D.C. paramedics to begin blood transfusions
Trauma victims will soon be able to receive blood transfusions from D.C. paramedics before they reach the hospital, which officials estimate could help as many as 400 patients a year, including those suffering from gunshot and stab wounds.
As the American Red Cross faces an emergency blood shortage and a 20-year low in donors, pressure is on D.C. Fire and Emergency Medical Services leaders to strategically deploy blood to ensure zero waste.
Physicians say giving patients blood as soon as possible after a traumatic injury will save lives in the District, where it can take 40 minutes for an ambulance to reach trauma centers at Washington Hospital Center or George Washington University Hospital from Southeast D.C., which does not have a trauma center.
The blood program is the city’s latest effort to try to improve the health-care system, Mayor Muriel E. Bowser said at a news conference Thursday at the Red Cross headquarters and donation center in downtown Washington.
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She touted the newly opened Stabilization Center for intoxicated individuals and Cedar Hill Regional Medical Center under construction east of the Anacostia River, where Black residents have disproportionately poor health outcomes.
“We also know what it takes for blood transfusions to be successful, and that’s donors,” Bowser said. She encouraged residents to give blood.
D.C. joins emergency medical services departments across the country training to administer blood before patients reach the hospital, based on protocols developed by military personnel in the battlefield. Texas and New Orleans were pioneers of EMS transfusion in the field, and their research helped D.C. develop protocols to bring whole blood to their departments.
Locally, Arlington County Fire and EMS personnel began carrying blood in 2020, and Howard County in the fall became the first EMS department in Maryland to administer blood. Fairfax County police can do blood transfusions in their helicopter. The Maryland State Police helicopter fleet that transports critically injured patients is equipped with blood, as well.
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Starting next month, D.C. FEMS will be the largest department in the region to carry a product known as whole blood, which is Type O blood that has not been separated into components and contains red blood cells that carry oxygen and platelets that help blood clot.
Six units of blood will be circulating in the District at all times: four with EMS supervisors split between central D.C. and east of the Anacostia River, and two with the roaming battalion chief. The blood, which has a shelf life of 21 days, will be sealed in cooler boxes between 1 and 6 degrees Celsius, and officials will monitor a dashboard to ensure proper storage.
Officials estimate the program will cost about $500,000 in the first year, including about $550 per unit of blood, equipment, start-up costs and training.
EMS officials say evidence-based studies — not the District’s 20-year-high homicide rate — influenced their decision to pilot the program, but said the rapid deployment of blood should help victims of violent crime.
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“Minutes count when you are bleeding. You can bleed to death within a few minutes,” said David A. Vitberg, FEMS assistant medical director.
Babak Sarani, chief of trauma surgery at GW Hospital, said he and other D.C.-area physicians reported a steep drop-off in trauma cases early in the pandemic as stay-at-home orders took effect. But they and doctors at other big-city trauma centers noticed a significant increase in “penetrating trauma” — wounds specifically from gunshots and stabbings, according to a paper they wrote for Trauma Surgery and Acute Care Open, a medical journal.
The trauma center at GW Hospital transfuses blood on average about twice a week and more in the summer than the winter, Sarani said. Starting the transfusion process before a patient enters the hospital could benefit their treatment, he said.
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Fire and EMS Chief John A. Donnelly Sr. said the case of Tanija Moore helped push officials to embrace whole blood.
The 24-year-old was shot 14 times on April 29, when she was brought to United Medical Center in Southeast. A bullet that had ripped through the roof of her mouth and split her tongue kept her from speaking, but she could walk.
A white bed rushed toward her, she said in a phone interview Thursday, and she remembers hearing someone say, “We don’t have a trauma center.” She thought to herself, “Oh, I’m about to die,” prayed, and made peace with her fate.
Moore was unconscious when clinicians cut off her clothes and started giving her blood, an intervention that paramedics kept going as they rushed her 30 minutes to GW Hospital, which at the time was outside their job description.
“Without the blood while I was being transported I probably wouldn’t have made it. I would have bled out,” she said.
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She woke up several days later with something metal holding her face together and her grandfather at her bedside. The next time she opened her eyes, her mom and sister were there. For the next five weeks she went back and forth from the intensive care unit to a regular floor, fighting to regain the ability to eat, drink and talk normally.
Today she’s enrolled in a phlebotomy course at the University of the District of Columbia, knowing she can relate to patients who feel alone.
“I feel great that my situation had some type of positive outcome,” Moore said. “Steps taken to save my life weren’t in their handbook. They’re the real heroes.”
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