Category Archives: Updates

COVID: Weak Points Exposed and Lessons Learned

Saying that the past two years have been unpredictable is an understatement. In the winter of 2019 our world changed in a way we could not have foreseen. COVID-19 puts a huge strain on our economy and healthcare system. While very unfortunate, crises such as COVID expose us where we are weakest. During the pandemic we have seen shortages in manufacturing supplies such as computer chips and other products. This brings up a great point of another consideration to take into account when purchasing a new piece of medical equipment. This article will focus on blood/fluid warmers, however regardless of the product you are in the market for, these same considerations will apply. 

The cause for supply shortages is multifaceted. Some reasons being increased demand for the product, as is the case for plastics. COVID put a huge demand for plastics just within the medical industry alone. The increased need for ventilators and disposable tubing and PPE are just a few of the products that caused the increased demand. Other factors include decrease in supply due to material shortages or low workforce from manufacturers. We saw that many agencies mandated that all non-essential laborers stay home to slow the spread of the virus. Those companies that did stay open often operated below max capacity in the factories to promote social distancing between employees. In reality all these factors combined resulted in shortages in vital supplies.

Of all the materials to have a shortage, plastics would probably be  the last guess for a lot of people. Yet that is what we are seeing today. Due to raw materials shortage and high demands, it’s becoming increasingly difficult for companies to maintain production of plastic disposables. This is important to consider because companies such as 3M utilize an all plastic consumable in their blood warmers. Consumers, such as EMS agencies and hospitals are having increased difficulty in obtaining disposable sets for their warmers. This should raise immediate concern. Often in trauma situations, mass transfusion protocols are necessary. Blood given rapidly must be warmed to body temperature prior to being infused into the patient. If you have no tubing set for your blood warmer, how can you warm blood and save your patient’s life?

Another consumer good that is experiencing shortages is microchips. Reasons for microchip shortages are many including manufacturing plants closed due to COVID. However that’s not the only way COVID caused the microchip shortage. Consumer consumption of chips drastically increased as people were shut indoors. Purchases in laptops, gaming consoles, and other electronic devices. Car sales also were higher than what was expected. Electric vehicles are also gaining popularity of consumers and more and more automotive companies are branching into that market. As such, microchip consumption continues to increase. Another reason for the shortages is sanctions against the Chinese tech companies. With a centralized means of production, most chips are produced in Asia. Only 12 percent of chip manufacturing is conducted in the U.S. Therefore sanctions really cut into the supply of chips this year.

Yet another reason for a microchip shortage is the current shipping crisis. When the Suez was blocked, chip companies were among the many who suffered. Chip companies were unable to receive necessary materials nor able to send their goods to consumers. This compounded with decreased manufacturing capacity due to factories being shut down, increased demand from consumers wanting tech goods that use microchips, and sanctions against the world’s largest producer of microchips, we can see how all these conditions have led to a mass shortage of microchips. 

Products that utilize microchips are being delayed in manufacturing. This includes blood warmers that use microchips in their disposables. Again we face the same challenge as discussed before. When utilizing a complex disposable solution for blood warming, consumers are at the mercy of manufacturers. When supply chains are interrupted, as has been the case with this pandemic, our patients suffer the cost when utilizing overly complex solutions. 

So what is the answer to these shortages? One answer is to use a blood warmer that comes with a simple design, that is microchip free, and uses readily available materials to produce. QinFlow’s Warrior warming set fits that description. They do not utilize microchips and are made from materials that are easily sourced. QinFlow’s Warrior disposable uses stainless steel, PVC tubing, and EPP foam for a lightweight yet durable product. The great news is QinFlow’s line of products are also aluminum free, which is a big deal if you have been paying attention to recent recalls of infusion devices containing aluminum. QinFlow’s disposables are also competitively priced. 

Another great advantage of utilizing QinFlow is that their disposable is compatible with ALL the warmers they produce. That’s right, you can use the same consumable from the Warrior lite while in the field to the Warrior AC used in operating rooms and intensive care units. This streamlines the transition of care of the patient while also reducing cost to the patient and waste produced which is great for the environment. 

