How ex-military surgeons are pushing for laws allowing ambulances to carry blood 

It shouldn't but when people choose to live out in the middle of nowhere away from services, it makes it extremely difficult and costly to give the same quality of care in a timely manner.

@@WELVAS. thats true but do you know who has the responsibility for this? The state - why else are you paying taxes? be it one the community, state or federal level...

@@funfungerman8401 Yes we do pay those taxes. However with the taxes we do pay, resources are limited to those who live away from services. While I agree location shouldn't affect, it's the unfortunate reality when choosing to live in a remote area.

I’ve had so many patients that needed blood in the field and could have been saved. I also know one ambulance could go weeks or more without a patient that’s a transfusion candidate. A good interim solution for urban and suburban services is equipped supervisor vehicles with blood instead of each ambulance

@cruisinguy6024 for my service area I think having it on the medivacs (which the one we use does) makes the most sense for us... Unless that drone delivery service they have in Africa wants to send us some by drone!

@@christophergrace1085 HEMS should absolutely carry it and a lot of hospital based services have for quite some time (for-profit money grubbers like PHI and AEL will have to be forced to). The problem is in many rural areas they can't get on scene in time for the blood to help and in most ubran/rural areas HEMS is rarely called because they're not any quicker than going by ground. I've had trauma patients that I/we DOA'd because they arrested due to blood loss, and some of them could have been helped if blood was available within minutes. Shame for trauma patients that arrested in our care - so rarely was there a positive outcome but that could be changed. Honestly a drone delivery service is an interesting idea, just thinking about the major suburban area where I often worked and sometimes a field supervisor could take 20 minutes to get on scene due to heavy traffic. The blood bank partnering with a drone service is an interesting idea, because carrying blood on the ambulance will absolutely be wasteful even though it'll save lives. There needs to be an efficient process to cycle through the blood and get it to hosptials prior to it expiring so it can be used for surgeries. On a personal note my info may be outdated as I'm no longer practicing after an injury that required multiple surgeries. As I was going through recovery that involved multiple surgeries I remember discussing with the surgeon how they had to order blood in advance for me as some of my procedures were likely to require blood. Even though they used a blood recovery system I still went through up to 4 units of whole donor blood. Anyway, there's no doubt lives could be saved by equipping HEMS and, at least, EMS supervisors and/or squads with whole blood but currently there's not a sufficient supply to do this. Maybe the prison population could be tapped into in exchange for something to donate blood?

True, most hospitals don't even have enough blood. It just isn't donated enough. The shelf life for platelets is even shorter. My service recently incorporated blood, and I'm honestly not sure how the medical director pulled that one off.

@therabbi9848 there are ways to do it. The medevac for example get a few pints at the start of their shift, and changes it out back to the hospital every 24hrs. It stays temperature controlled in between and never out of hospital rotation for too long.

A lot of HEMS programs do have blood products, but they really need to be initiated on the ground at the initiation of care.

A lot of air medical services have been carrying blood for many years but there’s definitely challenges that weren’t covered in this video. For one, WHERE is this blood going to come from? We need many more donors. Secondly it has a short shelf life not to mention requires special and expensive equipment to properly store it.

yeah HEMS carries it out here, but that's still at least 25 minutes away.

how much blood do you think there is?

Not a "must" at all. Plasma works as well for most cases.

@@f.n.schlub2269Whole blood is the best. 100% the best.

@@f.n.schlub2269 "most" cases, this would help ALL cases.

When I was younger, I regularly donated. Then I was exposed to a prion disease, so I'm prevented from ever donating again. I genuinely hate that I can no longer donate and that more people who can donate don't do so.

This is what I was thinking, how did they not address this. Who has enough blood to put in all the ambulances

I was donating regularly until they started turning me away because I have a high pulse. When I did donate they always took plasma, they said they needed that the most. They keep calling me to come and donate but when I get there I get turned away so I stopped.

It bothers me they didn’t address this.

