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October 01, 2019

Fire-Based EMS: Whole Blood Deployment

Firehouse: Dr. C. J. Winckler discusses how the San Antonio (TX) Fire Department revived an old practice.


"There are more than 60,000 hemorrhagic deaths per year in the U.S., about half of which occur in the prehospital setting and are associated with trauma. Additionally, gastrointestinal bleeds, perioperative hemorrhage, fistula bleeds, variceal bleeds and obstetric bleeds are some of the causes of medical prehospital hemorrhage. Every year hemorrhagic deaths account for nearly 1.9 million deaths worldwide and most affect young people."

In this article, Dr. Winckler explains how military knowhow with respect to whole blood damage control resuscitation and point of injury care is now applied to save lives in San Antonio by the San Antonio Fire Department (SAFD) and UT Health San Antonio Office of the Medical Director (OMD), supported by South Texas Regional Advisory Council (STRAC). For in the first time in the history of the U.S., this program is making whole blood available to an entire region and a metropolitan city.

Dr. Winckler then described the various considerations for whole blood deployment. "Deploying whole blood at the command staff level involves an understanding of state and local laws and regulations. It also requires money, equipment, training, sound operational planning and a collaboration with multiple partners—all things that fire departments are adept at already. Asking the ESD, city, state or governing entity for resources and permission requires coordination and a clear plan forward".

"Logistically we had to come up with an entirely novel solution to transfuse whole blood in a busy urban EMS system. Having a stationary blood refrigerator would not work as our ambulances are often out on calls all day. So, we have a cooler that can keep the blood from 1–10 degrees C for up to 50 hours. We have a blood warmer that warms the blood to body temperature almost immediately. We have blood tubing with blood filters. We use two pressure systems to get blood into patients; we use a pressure infuser and we have an in-line hand pump in the tubing that allows us to transfuse 500mL of blood at 38 degrees C in under five minutes."

Whole Blood2

A unit of whole blood and a Warrior blood warmer used by SAFD