We see that COVID showed us that using complex solutions puts the consumer at risk of supply shortages. When opting for a simpler solution, this allows more reliability in supply chains. The engineers at QinFlow have known this for a long time. They have backgrounds in Israeli Special Operations and Search and Rescue. People from these professions know that simpler solutions are often more reliable than overly complex designs when the unknown strikes. This is why QinFlow has not experienced the shortages that other companies offering more complicated designs have suffered. This allows them to keep supplying their customers who are saving lives on the front lines the peace of mind of a reliable product in these uncertain times. 

“The patient survived a non-survivable gunshot wound to the chest!”

How often does a company have the opportunity to contribute to an ‘impossible’ recovery of a patient?

We, therefore, felt privileged when we got the following testimonial from Wren Nealy, CEO of Cypress Creek EMS (CCEMS) in Spring Texas:

We are having amazing success and save cases this past year [2020].  Just last week we infused a unit of WARMED LTOWB in 2 min [i.e. 250ml/min].  The patient received 3 on the ground and 2 in flight* and survived a non-survivable gunshot wound to the chest!

CCEMS is probably one of the most innovative ground EMS agencies in the USA (and beyond). The service pioneered prehospital blood transfusion by ground EMS. It started carrying whole blood in mid 2017, and since then its paramedics transfused whole blood in the field to hundreds of serervly wounded patients. We are obviously excited to partner with CCEMS!

Note:

* The flight partner is Memorial Hermann LifeFlight. Since LifeFlight also carries the Warrior blood warmer, the handoff process of the patient from CCEMS team to flight crew is significantly facilitated: simply disconnect and reconnect the disposable unit between the Warrior devices of the 2 services.

Prehospital Transfusion of Low-Titer O + Whole Blood for Severe Maternal Hemorrhage: A Case Report

Access full study in PubMed

Ryan NewberryC J WincklerRyan LuellwitzLeslie GreebonElly XenakisWilliam BullockMichael StringfellowJulian Mapp

Abstract

Introduction: Beginning in 2017, multiple stakeholders within the Southwest Texas Regional Advisory Council for Trauma collaborated to incorporate cold-stored low-titer O RhD-positive whole blood (LTO + WB) into all phases of their trauma system, including the prehospital phase of care. Although the program was initially focused on trauma resuscitation, it was expanded to included non-traumatic hemorrhagic shock patients that may benefit from whole blood resuscitation. Case Report: We report the case of a patient with severe maternal hemorrhage secondary to placenta accreta who received a prehospital transfusion of LTO + WB. We believe this to be the first reported case of post-partum hemorrhage resuscitated out of hospital with whole blood. Discussion: This case highlights the potential benefits of a prehospital whole blood program as well as the controversy surrounding a LTO + WB program that includes females of childbearing age.

3 takeaways from the recent TCCC guidelines for the management of hypothermia in tactical combat casualty care

The recent TCCC guidelines TCCC guidelines for the management of hypothermia in tactical combat casualty care conclude that the use of IV fluid/blood-warming devices is an essential component for managing hypothermia caused by either penetrating, blunt, or burn trauma and should deliver consistent output temperatures at 38° (100°F) but no higher than 42°C (108°F) at a flow rate of up to 150mL/min and perform to standard within the extremes of military environments.

The guidelines also state that currently available, FDA-approved portable infusion fluid warming devices vary significantly in regard to ideal device specifications (e.g., weight, size, cost, flow rates, output fluid temperature). Therefore, the guidelines recommend that selected devices should be tested to ensure that desired performance characteristics are met.

There are 3 important takeaways regarding active warming devices that can be derived from the guidelines: 

1. The Warrior outperforms traditional warmers:

The TCCC Guidelines state that in a recent study, Lehavi et al. evaluated the following four in-line, battery-operated fluid warmers that were developed for use in the prehospital environment: Belmont Buddy Lite™ (Belmont Medical Technologies), enFlow™ (Vyaire Medical), Thermal Angel™ (Estill Medical Technologies), and QinFlow Warrior™. Using normal saline, they studied three warming device characteristics: (1) heating performance over time, (2) the volume that can be effectively heated, and (3) the flow resistance. The authors reported that the performance characteristics of these fluid warmers varied with flow and initial input temperatures. They studied two input fluid temperatures, 10°C and 20°C, and two fluid flow rates, 50 and 200mL/min. Among the portable fluid warmers evaluated in the Lehavi et al. study, the Warrior™ provided the best warming performance at high infusion rates and low input temperatures (i.e., average output temperatures were 37.8°C [100°F] at 50mL/min; 36.1°C (97°F) at 100mL/min; and 34.4°C (94°F) (at 200mL/min). Only the enFlow™ and Warrior™ functioned reliably in accordance with the manufacturer’s specifications. The Buddy Lite™ was limited to moderate input temperature and low flow rates, and the Thermal Angel™ was limited by battery capacity to low fluid volumes and low output temperature in cold environmental conditions. 