I dont donate because ive seen the arms of those who do it constantly. Lookin like heroin addicts with arms filled with track marks 🤮

However, The blood should be going where it is needed most first which is in emergency vehicles NOT some random med-surg floor.

@@Slagathor-uj9fs I understand stand what you are saying, but aren’t you also making a decision as to who lives or dies?

@@deniseurban6704 This is about the proper use of resources in emergent situations. Its not about who lives or dies as we all will anyway. But better pre-hospital interventions and timely access to care are known determinants of the success of emergency treatments. Making someone who needs blood wait until theyre at the hospital to recieve blood is nonsensical.

Keep in mind that as long as the blood is being rotated, this shouldn't increase the need by much, if anything. The blood actually being used would be shifted from the hospital to the medics or paramedics. The blood that's not being used, would get rotated back to the hospital. It would take time to build the supply, but then you'd also have extra on hand in case of a natural disaster. The other logistical issues are a much bigger deal.

when was your last donation?

O negative is universal. But O positive will help about 85% of people so it's almost universal.

@@eepinwillow Thank you for sharing that information about the difference for others.

@@eepinwillow For now, I don't know that it's going to be that much longer before they can take O+ blood and covert it into O-. That would make a pretty significant improvement.

@@SmallSpoonBrigade That'd be awesome. I'm rH negative so I do worry about that kinda stuff for me and my siblings.

how can they type and screen on the scene tho? this can be so dangerous. what about an embolus, or a clot? before they get there. theses are things we stay at the bedside for a reason for, when we as RNs administer blood. they would HAVE to carry universal only, and they would have to have a whole new semester of education on this.

@@barbarashaffer8486 Yes!! Wait till road transfusions cause complications and then the news will be pointing fingers at healthcare again.

The first reach should be for plasma. A unit of whole blood only becomes necessary if the pt is 2+ down; on a 1 whole to 2 plasma basis. As a Type O- donor, I can undergo plasmapheresis more frequently than I can donate whole.

Lawsuits from blood antibodies incompatiblity.

@@barbarashaffer8486 I agree, giving blood can be dangerous however every intervention has a cost/benefit for the patient. Someone bleeding out, of course we have crystalloids but that will further dilute blood component volume and cause the patient to bleed more. We currently do carry universal only. There is always risks of developing clots and emboli prior to arrival at the receiving facility however that risk is small. I do not believe it requires a whole semester of education however, as I am sure in nursing education it does not require that.

Bro special forces already carries blood and can do in theater transfusions. We have the technology. It saves lives. Army is pushing in the next 20 years for medics to be able to give blood across the board

Critical Care Paramedic working a 911 EMS system here: we’ve had whole blood for years at my service and I’d like to answer some of your questions. To keep logistics cost down we keep the blood in a temperature monitored box on the supervisor unit who brings the blood with them to more serious calls. To keep costs down we participate in a regional blood bank program where O negative blood is circulated between us and local trauma centers. In our case we are funded by the taxpayer as a public service and insurance reimbursement rates are not a factor in the care we provide. We’ve given blood for trauma, GI bleeds, OB bleeds, and even hypovolemic anemia in one case. It’s saved a lot of lives. Hope this helps, and feel free to ask any questions you might have!

Thank you for commenting about the issues with transfusing whole blood. I'm a fairly new blood bank tech and there's a lot I'm still learning but the questions you raised were similar to what I was thinking. Nevermind unexpected antibodies, what about the anti-A and anti-B that's going to be in type O whole blood? Wouldn't that cause hemolysis of the patient's RBCs if they're not type O? And I saw what looked like O pos blood in the video. Is that what's going to be given to women of childbearing age and risking complications in any potential pregnancies? I get why trauma surgeons, EMTs, etc would want to do everything possible to save their patients but there's a lot to consider when giving uncrossmatched blood and emergency personnel aren't going to be the ones who will be dealing with the consequences of doing so. Still, it's definitely something that should be looked into more.

