Eagle County Paramedic Services launches innovative whole blood program to save more lives
Carefully designed system gives paramedics an improved tool to treat patients who are bleeding to death
Eagle County Paramedic Services/Courtesy photo
Eagle County Paramedic Services has a new tool to save patients: whole blood.
The ambulance district‘s new whole blood program, which started on Oct. 8, involves a carefully designed system to make the most of the potentially lifesaving treatment for patients who are bleeding to death.
“Pre-hospital blood, in the EMS setting, is similar for the resuscitation of trauma patients as the AED was 30 years ago in the resuscitation of cardiac arrest patients. It is a standard of care that provides a very small cohort of patients a real inflection point for their survival,” said Brandon Daruna, Eagle County Paramedic Services CEO. “A small percentage of what we do is the extreme stuff, but those are the places where we really have the opportunity to make a huge difference.”
Chris Carr, a critical care paramedic and a champion of the system’s whole blood program, said Eagle County Paramedic Services now has pretty much every single capability that you would see on a medical helicopter.
“Between our critical care and now this blood availability to be given in the field, we provide that same level of care as an agency,” Carr said. “We’re pretty unique in that. We really are doing things that aren’t really available in most of the other parts of the state.”
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Carr would know. A paramedic of 20 years who has worked for Flight For Life, he represents Eagle County on the state’s Whole Blood Coalition, a committee of experts working to bring whole blood treatment to agencies throughout Colorado.
Why bring in a whole blood program?
Eagle County Paramedic Services responds to about 6,000 calls per year. Approximately 25 of those are cardiac arrests. Another 10 are bleeding cases that can be helped by whole blood — and the difference has the potential to be dramatic.
“I feel like it’s really going to alter the course of several of our community members per year,” Daruna said.
“To save a life, we would need to give (whole blood) to about five people,” Carr said. That makes whole blood “kind of the most meaningful intervention that we have in emergency medicine.”
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“We think about early CPR and public access AEDs as another huge intervention that we can point to that has directly, tangibly saved lives, and the number there is about 15 (people),” Carr said. “So in theory, this is three times more effective than public AEDs and early CPR in cardiac arrest.”
When a person is bleeding out, the pressure in their vessels drops and their heart stops functioning properly. For decades, the best practice in medicine has been to put saline, or salty water, back into the bleeding body to keep pressure up.
“The problem with that is saline doesn’t carry oxygen, saline doesn’t have clotting, saline doesn’t really replace blood, and what we were probably doing … was artificially improving blood pressure, and that was causing patients to bleed faster,” Daruna said.
In addition to being a CEO, Daruna is a paramedic himself.
More than a decade ago, the U.S. military began to put whole blood back into patients who were bleeding out. The results were overwhelmingly positive.
“As the military has moved away from saline and toward whole blood, what they are seeing is not just a volume expansion but also a return of systemic function as that blood aids clotting and improves oxygen carrying capacity,” Daruna said.
It is only recently that whole blood became available for broader use across EMS agencies. Previously, “it was just in the domain of larger hospitals,” Carr said.
As a paramedic with Flight For Life, Carr treated patients with whole blood and saw the difference it made.
“It’s one of those very few interventions in EMS where most of the time, you can give it and you can see a noted improvement in the patient condition,” Carr said. “You can see the (patient’s) color change, they feel better, and stabilization in vital signs.”
Whole blood can save lives when treating patients who are bleeding to death, from traumatic injuries or medical illnesses, including obstetrics patients and GI bleeds.
“Any situation where a patient is experiencing shock from exsanguination, or bleeding, would be a good time to use whole blood,” Daruna said.
The treatment stops patients from deteriorating as quickly and seems to help them bounce back faster during recovery.
“There is good research that blood given within 30 minutes of injury is a transformative treatment. What I’ve seen is when it’s given within 30 minutes of treatment, it reduces hospital stays by 50%, and, interestingly, it reduces total blood utilization by 50%,” Daruna said.
For a rural EMS provider like Eagle County Paramedic Services, carrying whole blood has the power to be transformative.
“Say a patient is hunting on the Flat Tops and they have a mishap and they’re bleeding and they require transport. By the time we get to them, we may even be challenging the 30-minute window,” Daruna said. “For us to get to them, control bleeding and then move them to a facility, even if it’s by flight, is going to be outside of that 30-minute window. What we want to be able to do is get to them, control bleeding and be able to start the therapy, because that’s going to give them the best chance of survival.”
How the program works
Most of the EMS systems in Colorado that use whole blood have a direct interaction with a level I trauma center, enabling them to easily pick up and return blood. Due to Eagle County’s rural nature, with no direct connection to a level I trauma center, Eagle County Paramedic Services had to get creative with its whole blood program.
“We’re not the first ones to do this in Colorado,” Daruna said. “I do think we’re the first that are doing it like we’re doing it.”
The program relies on essential partnerships with the American Red Cross and Denver Health.
Saline lasts for two to three years and can be stored in virtually any condition. “Whole blood is definitely more temperamental. It’s essentially a living organism,” Carr said. “It’s almost like an organ donation.”
Whole blood has a shelf life of 21 days once it leaves the donor’s body, and must be kept under carefully monitored, temperature-regulated conditions.
“(Whole blood) is a very, very precious resource, it’s very sensitive, and we do not want to squander it,” Daruna said.
Avoiding wasting the blood is “one of the bigger challenges” of the program, Carr said.
After years of planning, the strategy found to work best for Eagle County Paramedic Services is as follows: The American Red Cross FedExs two units of blood to Eagle County in a temperature-controlled container once per week.
Eagle County Paramedic Services receives the blood and transfers it to two supervisors’ vehicles, one in Gypsum and one in Vail, where it lives in a temperature-controlled container and is available for use if a call comes in that might benefit from whole blood.
“Between those two locations, we can get to 96 percent of our calls within 15 minutes,” Carr said.
“We have a protocol so that if a call comes out and we have a reasonable suspicion that that person will be a candidate, (the supervisor is) responding with the ambulance,” Daruna said. “If the paramedics determine that the person needs blood, the supervisor will be there to provide it.”
At the end of the week, ECPS FedExs any unused unit(s) of blood to Denver Health. “Denver Health, then, because they have a high volume of trauma patients, would put that into the queue and hopefully use that blood to resuscitate someone. If they didn’t, they have a process where they would spin that blood into its componentry, which extends its life,” Daruna said.
“Our goal here is to be as efficient with this really precious cargo as we possibly can,” Daruna said. “We don’t want to have any loss rate.”
The planning process took a couple of years, plus a month to test the protocols with fake blood, before the program launched earlier this month.
“We are definitely unique in what we’re doing, and it has definitely increased the logistical hurdles that we deal with, which has taken us a little bit more time,” Carr said.
Since the program launched, whole blood has already been used to treat patients in Eagle County.
“Hopefully we can be a leader and a model for other agencies similar to us so they can start a program there,” Carr said.
“As a district and as an EMS organization, we want to be on the leading edge of good technology and good therapies that we can bring to the community that will improve their worst day,” Daruna said. “We want the community to know that we’re always thinking about how we can improve the EMS care we provide, and this is one of the ways.”
