Howard County aims to save more lives with blood transfusions in the field

Blood loss is a leading cause of death for people critically injured, yet most emergency responders to the scene of a car crash or other trauma can do little more than try and stem the flow of blood and rush to a hospital.

State Medevac helicopters recently began carrying whole blood for transfusions in the field, and Howard County Department of Fire & Rescue Services announced Thursday that it has become the first local jurisdiction in the state to carry whole blood on some of its emergency trucks, hoping to improve more people’s chances of survival.

“This will save time and save lives,” said Calvin Ball, the county executive, from a fire station in Elkridge where officials showed the equipment that will ferry the O-positive units of blood to the scene.

Transfusions are critical to saving patients who have lost blood, and the military has been successful in transfusing the blood in the field. But emergency responders around the country are more likely to carry only blood components to address specific patient needs.

Administering whole blood outside of hospitals is less common, as it has limited shelf life and is tougher to preserve than components.

That is beginning to change as studies are showing whole blood is more life-saving against hemorrhagic shock from severe blood loss common in traumatic injuries.

Training is required, as is the proper type of blood for patients; O-positive blood is the nation’s most common blood type and can be safely given to most people because it is compatible with other blood types. The emergency responders in Howard will attempt to get patient consent when possible.

Ball and Dr. Matthew Levy, the fire department’s medical director, said the county is following other cities and counties around the country who have begun training and acquiring the necessary equipment to carry blood, such as coolers, that are highly regulated for temperature.

They said it should have a large impact for injured residents of the county, one of the state’s most populated, and others who pass through the county located between Baltimore and Washington.

Howard County officials are following the University of Maryland Shock Trauma Center and the Maryland State Police who operate Medevac helicopters, which partnered on a program to stock units of blood for use on patients from around the state.

Officials said at the Medevac announcement last month that 23 critically injured patients had already received transfusions before they reached shock trauma or another trauma hospital in Maryland.

Most patients were victims of car crashes, but there were also victims of machinery accidents and shootings, and officials said some would have likely gone into cardiac arrest and died without the blood. Other uses, officials said, were women who lose blood after birth and those with gastrointestinal bleeding and aneurysms.

Dr. Thomas Scalea, physician in chief at shock trauma, consulted on the Howard County program. He called such programs “shock trauma in the field” and essential to saving more lives.

“It’s all about limiting shock,” he said during the news conference announcing the Medevac program.

“If you’re in hemorrhagic shock and get to the hospital with a low but still decent pressure, your chance of survival is about 30% to 40%,” he said. “If you proceed to cardiac arrest, survival is less than 1%, so being able to limit shock before we get to the point where the wheels fall off the machine is really a very important thing.”

Emergency services in the state are coordinated under an independent agency called the Maryland Institute for Emergency Medical Services Systems, so Scalea and Levy said other counties around the state are likely to follow the first two programs once they can be trained and acquire necessary equipment.

Levy said the county had already transfused one patient in the field with the whole blood, which will be stored in coolers on supervisors’ vehicles and closely monitored to ensure it’s safe and not wasted.

“It’s been shown safe for patients suffering hemorrhagic shock, the kind of shock someone goes into when they are critically ill or injured,” he said. “This will allow us precious time.”

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