Wisconsin Diagnostic Laboratories Milwaukee, Wisconsin, United States
Background/Case Studies: A large metropolitan county fire-based emergency medical service (EMS) proposed the concept of carrying units of blood on board ambulances for pre-hospital transfusions. The county EMS partnered with a large medical center blood bank to make this concept a reality.
Study
Design/Methods: The county EMS services a population of over 500,000 people in a large geographical area. The concept of carrying units of low-titer group O whole blood (LTOWB) on strategically placed ambulances would allow patients to receive pre-hospital transfusions when required. The logistics of this partnership were based on a similar arrangement between the blood bank and the air ambulance company that services the same county. New logistical issues existed with the EMS on how the blood would be stored, transported aboard the ambulances, and training for the large number of staff in all EMS departments involved. Military-grade coolers were purchased to store and transport the blood aboard the ambulances. This varied from the air ambulance program, since the air ambulances utilize refrigerators to store the units of blood in between flights. The EMS coolers are able to be monitored in real-time via a cellular connection to a phone-based application. Two units of LTOWB were the ideal products to be carried on the six ambulances but based on the high rate of unit turn-over, units of red cells may be substituted for better expiration dates. Units are issued to each EMS department based on use or unit expiration, and returned seven days prior to unit expiration. Fresh units are issued based on the current blood bank inventory.
Results/Findings: Finalization of the contract and validation of coolers began in June of 2024. The first three EMS departments began to carry units in November of 2024. The first unit of blood was transfused by the end of November 2024. To date, there have been five units transfused to patients in the field. Over 80 units of blood have been issued to the EMS departments since the beginning of the program. Only three units have been wasted: one unit was spiked and not transfused and the other two units had numbers written on the physical bag with black marker making them no longer acceptable for transfusion.
Conclusions: From contract finalization and cooler validation, to first units issued and transfused, only five months had passed. This quick turn-around allowed the fire-based EMS departments to get life-saving blood to patients in need. Three more ambulances are being evaluated for the program to offer better geographical placement of blood within the county. The minimal number of wasted products shows that the training of the EMS crews was pivotal to the overall program.