2. Although the Quantum™ device was developed to military prehospital specifications, it does not meet the key ideal performance characteristics for use on the battlefield:

The guidelines mention the recently-introduce Quantum™ device (Life Warmer). As can be inferred from the guidelines, although this device was developed to military prehospital specifications, it does not meet the ideal performance characteristics for use on the battlefield. These specifications require the warming of 4 units of whole blood at 150ml/min. According to the manufacturer, this device is limited to 2 units of blood and 100 ml/min (50% and 66% of the ideal performance spec, respectively).

3. Aluminum fluid path is potentially toxic!

The guidelines alert users regarding solutions that include aluminum since aluminum may be toxicRecent research on the enFlow™ warmer device show elevated aluminum level in IV fluid after it passes through the uncoated aluminum heating plate in this device. No other [FDA cleared] portable warming device has a similar warming-plate system with aluminum contacting blood.

Press HERE to read the full TCCC guidelines. 

Warrior superiority recognized in TCCC Guidelines for Management of Hypothermia in Tactical Combat Casualty Care

PLANO, September. 25, 2020 – QinFlow, the manufacturer of the Warrior, a modular blood and IV fluid warming solution for the entire continuum of emergency care, is proud to announce that its Warrior solution was acknowledged again for its superior performance in comparison to other battery-powered blood warmers in the Tactical Combat Casualty Care (TCCC) Guidelines for Management of Hypothermia in Tactical Combat Casualty Care.

Tactical Combat Casualty Care (TCCC) is the standard of care in Prehospital Battlefield Medicine. The TCCC Guidelines are routinely updated and published by the Committee on Tactical Combat Casualty Care, a component of the Joint Trauma System. The TCCC committee recently released Guidelines for Management of Hypothermia in Tactical Combat Casualty Care.

The TCCC Guidelines state that in a recent study, Lehavi et al. evaluated the following four in-line, battery-operated fluid warmers that were developed for use in the prehospital environment: Belmont Buddy Lite™ (Belmont Medical Technologies), enFlow™ (Vyaire Medical), Thermal Angel™ (Estill Medical Technologies), and QinFlow Warrior™. Using normal saline, they studied three warming device characteristics: (1) heating performance over time, (2) the volume that can be effectively heated, and (3) the flow resistance. The authors reported that the performance characteristics of these fluid warmers varied with flow and initial input temperatures. They studied two input fluid temperatures, 10°C and 20°C, and two fluid flow rates, 50 and 200mL/min.

Among the portable fluid warmers evaluated in the Lehavi et al. study, the Warrior™ provided the best warming performance at high infusion rates and low input temperatures (i.e., average output temperatures were 37.8°C [100°F] at 50mL/min; 36.1°C (97°F) at 100mL/min; and 34.4°C (94°F) (at 200mL/min). Only the enFlow™ and Warrior™ functioned reliably in accordance with the manufacturer’s specifications. The Buddy Lite™ was limited to moderate input temperature and low flow rates, and the Thermal Angel™ was limited by battery capacity to low fluid volumes and low output temperature in cold environmental conditions. 

The guidelines also mention the recently-introduce Quantum™ device (Life Warmer). As can be inferred from the guidelines, although this device was developed to military prehospital specifications, it does not meet the ideal performance characteristics for use on the battlefield, which include the warming of 4 units of whole blood at 150ml/min. There is only one device that can meet (and exceed) this aggressive spec in a small and light from factor: the Warrior lite with an Extra Power battery (6 units of whole blood at 180ml/min; 1.1kg). Since this device is FDA pending, it was not included in the guidelines.

