, Trauma and Behavioral Health at UNC Health Blue Ridge.

The effort has truly been a collaboration between the hospital, three county agencies, and the blood banks. "One thing this program demonstrates is the strong partnership between Blue Ridge and local EMS systems," said Will Kehler, Emergency Services director, McDowell County. "It is a proven fact that you do not have to live in an urban area to receive world-class emergency care. Our citizens should take great comfort in knowing that this level of care is coming to the streets."

Depending on where the call is, transport time to the hospital can be more than 35 minutes. "Burke is a fairly large county and sometimes we have transport times up to 35-45 minutes," said Robbie Milton, Burke County EMS operations manager. "For a patient who is severely hemorrhaging, that's just too long to go without blood. This will allow us to bring blood out into the county. Even up into the wilderness areas of the (Linville) Gorge for special operations response that traditionally has not been an option. This gives us a lot of good options."

An incident in October highlighted the reason why this service is needed. When a hiker fell off Hawksbill Mountain and had life-threatening injuries, rescuers knew the patient would require whole blood before making it out of the woods. A helicopter flew in the blood and nurses hiked to the spot to administer it.

This new blood transfusion program will mean rescue personnel will be able to carry the blood and administer it without having to wait for a helicopter.

"In that particular rescue, the plan was for someone to come by the hospital and pick up the blood," Milton said. "But of course, that's an hour's ride from here to there. That's not really in the time frame you need it. The helicopter was already on its way so it was easier for them to land and bring it in."

"From our standpoint, the helicopter is wonderful, but the time we have patients in our care until that helicopter lands can be the difference between life and death," said Marvin Hancock, captain, McDowell County EMS. "We're in the same situation with Burke with wilderness medicine we do. To be able to have something portable like this to carry into the woods, and have that treatment done long before we carry them out of the woods will be the complete difference in the quality of life somebody has."

Mahaffey agreed, saying, "Many patients who are bleeding die of that bleeding within an hour. By enabling EMS to give blood on the scene and while they are en route to us will save lives and improve outcomes."

UNC Health Blue Ridge (www.unchealthblueridge.org) is a not-for-profit community health care system, providing advanced health care and wellness services from more than 40 locations across a three-county region of Western North Carolina. The system includes one hospital with two locations, a wellness center, and a continuing care retirement community. Nearly 120 primary care physicians, physician specialists and extenders in the Blue Ridge Medical Group combine with other physicians on the medical staff to serve patients in the region. UNC Health Blue Ridge provides graduate medical education programs for medical school graduates and students in allopathic and osteopathic medicine. UNCBR is affiliated with UNC Health System (www.unchealthcare.org), a not-for-profit integrated health care system owned by the state of North Carolina and based in Chapel Hill.