Its very studied. I work as a trauma RN at one of these pre-hospital blood areas, and see WB hung *daily* pre-hospital. Yes we see all these negatives, and we handle them as they come. But the reality is, if we're grabbing the whole blood, you're about to tank and die. If you live long enough to show signs of an antibody reaction, its considered a win for these type of patients. Same for infections.

You would need a refrigerator on every ambulance and a right team. Stupid idea. Not practical. Store them at hospitals and better ambulance

It's unlikely to cause problems with the shortage. The issue likely would be simply building up the supply to do it. Once the vehicles are stocked, the blood would be rotated in and out of the vehicles, and the blood that is actually administered should be mostly the blood that would have been administered in the hospital anyways. The other issues with logistics are more likely to be a problem.

or the lobbyists paying them(big pharma) are the ones dictating medicine

They’re too busy looking to discipline EMTs.

Here in WA, we've apparently had blood for the medic one program for years. Basically ER doctors attached to the fire department that go to the scene of the accident and stabilize patients for transport to the ICU. I'd be surprised if laws don't change as the understanding of how to run this part of the program improves and changes are made to ease the blood shortages.

I'm not an EMT, but years ago, when a call to 911 didn't properly relay my medical emergency, the crew didn't bring any pain medication -NONE. When the EMTs saw the state I was in, they immediately started apologizing and said that they only bring pain meds when the 911 call indicates that they're actually needed. That was just pain medication, which is less temperature sensitive, less likely to have unforeseen side-effects, is cheaper, and there is a more plentiful supply of than blood. All of which is to say, they're likely only going to send out "appropriate ER vehicle units" that are responding explicitly to trauma calls which appear to might warrant such a blood for that specific call.

@@im.empimp thats not a thing im sure it was just a bls unit

@@neilpatel9765 - Considering it was the actual paramedics on the ambulance who were telling me this, and I hadn't asked for any pain medication, they simply and repeatedly told me before getting me on the gurney (which caused me enough pain that I blacked out), and then again, repeatedly apologized en route to the emergency department (whenever we hit a bump, I'd pass out from the pain, and wake up to them apologizing yet again) I have absolutely no reason to doubt what they told me. In the decade since my accident, I've had multiple people -who are much more knowledgeable about our local paramedics than either you or me- tell me that _because of paramedic abuse of pain medications_ the ambulances in our areas are not actually stocked with pain medications by default, instead, those medicatinos are in a secure box that the paramedics have to access at the station on a per call basis. Regardless of whether the items are in a lockbox to be grabbed on a per call basis (although, for temperature control, this would likely cause some logistical challenge for blood), or whether there are different ambulance configurations for different types of responses, doesn't matter, the point is that the whole blood supply wouldn't need to be sent out on every single response, it could be sent out only when the specific emergency warranted it. For example, in the video, when the chief made a point of telling dispatch to make sure there was whole blood. Whether the responding crew came in an ambulance that had whole blood stocked by default or it simply had a temperature control unit and the crew loaded the blood when the call came in, doesn't matter. What matters is that _for that specific call_ they brought blood. Since blood degrades in the 30-60 days after being collected, making it available initially to the lower probability consumers (e.g. ambulances) in an early window (for example, in the 15-30 days after collection), and if it isn't used there during that time frame, then transfer it to where it will have a higher probability of being used (e.g. hospital surgical units). This maximizes it's potential use before expiration.

@@im.empimp sounds like 911 triaged your call to a BLS units. EMT's cannot give meds. Paramedics on an ALS unit would have been able to.

​@neilpatel9765 guy says "this was my experience receiving medical care" and your response is "that didn't happen" instead of "that sucks, we need to fix that". A-1 process there, chief.

thats for in hospital policy/state laws

Agreed

It's not in Missouri. Many services are carrying it now.

@@johnkitners9386 Around here the medics have had the blood for about 6 years. I would imagine that as the problem is better understood that more areas will require it for at least some units.

