SAFD medics now doing blood transfusions in ambulances, saving lives with whole blood

INSIDE LOOK: High-tech coolers, warmers allow medics to use whole blood

By Courtney Friedman - VJ, Reporter

SAN ANTONIO - San Antonio is the first large metropolitan city in the nation to begin carrying whole blood inside ambulances and response trucks.

Patients suffering traumatic injuries and losing blood fast now have a much better chance of surviving.  And local medics believe it's the biggest trauma response game changer in decades.

The change allows medics to perform blood transfusions after trauma events, such as a shooting, stabbing or major crash, before the patient gets to the hospital.

"That's the whole blood right there. This is our temperature scan," said Lt. Josh Frandsen, a medical with the San Antonio Fire Department, while opening a small cooler with a bag of blood inside. On the top of it is paperwork to record temperatures every time the cooler is opened.

One small bag of blood means the difference between life and death.

"At least a twofold increase in life saving," said C.J. Winckler, the deputy medical director of the Fire Department and assistant clinical professor at UT Health.

The technological coolers and warmers were put in local medical helicopters early this year after the military found that giving soldiers immediate whole blood transfusions on the battlefield saved lives.  

Trauma surgeons have traditionally been taught to break blood into its three components: red blood cells, platelets and plasma. Once the military research on whole blood came out, however, it was clear that medics needed a way to carry the whole blood with them.

"Both Brook Army Medical Center and University Hospital, they are seeing better outcomes. Patients are arriving a little less sick, and then the resuscitation required in the trauma room is less," said Randi Schaefer, who used whole blood on the battlefield when she was an emergency trauma nurse in the Army.

Schaefer is now the research director at the Southwest Texas Regional Advisory Council, or STRAC.

The high-tech coolers and warmers are now in seven San Antonio Fire Department emergency medical services units.

"That solution involves keeping the blood near freezing, 1 to 9 degrees Celsius in 120-degree Texas weather, and then you have to warm that blood up to body temperature to get (it) into the patient," Winckler said.

Frandsen sat in one of the two special operations ambulances now carrying the whole blood, explaining how the warmers heat the blood almost immediately. The cooler and warmer are extremely small, so medics can take them along if they need to do transfusions outside the truck.

The results from whole blood on the 18 medical helicopters has shocked Winckler, who said most trauma patients don't survive.

"I mean, we're talking 20 or 30 percent. Now, our trauma survival injury could be as high as 70 percent," he said.

He expects similar results on the ground, where San Antonio medics have already used the whole blood four times.

"They got a person who was in shock that had been stabbed multiple times. The person received additional blood in the OR (operating room) and is expected to make a 100 percent recovery," Frandsen said.

Frandsen said research predicts 200 San Antonio residents could be saved in just one year.

STRAC received a U.S. Department of Defense grant to spend about $28,000 for the seven sets of coolers and warmers. The City of San Antonio pays the Texas Blood and Tissue Center $418 per bag of whole blood.

San Antonio Fire Department medics share the blood with the helicopters and then eventually with hospitals. The blood is good to use for 35 total days before it expires.

The helicopters have the bags of blood for the first 14 days. The ground ambulances get them for the next 14 days. If the blood still hasn't been used, it is given to the hospitals. The system will ensure no blood is wasted.

Only two other departments in the country carry whole blood in ambulances. Cypress Creek EMS and Harris County ESD 48, which are both departments near Houston, were the first two in the country to carry whole blood in September 2017. They are currently developing statistics and success rates.

STRAC is tracking San Antonio's numbers and will put together research to find out how many lives can actually be saved.

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