Finally, the guidelines alert users regarding solutions that include aluminum since aluminum may be toxic

The guidelines conclude that the use of IV fluid/blood-warming devices is an essential component for managing hypothermia caused by either penetrating, blunt, or burn trauma and should deliver consistent output temperatures at 38° (100°F) but no higher than 42°C (108°F) at a flow rate of up to 150mL/min and perform to standard within the extremes of military environments. That said, the guidelines state that currently available, FDA-approved portable infusion fluid warming devices vary significantly in regard to ideal device specifications (e.g., weight, size, cost, flow rates, output fluid temperature). Selected devices should be tested to ensure that desired performance characteristics are met.

We are very proud with the TCCC acknowledgment”, said Ariel Katz, CEO QinFlow Inc. “The Warrior’s superior performance is derived from its underlying state-of-the-art, highly efficient and patent-protected warming technology, which allows it to safely warm near-freeze fluids and blood products to body temperature extremely fast, even at high flow rates, thus allowing first responders, critical care transport teams, and emergency care professionals within the hospitals to focus on what they do best – saving lives”, he added.

Press HERE to read the full TCCC guidelines. 

About QinFlow
Since 2009, QinFlow (short for Quality in Flow) has worked to develop and perfect a proprietary fluid warming technology (patented) that delivers unparalleled levels of warming efficiency. The company’s flagship product – the Warrior – provides front end rescue teams, first response teams, critical care transport teams, and emergency care professionals within various hospital settings with high performance, reliable, simple to operate, and completely portable blood and IV fluid warming device that operates flawlessly in all environmental conditions in order to fight hypothermia and save lives. QinFlow is headquartered in Rosh Ha’ayin (Israel) and Plano TX (USA). TCCC acknowledgment refers to an independent study performed by Amit Lehavi, MD, et al, that was published by the Emergency Medical Journal (BMJ; Download the full study here). QinFlow is not affiliated with the companies mentioned in the study.

For more information on QinFlow and the Warrior modular system, visit www.QinFlow.com or submit a request for a free trial for your agency by filling out your information here.

Accident Survivor, Military Family Finally Able to Donate Blood

BY BRYAN BOES SAN ANTONIO
PUBLISHED 6:16 AM CT JUL. 06, 2020
FULL ARTICLE Spectrum News

SAN ANTONIO –  A recent decision by the Food and Drug Administration might help with recent blood shortage caused by the COVID-19 outbreak. This might be especially helpful in San Antonio, where some military members and their families who had been stationed in Europe can now give blood. 

Tiffany Kieschnick-Rivas has had July 1 circled on her calendar.

We last saw Kieschnick back in January, when she was meeting the men from the Brothers In Arms Initiative whose whole blood saved her life after a horrific car accident in January 2019.  

Bright and early on Wednesday, July 1, she was ready to pay it forward.

“This is my way of being able to give back after my accident and receiving blood,” Kieschnick-Rivas said.

But it wasn’t the accident that kept her from donating all these years. It was the FDA, which just recently lifted a deferral for military and their families who had been stationed in Europe during the mad cow disease outbreak in the 1980s and ’90s. The entire Kieschnick family fit into that category as Kieschnick-Rivas’s father, Charles Kieschnick, was stationed in Germany during his 30-year career.

Mom, dad, and daughter were all ready to give blood until Kieschnick-Rivas returned from the screening room inside the South Texas Blood and Tissue Center in San Antonio.

She was turned away because her iron was too low.

“Too low of iron.  I’ll be back, though,” she said.

Charles Kieschnick donates blood in this image from July 1, 2020. (Bryan Boes/Spectrum News)

Still eligible to donate, she’ll have to wait a few days for her numbers to improve.  But that didn’t stop her parents from giving blood.

With Tiffany Kieschnick-Rivas sitting this one out, Charles Kieschnick took a seat and donated blood for the first time in more than 20 years.

“I’ll tell you what,” Kieschnick said, “that was the most painless stick I’ve ever had.”

An easy process he hopes will help with the blood shortage recently experienced in San Antonio and across the globe.

“I can’t even guess the number that are probably sitting there that are eligible again that may or may not even know about it. Hopefully, this gets the word out and get them in here,” said Charles Kieschnick.

