Whole blood transfusions in the field give trauma victims a fighting chance to survive

When a medical emergency strikes, every second counts. 

And that’s especially true when trauma and severe blood loss are involved. 

Trauma is the leading cause of death for people 45 and younger, and among trauma patients, uncontrolled bleeding is the leading cause of preventable deaths, according to the American Association for the Surgery of Trauma.

Nationally, there’s been a shift in thinking about how to give those trauma patients a better chance for survival by turning to a protocol previously used mostly on battlefields: whole-blood transfusions.

It’s a strategy that in recent years has found a foothold in South Florida, including within the ranks of Palm Beach County Fire Rescue, which in 2022 began training some of its firefighter-paramedics on how to do blood transfusions in the field. The department’s whole blood transfusion program launched in July 2022 and has proven to be a lifesaver (more on that in moment).

South Florida’s whole blood transfusion protocol actually got its start one county south of us ― with an effort begun by Broward Health.

“Our EMS teams have been trained and equipped to administer whole blood to trauma patients who are hemorrhaging — before they arrive at the hospital. The Broward Sheriff’s Office Air Rescue was the first in the state of Florida to establish whole blood transfusion protocol,” said Dr. James Roach, Chief Medical Officer at Broward Health Medical Center and the District Chief of Emergency Medicine.

IV fluids vs. whole blood battle tested 

As Roach explained, the current protocol for most EMS or emergency medical service teams around the country is to use only IV fluids to treat hemorrhaging patients until they arrive at the hospital for a blood transfusion. However, whole blood transfusion may be a better approach to treating hemorrhaging trauma patients. Whole blood is natural blood that is unseparated, meaning it contains all the components of blood (red blood cells, white blood cells, platelets and plasma). 

What EMS first responders are doing with whole blood is different than what is done with patients who receive transfusions in a hospital setting. 

“With a blood transfusion in a hospital, a pint of donated blood is usually separated out into components,” explained Roach. “For example, a cancer patient may receive platelet transfusions, while an anemic patient might get red blood cells.” 

Roach notes that the U.S. Armed Forces have used whole blood transfusions for years to save lives in combat, but civilian use by EMS is relatively new.  

“Evidence in peer-reviewed medical journals suggests that whole blood may be a better option than IV fluids during pre-hospital trauma care, and that it can improve chances of survival,” said Roach.

For example, a study published in the Journal of Trauma and Acute Care Surgery in 2020 compared outcomes of trauma patients who received a transfusion of whole blood with trauma patients who received only red blood cells and or plasma between November 2017 and June 2018. Taking into account the patients’ ages, severity of injuries, and their pre-hospital physiology, receiving whole blood (compared to blood components) was associated with a two-fold increase in likelihood of survival. 

Despite the data that supported the efficacy of the whole blood transfusion approach, some municipalities — including Palm Beach County — have been hesitant to adopt the protocol. 

A National Institutes of Health report in August noted that the “Palm Beach County [whole blood transfusion] program had several obstacles to overcome, with one of the major obstacles being the legal team’s perception of potential liability that might occur with a new prehospital blood transfusion program. This obstacle was overcome through education of local elected officials regarding the latest scientific evidence in favor of prehospital whole blood transfusion with potential life-saving benefits to the community.”

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That’s why NIH report ultimately concluded that, by the end of 2022, “Palm Beach County Fire Rescue had successfully implemented a prehospital whole blood transfusion program” and that “other EMS systems that are considering a prehospital whole blood transfusion program should review the barriers to implementation that were faced.”

Heath Clark, Division Chief of EMS at Broward Sheriff’s Office’s Department of Fire Rescue and Emergency Services, believes that what the Broward and Palm Beach County whole blood transfusion programs are doing is nothing short of miraculous. 

“We are giving these patients a fighting chance that they have never had before,” said Clark. “There is absolutely no shortage of stories where it saved a life. This stuff is like magic.” 

Could whole-blood protocol have saved her?  

For Roach, the motivation to give bleeding trauma patients a better chance at survival is both professional and personal. 

In 2018, Roach’s 23-year-old niece, Taylor Brooke Lee, died in an automobile accident. 

He often wonders whether a program like the one he helped create might have saved his niece’s life. 

“I have thought a lot about Taylor, and I have thought about how this is happening somewhere every day to someone’s loved one, and that we have to give our EMS more tools to try to save lives.” 

The success stories he hears about do buoy his spirits — and motivate him to expand the program further. 

“It is heartbreaking to hear a paramedic describe how demoralizing it is to watch a hemorrhaging patient deteriorate while waiting to be extricated after a car crash,” said Roach. “By contrast, a paramedic recently shared a success story where he provided a lifesaving transfusion to a patient who was bleeding internally while trapped in a vehicle.”