That's why you wouldn't do that. You'd just give the blood to the ambulances that are specifically designated to stabilize patients for transport. Patients in that condition need more care anyways, so just give the folks that are trained for that the blood to do the transfusion. It takes the number of vehicles that need to be supplied from thousands to only a few hundred for a major city.

You have to have a compatible blood type. O neg is the universal donor. O positive the most common.

Shelf life for whole blood is 21-35 days, and for packed red blood cells (the most important part of the fractionated blood) lasts 21-49 days. Must also remain refrigerated during this time. You will likely only see O type blood, which is the universal donor based on type. The other component, Rh factor, is a little tricky. If the patient does not have the Rh factor, they are negative and the second time they are exposed to Rh + blood (either by pregnancy or transfusion), they may develop a reaction. Since O+ is more widely available, that's usually what EMS services carry, although O- is preferred. Luckily, there is medication (Rhogam) that will be administered to the patient after the transfusion to prevent future reactions.

It is not going to waste. Almost all EMS systems have a rotation program in place to move the blood to a hospital before it expires. EMS is being good stewards of the blood.

Around here our medic one program has been carrying blood for transfusion for about 6 years. We were the first place in the world to routinely send actual ER doctors out on calls for critical care directly to patients in need of stabilizing prior to transport. So, this is probably going to spread through the US eventually, but the blood supply is rather limited, so it probably will just be select units for the time being.

I can see those units of blood going bad before getting used in some cases. Hopefully they'll be able to switch them out for fresh units every day, and give the unused one back to a nearby hospital where they are more likely to be used before the expiration.

@@TakenTook same problem for small squads though…unless you base every ambulance right at the hospital…you have to drive back and forth to the hospital at least twice a day…many squads don’t get a call every day…this idea is fine for urban squads…not so fine for rural squads run by volunteers…HEMS should already be doing this…

@@marksmadhousemetaphysicalm2938 -- agreed 100%

Not every EMS program should be carrying blood products. As a rural squad, you should be adding blood as a distinct capability in your Mutual Aid, MCI, and Disaster Response plans. Know who carries it in your area (air and ground), and know how to scale up efforts when needed. Everybody has a role in this- even if you are not a blood carrying agency.

@@RandiSchaefer-uw2su Yep, around here the medics have blood with them, but they're also in a relatively urban area. A smaller town might just designate somebody to get the unit from the hospital and start driving to meet up with the ambulance along the way. (Obviously, starting a transfusion, even if the needle is already in, is probably going to necessitate stopping for a bit)

Spoken like someone who knows what’s up!

@@rwskiller5 🫡

O- can be given to ANY blood type. I’m a universal donor ❤

no. ALL EMTs aleady know how to put in an IV. Plasma or whole blood are no different.

It’s time to invest in the United States. It’s time to take care of our fellow Americans. It’s time are we the greatest nation in the world I don’t think so!!! As a first responder this life-saving treatment should have been implemented over 15 years ago!!!! Millions of lives would have been saved!!!! I guess it’s always about money in the United States 🇺🇸🇺🇸🇺🇸🇺🇸 God bless these trauma doctors for speaking up 🙏🙏🙏🙏 Thank you doctors for educating my fellow Americans that there is a Technology out there, but we are behind in in providing this life, saving intervention!!!

We have a blood shortage.....I don't think this is realistic

It depends where you are. In this portion of the US, the medics do bring blood whenever they respond to a call. And apparently they've been doing so for about 6 years.

they are most likely using the universal blood donor type.

Type O blood. That’s why all the bags have type O on them.

Type O blood can be used for anyone

Then make sure the blood is not infected.. duh

This blood is received from the same blood banks that supply to hospitals, and it undergoes testing to ensure that the risk of infection is incredibly low. There is no such thing as zero risk, but informed consent, including the actual risk of infection, will be obtained prior to administration if the patient is conscious. If the patient is unconscious and we administer it via implied consent, well, the patient was probably going to die without it and the remote risk of infection is minimal compared to the risk of imminent death.

why?