FDA Updates to Bring in New Blood Donors Starting July 1 at South Texas Blood & Tissue Center

FULL ARTICLE

South Texas Blood & Tissue Center

June 30, 2020 at 5:04 pm CDT

By Johnnie Walker

San Antonio — Agency removes longtime blood donation deferral for military deployed to Europe

WHAT: Military veterans and their family members will be making their first blood donations at the South Texas Blood & Tissue Center Donor Pavilion after new FDA changes about donor eligibility were announced in April.

The local blood center, a subsidiary of San Antonio nonprofit BioBridge Global, updated multiple questionnaires and procedures during a time when it also changed the way it hosts community blood drives and launched its COVID-19 convalescent plasma program. Like all blood centers in the United States, STBTC is required to follow FDA guidelines about donor eligibility.

WHO: The first blood donors will be Tiffany Kieschnick-Rivas and her family, who lived in Germany when her father was in the military. Tiffany is alive today because of fast-acting community members, first responders, and blood donors.

  • Weeks after her car accident and traumatic cardiac arrest, doctors told Tiffany there had been little chance she would survive her injuries.
  • But after a transfusion of whole blood en route to the hospital, Tiffany became responsive – shocking her paramedics, who had never experienced such a case.
  • Tiffany and her family are paying it forward now that they are eligible to donate and hope to help patients in need.

WHEN: Wednesday, July 1, 10 a.m.

WHERE: STBTC Donor Pavilion6211 IH 10 West at First Park Ten Boulevard, San Antonio, TX 78201

Resident Eagle: Whole Blood in the Rural EMS Environment

EMS World

Issue: July 2020

Casey Ebrom, EMT-P, FP-C; Craig Manifold, DO, FACEP, FAAEM, FAEMS; and Randi Schaefer, MSN, RN, ACNS-BC, CEN

FULL ARTICLE

Related Content

Blood on Demand: Designing an EMS Massive Transfusion Program

Prehospital Transfusions: A Cold-Blooded Approach

Blood Transfusion During HEMS Transport

Resident Eagle is a monthly column profiling the work of top EMS physicians and medical directors from the Metropolitan EMS Medical Directors Global Alliance (the “Eagles”), who represent America’s largest and key international cities. Tentative dates for Gathering of Eagles 2021: June 14–18, Hollywood, Fla. For more see useagles.org.

You are dispatched to an early-morning call to a long-term care facility for a 71-year-old male with severe bleeding. Upon arrival you find a semiconscious elderly male lying supine in a blood-soaked bed. 

Prior to EMS arrival the patient had significant bleeding from a dialysis shunt in his left upper arm. Staff applied a pressure dressing and stopped the bleeding. Nursing staff noted blood-soaked sheets and called 9-1-1. They estimated his blood loss in excess of 1,000 mL. 

Initial assessment reveals altered mental status (alert to painful stimulus), weak carotid pulse, and pale, cool, and diaphoretic skin. The patient has a past medical history of diabetes mellitus, hypertension, and end-stage renal disease requiring hemodialysis, which he had completed earlier in the morning. Initial vital signs are BP 54/30, HR 88, RR 12, SpO2 94% on room air, EtCO2 22 mmHg, and compensatory reserve index 0.3. The patient is confirmed as experiencing hemorrhagic shock and meets criteria for a transfusion of low-titer O-positive whole blood (LTOWB).

Your crew notifies the EMS supervisor, who heads to the scene. A secondary assessment and repeat vital signs reaffirm the patient is a candidate for prehospital emergency transfusion. As you initiate IV access, the supervisor arrives with one unit of LTOWB. To prepare for transfusion, you confirm the product type, prime the blood filter tubing, and connect to a warming device. You initiate transfusion and prepare for transport. 

In your rural setting the local hospital is not staffed with vascular surgeons or interventional radiology specialties. You quickly confirm with your partner that the patient requires vascular intervention not available in your service area. The facility of choice is 68 miles away. Due to poor weather, a helicopter is not available. You thus begin ground transport to the hospital with specialists.

During transport you continue to reassess the site of blood loss and find the pressure dressing is providing adequate hemorrhage control. While the whole blood transfusion continues, you obtain additional IV access and administer tranexamic acid (TXA) for antifibrinolytic therapy. Repeat neurovascular assessment of the injured extremity shows no pulse, motor, or sensory changes. The whole blood transfusion completes within approximately 10 minutes, and you note marked improvements in hemodynamics (including increases in systolic blood pressure and EtCO2) and the patient’s mental status. 

