After a successful four-month trial run, Montgomery County Fire and Rescue Service (MCFRS) debuted a Whole Blood Transfusion Program on Wednesday as the latest life-saving tool for county emergency medical services providers to use in the field.
The initiative is “one of the greatest milestones that we’ve achieved in my entire 24 years” with the county department, MCFRS Medical Director Dr. Roger Stone said Wednesday during a press conference at the county’s public safety headquarters in Gaithersburg.
“For some time, trauma surgeons have long recognized that there’s a value to pre-hospital transfusion of blood as a vital life-sustaining bridge when patients are on the way to a facility where they can get rapid surgical intervention to stop the bleeding,” Stone said.
Having the capability to give whole blood transfusions allows first responders to provide critical care at the scene of an incident before a patient is transported to trauma care at a hospital, officials said.
Within the first four months of the program’s implementation, county emergency medical services (EMS) providers have conducted whole blood transfusions on 24 patients in the field, according to MCFRS officials. Of those 24 individuals, 16 survived.
Whole blood is the “preferred product for resuscitation of severe traumatic hemorrhage,” according to the National Institutes of Health in Bethesda. “It contains all the elements of blood that are necessary for oxygen delivery” and hemostasis, or the body’s process of stopping bleeding and repairing an injury.
The program stemmed from interest in trauma resuscitation due to an increase in the number of “penetrating injuries, shootings and stabbings” that are occurring in the county, according to MCFRS Assistant Chief Ben Kaufman.
“What we didn’t realize was the high volume of medical patients that we were going to be seeing and able to resuscitate with whole blood,” Kaufman said, noting that patients with a medical problem such as a gastrointestinal bleed or an obstetrics issue also benefit from the transfusions.
According to Kaufman, about one third of the county’s whole blood transfusion patients suffered from medical issues, not trauma. MCFRS Chief Corey Smedley said at the press conference that the program is bringing “the right resources at the right time.”
Two years ago, Stone said, the county began reviewing medical literature and looking into bringing whole blood transfusion capabilities to EMS. Nationwide, he said, only about 1% of EMS systems have the capability to do whole blood transfusions on scene.
“In conducting data analysis, [we] estimated that by giving whole blood in the field, we could help save more than 40 patients every year with life-threatening hemorrhagic shock,” Stone said.
In a recent case, Stone noted, paramedics conducted a transfusion on a patient with a severe neck injury who was bleeding profusely and “on the verge of cardiovascular collapse.” The patient survived, he said.
Stone also noted that the county contacted other local agencies already implementing the program. MCFRS is the third in the state to have its paramedics implement a Whole Blood Transfusion Program, after Maryland State Police and Howard County. In April, Washington, D.C. also began implementing a whole blood transfusion program for paramedics.
MCFRS officials learned from the Maryland State Police that the agency had administered more than 122 units of blood to more than 100 patients in state helicopters during the program’s first year of operation.
How does the program work?
MCFRS partners with Suburban Hospital in Bethesda and Fairfax-based Inova Blood Donor Services to get the O-positive blood they administer to patients in the field.
According to officials, the blood is acquired from Inova blood drives and donor centers. The blood is then supplied to Suburban Hospital’s blood bank, which processes and holds the blood for MCFRS paramedics to use in the field.
Kaufman said paramedics can carry blood in a refrigeration box for up to two weeks. If the blood is not used within those two weeks, it is given back to Suburban Hospital to be used on another patient or broken down into other blood components such as platelets.
LeighAnn Sidone, president and chief operating officer at Suburban Hospital, said at the press conference that teams at Suburban Hospital’s Trauma and Transfusion Medicine also prepare the blood for patients who are en route to the hospital.
“In these moments of severe hemorrhage, receiving blood as soon as possible improves a patient’s survival rate,” Sidone said.
Nicholas Lilly, senior director of Inova Blood Donor Services, said Inova services more than 20 EMS partnerships in the region and relies heavily on the involvement of the community to provide the blood needed for transfusions.
“We can’t do this without those members of the community. So, I just want to thank everyone out there that hosts blood drives, helps by donating blood and spreading awareness,” Lilly said.
Stone said the blood transfusion program “speaks to” Montgomery County’s vision for improving access to medical care and closing disparities in health care access.
“Whole blood is the quintessential example of an equal opportunity life saver,” Stone said. “We’ll continue in Montgomery County to always keep that in mind when we think about future medical innovations.”
