One August afternoon in 2023, cousin Angela Martin called alarming news. 74-year-old Aunt Martin was weakened by 4 dogs while walking near her house in a rural Purlear in North Carolina. She was bleeding strongly from bites on each legs and her right shoulder, where she tried to guard her face and neck. The ambulance was on the best way.
“Tell them that he is on eliquis!” -said Martin, a nurse who lived an hour by automobile in Winston-Salem. She knew that thinner blood could lead on to life -threatening blood loss.
When an ambulance arrived, the doctors evaluated Aunt Martin, after which did something few rescue medical services: they gave her blood transfusion to exchange what she lost, stabilizing her blood pressure.
The ambulance took her to an area highschool, and from there the medical helicopter flew her to the closest trauma center in Winston-Sale. She needed more blood units in a helicopter and within the hospital, but eventually fully recovered.
“The whole situation would be different if they did not give her blood right away,” said Martin. “She could die very well.”
Over 60,000 people In the United States, they bleed to death yearly from traumatic events corresponding to automobile accidents or gunshot wounds or other crisis situations, including pregnancy or gastrointestinal hemorrhage. This is the important explanation for death that may be prevented after a traumatic event.
But lots of these people probably wouldn’t die in the event that they immediately received blood transfusion, specialists say. On Press conference Last autumn, members of the American College of Surgeons estimated that 10,000 people may be saved yearly if more patients received blood before arriving on the hospital.
“I don’t think people understand that ambulances do not wear blood,” said Jeffrey Kerba, chairman of the ACS committee for trauma and manages the surgery of trauma and acute care on the University of Alabama-Birmingham Heersink School of Medicine. “They just assume they have it.”
From over 11,000 EMS agencies within the USA, which give ground transport to hospitals of acute care, only about 1% transfers blood, According to the study 2024.
The term “blood deserts” generally refers back to the problem in rural areas, where the closest traumatic center is positioned dozens of miles. But large traffic and other aspects in suburban and concrete areas can even transform these areas into blood deserts. In recent years, several EMS agencies throughout the country have established “pre -hospital blood programs” to offer blood to wounded individuals who may not survive an ambulance to the trauma center.
With blood loss, Every minute counts. Blood helps to transfer oxygen and nutrients to the cells and keeps the organs. If the quantity becomes too low, it could not perform these basic functions.
If someone is catastrophicly wounded, sometimes nothing can save him. But in lots of serious bleeding situations, if rescue staff can provide blood inside half-hour, “this is the best chance to survive for these patients,” said Leo Reardon, director of the rescuer program in the sector in Canton, Massachusetts, Fire Department. “They are at an early stage of the shock, in which blood will be the biggest difference.”
There are several blockades of roads that prevent EMS from providing blood providing agencies. Several states don’t allow the staff of emergency services to manage blood before arriving on the hospital, said John Holcomb, a professor from the Department of Trauma and acute care surgery at UAB Heersink School.
“It’s mainly a tradition,” said Holcomb. “They say,” It’s dangerous. You don’t have any qualifications. But each of these items are not true. “
In the fields of battles within the Middle East, military medical facilities would maintain that only nurses and doctors could perform blood transfusions, said Randall Schaefer, traumatic nurse of the American army, which was placed there, and now seek the advice of with countries within the implementation of pre -hypothable blood programs.
But in combat situations, “we didn’t have this luxury,” said Schaefer. Medical staff sometimes relied on medics who wore blood units of their backpacks. “Medics can absolutely make the right decisions regarding blood transfusions,” she said.
A fast response made the difference: soldiers who received blood inside just a few minutes of injury were 4 times more likely that they survived, According to military research.
Civil emergency services currently include conclusions drawn by the military to their very own operations.
But they face one other significant obstacle: compensation. Payments for ambulance services They are based on how far the vehicles and the extent of services rendered, with some corrections. But the fee schedule doesn’t include blood products. If EMS respondents wear blood on connections, it is normally low tuty for full blood, which is usually protected for everyone, or blood-plasma blood ingredients and packed red blood cells. These products can cost According to Schaefer, on average from 80 to 600 USD. And payments don’t include blood fridges, fluid insulation equipment and other equipment needed to offer blood on site.
Is January 1Medicare & Medicaid service centers began to count any blood administration during pre -hospital transport of ambulance ambulance as a “advanced life support, level 2” (ALS2) service, which in some cases will increase payment.
Schaefer said that the next reimbursement is welcome, however it will not be enough to cover the prices of providing blood to a patient who can last as long as over 1000 USD. Agencies that launch these programs pay for them from their very own operational budgets or use subsidies or other sources.
Blood deserts exist in rural and concrete areas. In August last yr, the coat of arms Joseph went down the steps in his cousin’s house in Brockton, Massachusetts, when he slipped and fell. The glass plate, which was wore broken and cut by blood vessels in his right hand.
“I saw a blood flood and called my cousin to call 911”, he remembered 37 -year -old Joseph.
The ambulance team arrived only just a few minutes, assessed him and called him to the Sanitary Transfusion Sanitary Program team based within the canton, which soon began to offer blood transfusion. The program serves 30 cities within the Boston region. From the time when the transfusion program began in March last yr, the team responded to over 40 connections, lots of them concerned automobile accidents along the ring of interstate motorways surrounding this area, said Reardon.
Brocton has a level 3 traumatic center, but Józef’s injuries required more intensive care. Boston Medical Center, level 1 trauma, during which the EMS team took Joseph, is positioned about 23 miles from Brocton, and in depending on road traffic can take over half an hour.
Joseph received more blood on the Medical Center, where he stayed for almost every week. Finally he underwent three operations to repair his hand and now returned to his warehouse work.
Although Boston has several trauma centers at level 1, the region south of town is nearly a traumatic desert, said Crisanto Torres, certainly one of the trauma surgeons who cared for Józef.
The Boston Medical Center cooperates with Canton Fire Department to run a field transfusion program. This is a very important service, said Torres.
“You can’t just set up a new level of 1st level,” he said. “This is one of the ways to concentrate unevenness in access to care. He buys patients. “
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