Blood Transfusions at the Scene Save Lives, but Ambulances are Rarely Equipped to Do Them
A Crisis in Emergency Medical Services
One August afternoon in 2023, Angela Martin’s cousin called with alarming news. Martin’s 74-year-old aunt had been mauled by four dogs while out for a walk near her home in rural Purlear, North Carolina. She was bleeding heavily from bites on both legs and her right arm, where she’d tried to protect her face and neck. An ambulance was on its way.
A Timely Intervention
When the ambulance arrived, the medics evaluated Martin’s aunt and then did something few emergency medical services crews do: They gave her a blood transfusion to replace what she’d lost, stabilizing her sinking blood pressure. The ambulance took her to the local high school, and from there a medical helicopter flew her to the nearest trauma center, in Winston-Salem. She needed more units of blood in the helicopter and at the hospital, but eventually recovered fully.
A Preventable Cause of Death
More than 60,000 people in the U.S. bleed to death every year from traumatic events like car crashes or gunshot wounds, or other emergencies, including those related to pregnancy or gastrointestinal hemorrhaging. It’s a leading cause of preventable death after a traumatic event. But many of those people likely wouldn’t have died if they had received a blood transfusion promptly, trauma specialists say.
Why It’s Not Happening
Of the more than 11,000 EMS agencies in the U.S. that provide ground transport to acute care hospitals, only about 1% carry blood. The term “blood deserts” generally refers to a problem in rural areas where the nearest trauma center is dozens of miles away. But heavy traffic and other factors in suburban and urban areas can turn those areas into blood deserts, too. Several EMS agencies throughout the country have established “pre-hospital blood programs” aimed at getting blood to injured people who might not survive the ambulance ride to the trauma center.
A Lack of Training and Resources
There are several roadblocks that prevent EMS agencies from providing blood. Several states don’t allow emergency services personnel to administer blood before they arrive at the hospital, said John Holcomb, a professor in the division of trauma and acute care surgery at UAB’s Heersink School. On the battlefields in the Middle East, operators of medical facilities would maintain that only nurses and doctors could do blood transfusions, said Randall Schaefer, a U.S. Army trauma nurse who was deployed there and now consults with states on implementing pre-hospital blood programs. But in combat situations, “we didn’t have that luxury,” Schaefer said. Medical staff sometimes relied on medics who carried units of blood in their backpacks.
A Compensating Solution
Civilian emergency services are now incorporating lessons learned by the military into their own operations. But they face another significant hurdle: compensation. Ambulance service payments are based on how far vehicles travel and the level of services they provide, with some adjustments. But the fee schedule doesn’t cover blood products. If EMS responders carry blood on calls, it’s usually low-titer O whole blood, which is generally safe for anyone to receive, or blood components — liquid plasma and packed red blood cells. These products can cost from $80 to $600 on average, according to Schaefer’s study.
Conclusion
Blood transfusions at the scene can save lives, but ambulances are rarely equipped to do them. This is a crisis in emergency medical services, and it’s a leading cause of preventable death after a traumatic event. With blood loss, every minute counts. Blood helps move oxygen and nutrients to cells and keeps organs working. If the volume gets too low, it can no longer perform those essential functions. It’s time for a change, and it’s time for more ambulances to carry blood.
FAQs
Q: Why is it important to provide blood transfusions at the scene?
A: Providing blood transfusions at the scene can save lives. It can help stabilize patients’ blood pressure and prevent further blood loss, which can lead to shock and even death.
Q: Why do ambulances not carry blood?
A: Many emergency medical services agencies do not carry blood due to a lack of resources, training, and equipment. Some states also do not allow emergency services personnel to administer blood before they arrive at the hospital.
Q: What is the cost of providing blood transfusions at the scene?
A: The cost of providing blood transfusions at the scene can range from $80 to $600, depending on the type of blood product used.
Q: How can we improve access to blood transfusions in emergency situations?
A: Improving access to blood transfusions in emergency situations requires a multifaceted approach, including increasing the availability of blood products, providing training for emergency medical services personnel, and addressing the lack of resources and funding for pre-hospital blood programs.