Discussion

Historically, prehospital patients presenting in hemorrhagic shock have been difficult to manage due to the lack of appropriate damage-control resuscitation intervention options. Current prehospital care is focused on stopping the bleeding, maintaining airway patency, ventilation, and circulatory support via IV crystalloid.1 In recent years permissive hypotension (in the absence of traumatic brain injury) has also become acceptable. But numerous military and civilian research studies have shown crystalloids carry significant downstream consequences, including acidosis, hypothermia, and coagulopathy.2 Blood products may provide a better alternative and aid providers in attempting to correct coagulopathy and restore perfusion to vital organs. 

Recent helicopter EMS trials have found prehospital transfusion of blood products (in this report plasma) yielded significant improvements in 30-day mortality when compared to traditional IV crystalloid.3 In the ground prehospital community, blood products are believed to benefit patients, but many questions and challenges still exist, as well as a lack of strong supporting evidence.

Whole blood transfusion is by no means a new concept. Fresh whole blood was historically transfused in the military setting due to availability of donors and its ease of use. Over the recent years whole blood, more specifically LTOWB, is regaining traction in the trauma community and showing favorable outcomes opposed to component therapy.4 Medical directors, EMS leaders, and prehospital care clinicians are looking for blood products that provide the easiest and safest method of blood replacement. LTOWB contains all blood components (i.e., red blood cells, plasma, platelets, etc.) in a single bag, as well as being sourced from a single donor (potentially lowering the risk of transfusion reactions). Cold-stored WB has shown to have improved function compared to 1:1:1 component therapy.4 

In January 2018 the Air Medical Provider Advisory Group (AMPAG) of the Southwest Texas Regional Advisory Council (STRAC) collaborated with the South Texas Blood and Tissue Center and University Hospital to initiate the country’s first ever regional deployment of LTOWB. It was deployed across the 22-county region utilizing established HEMS providers.

Following its initial success, STRAC expanded the program to include ground EMS organizations. In October 2018 the San Antonio Fire Department joined the coalition with a deployment strategy for the urban environment.5 Now more than 30 air and ground EMS assets are equipped with LTOWB in the STRAC region. Multiple improved outcomes and/or saves have been seen since the program’s inception. Early results indicate a significant reduction in mortality in patients receiving LTOWB as opposed to traditional component therapy (18.8% vs. 76%).6  

Carrying Considerations

Factors for agencies to consider when considering carrying whole blood include call types/volume and proximity to definitive care. Agencies having increased transport times may benefit most from more aggressive care. Regardless, maintaining the core concepts of remote damage control resuscitation in patients presenting in hemorrhagic shock, along with a commitment to rapid transport to definitive care, has proven to be successful.5  

Logistical issues are likely more complex to overcome. Support from your regional healthcare system(s), agency leadership, municipality/government, physician partners, and lay public are keys to success. Though a single agency can attempt to forge its own path, a collaborative movement allows the ability to share costs and reduce waste. Donated blood product can be rotated near the end of its shelf life to an area or system where the highest potential for transfusion exists. This concept has proven to be successful in the San Antonio region, producing a monthly waste rate of just 1%–2%.

Commitment by far is the most important item within this chain of success. An EMS agency must be committed to: 1) procuring the appropriate equipment for storage of the blood product; 2) developing a rigorous program for continuous temperature monitoring; 3) procuring a device capable of warming the blood product for administration; 4) developing clinical guidelines for transfusion as well as initial and ongoing training; and 5) developing and implementing a quality assurance program with physician oversight to ensure good clinical practice.

Case Resolution

As transport continues, reassessment of the patient finds no signs or symptoms of a transfusion-related reaction. Care remains focused on prevention of hypothermia, acidosis, and coagulopathy. At the receiving hospital the patient receives subsequent transfusions of blood products while in the emergency department and has a surgical repair of his left upper arm via fistulogram with balloon angioplasty of the peripheral dialysis shunt.  

References

1. Udeani J. Hemorrhagic Shock Treatment and Management. Medscape, https://emedicine.medscape.com/article/432650-treatment.

2. Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma, 2007 Feb; 62(2): 307–10.