@@sarahschreffler5407 guess you’ve never received a bill for an ambulance ride!?!? When you do, then you’ll understand why!

Until I was exposed to a prion disease, I too was a regular donor. I hate that I can no longer donate, but am really appreciative of all those who can _and do_ continue to donate! THANK YOU for donating!

And some folks are barred from giving for reasons that are no longer relevant. It's also a matter of bureaucracy.

They have, it just depends where you're living. Around here the medics have blood to transfuse and have had for years. I'd expect it to spread, but the amount of blood needed does require a temporary diversion of blood to the program, after that, it should be a relatively minor amount to replace any that is spoiled in some way. But, most of the blood being transfused is going to be the blood that would have been transfused in the ER anyways. So, it's mostly a wash in that regards.

First off its Republicans that don't want to do anything.

We carry blood as a critical care/flight service. I know some places in the states allow lower levels of care to administer blood, but in most cases, it would be reserved for paramedics who receive additional training on it. The shelf life is short, but this takes collaboration with the blood bank. We rotate our blood when getting closer to expiration so it can be pushed to the front of stock at the hospital where it is more likely to be used.

We get our blood typed and screened, usually O+. While O- is the universal donor, O+ is sufficient as Rhogam can be administered 48 hours after transfusion to prevent future reactions if the patient is Rh-.

LTO+WB opens up a whole new donor population.

A person can have an allergic reaction to a blood transfusion which can be lethal

Yes, although rare. Potential risks include reactions to the blood (usually fever, rashes, and high heart rates), infection, and pulmonary edema (fluid in the lungs). The current standard, saline, can keep people alive until we get to the hospital, but it leads to more adverse effects in the patients that need blood (it's still safe in smaller quantities, usually less than two liters, or in patients that aren't bleeding). In the absence of either of these, the usual effect is death or permanent disabilities due to loss of blood flow to the brain, kidneys, and other organs.

If you're bleeding so profusely that you need a transfusion en route to the hospital an allergic reaction is the least of your issues.

@@Matt-fl8uy but a reaction to blood is far different than even a bee sting....

Type O-negative is the universal donor and triggers NO rejection reaction. Sadly for Type O- donors, they are not universal recipients, and can ONLY receive blood or plasma from other Type O- donors.

@@barbarashaffer8486 exactly. I've seen a few in my time as a nurse. Very, very serious.

@@user-zg9ks7xb4f the worst i personally saw in my 10 yrs on the floor was a blood clot thank god, but that poor patient was in so much pain and agony within literal minutes. that could be so dangerous out in the feild cause now you have to STOP right away and start Heparin now are you are in for much larger issues to come. the route to the ER is just to long. even 5 minutes is to dangerous for those things.

LTO+WB opens up a whole new donor base.

Fun fact, we actually carry the whole blood in specifically designed coolers that we change the internal cooling mechanism daily. We also have temperature monitors in each cooler and are notified if the blood is getting too cold or too warm so we aren't damaging or wasting blood products. Unfortunately, there are no current substitutes for whole blood. Maybe in the future but isotonic crystalloids worsen hypovolemic shock in a trauma patient due to decreased clotting abilities and oxygen carrying capacity.

@@caleb_sq5145 thanks for the info :)

In the UK nhs blood is part of the standard kit on a&e ambulances

Illegal for ground ambulances in New York. State law only changed in 2021 to allow helicopters to carry it.

Please check out the latest literature. Administration of prehospital blood decreases SI, improves ETCO2, and requires less blood products upon arrival at the hospital. The logistics have been solved. Tech has come a long way to support prehospital needs. Blood coolers that are rated as FDA approved fridges that are the size of a Yeti. Agencies are carrying either LTO+/-WB, O neg PRBCS, depending on availability. Blood is being rotated to hospital prior to expiration so it can be used and not wasted.