3. Sperry JL, Guyette FX, Brown JB, et al. Prehospital Plasma During Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. N Engl J Med, 2018; 379(4): 315–26.

4. Spinella PC, Pidcoke HF, Strandenes G, et al. Whole blood for hemostatic resuscitation of major bleeding. Tranfusion, 2016 Apr; 56 Suppl 2: S190–202.

5. Bartikoski S. Weymouth W, Winckler CJ. Whole Blood in Trauma: Ready for Primetime? emDocs, 2019 Mar 18; www.emdocs.net/whole-blood-in-trauma-ready-for-primetime/.

6. Jenkins D. Pre-hospital Whole Blood. Southwest Texas Regional Advisory Council, www.strac.org/files/Research/AMPAG_Whole_Blood_09_2018.pdf.

Casey Ebrom, EMT-P, FP-C, is assistant EMS director for Karnes County EMS in South Texas. 

Craig Manifold, DO, FACEP, FAAEM, FAEMS, is medical director for the National Association of Emergency Medical Technicians. 

Randi Schaefer, MSN, RN, ACNS-BC, CEN, is director of the Southwest Texas Regional Advisory Council’s Research Division.

From battlefront to homefront: creation of a civilian walking blood bank

Published by STRAC

Supplement Article, Online Library

FULL ARTICLE

Maxwell A. Braverman, Alison Smith, Charles Patrick Shahan, Benjamin Axtman, Eric Epley, Scott Hitchman, Elizabeth Waltman, Christopher Winckler, Susannah E. Nicholson, Brian J. Eastridge, Ronald M. Stewart, and Donald H. Jenkins

Hemorrhagic shock remains the leading cause of preventable death on the battlefield, despite major advances in trauma care. Early initiation of balanced resuscitation has been shown to decrease mortality in the hemorrhaging patient. To address transfusion limitations in austere environments or in the event of multiple casualties, walking blood banks have been used in the combat setting with great success. Leveraging the success of the region-wide whole blood program in San Antonio, Texas, STRAC reports a novel plan that represents a model response to mass casualty incidents.

8-minute miracle: Doctors save gunshot victim with blood transfusion in the back of an ambulance

KHOU 11; For the full article: press HERE

Author: Shern-Min Chow

SPRING, Texas — It was the best, worst day of Verne Smith’s life.

On February 22, a driver pulled up next to Smith’s vehicle in Spring, just off Aldine Westfield.

Smith looked over in time to see a woman recline her front passenger seat so the driver could fire a 12-gauge shotgun at him.

“I called my daughter because I didn’t know if I was going to make it. I started losing consciousness at the wheel and so I pulled over because I didn’t want to injure anyone else” Smith said Friday. “I said I’m just going to stop the car and sit here.”The shotgun blast cut through Smith’s digestive tract, lodging pellets in his liver. He was bleeding out. And dying.

Smith’s frantic daughter called 911 and directed Spring Fire Department crews to her dad’s vehicle.

The next 8 minutes would be the difference between life and death.

The paramedics’ point-of-view cameras show Dr. Nicholas Studer using an innovative technique to perform a whole blood transfusion in the back of the ambulance. He inserted a catheter into a vein under Smith’s clavicle and transfused blood directly into his heart.

The exceptionally rare field procedure is 3-4 times faster than traditional blood transfusion.

Studer is an army captain and flight surgeon who served in Egypt. He is part of a training program that shares battlefield medical experience with Cypress Creek EMS.

In another amazing stroke of luck, the “Lifeflight Scene to Operating Room” program was shooting that night.

From skids down at Spring Fire Station 74, to the first surgical incision at Memorial Hermann Hospital in the Texas Medical Center, it was a stunning 8 minutes.

Months later, Smith returned to Fire Station 74 to thank the team who saved his life.

“When something is going on that’s traumatic, it’s hard to think so I’m glad I had all of you guys to help think for me. I just didn’t know what to do,” Smith told them.

It wasn’t the first time they’ve seen Smith since that fateful night. His job brings him to the station on a regular basis in the battle against COVID-19.

“He services us every day sanitizing our stations so, for us to be able to do that for him is awesome and for us to get to see him frequently after he returned to work is even better,” Spring Fire Chief Scott Seifert said.