Residents of Clear Creek and Grand Counties can now receive potentially life-saving blood transfusions before they reach the hospital.
A Clear Creek EMS vehicle was stocked with whole blood on Wednesday, Dec. 11, and trained paramedics can now use it for on-site transfusions of critically ill patients in communities along the I-70 corridor west of Denver.
A similar program is set to start next week, covering much of Larimer and Weld counties north of Denver, according to a spokeswoman for University of Colorado Health. The health system’s medical aircraft began carrying whole blood in October and serves patients from Cheyenne, Wyo. to La Junta and Pueblo in Southern Colorado.
The new service comes after the apparent success of a pilot program that began in May in Colorado Springs, said Dr. Scott Branney, chairman of the Colorado Whole Blood Coalition, a group of about 200 medical providers now developing guidelines and education for medical providers across Colorado.
“Nothing I’ve done in emergency medicine in 50 years can save this many lives,” said Branney, an emergency room physician at St. Anthony’s Hospital in Lakewood who led the development of the program in Clear Creek and Grand counties.
Hemorrhagic shock – that is, bleeding to death – is the most common cause of death among Americans under the age of 46. National studies show a 50 percent reduction in mortality when early transfusions are available, according to Branney.
“We get excited for a lot of other things that are in the single digits. If you can get a 6 or 7 percent improvement in some other aspect of trauma care, those represent most of the major wins that have occurred in this sort of process, whereas this works spectacularly well,” he said.
“It's just a logistical issue of how do we make the logistics work? And that's what we're working through at the moment.”
While the mountain communities in Clear Creek and Grand counties have fewer permanent residents than Colorado Springs, the program will also benefit thousands of people who travel the I-70 corridor, he said.
“They usually see somewhere between 75,000 and 100,000 people from the Denver metro area move through those counties each weekend, so it's a tremendous exposure in terms of the highway traffic in Clear Creek and both the highway traffic and (resort) traffic in Grand County.’’
In Colorado Springs, 51 patients have received prehospital transfusions since May, and 44 survived, said Dr. Matt Angelidis, an emergency physician and co-chief medical director for the Colorado Springs Fire Department. Data also show those patients spend less time in intensive care and in the hospital than those who receive blood after they’ve arrived at a medical facility.
“It’s becoming really clear that patients who receive blood early in their trauma or hemorrhage course recover much quicker and spend less time in the hospital and require less care overall,” Angelidis said.
While there’s no way to prove that all of those people would have died without the transfusions, there is a clear link in cases where patients’ hearts had stopped at the scene, he said.
“We have patients in the pre-hospital setting who we have found without a pulse or a heartbeat who have a bleeding condition and starting blood causes the heart to restart. We regain a blood pressure and a pulse,” he said.
“(In) at least seven, maybe eight, of the cases … it's very clear that those patients would not have survived without blood products.”
Transfusions of whole blood – blood that hasn’t had components like red blood cells, platelets or plasma removed – were common until the Vietnam War, fell out of favor and came back into use during the wars in Afghanistan and Iraq, where survival rates improved markedly, Angelidis said.
In Colorado Springs, two paramedic units carry whole blood and respond to accident scenes or other medical emergencies. Clear Creek will have one responding unit and Grand will have two, each staffed by EMS captains. The blood is carried in special containers that store it at low temperatures. It’s then warmed before being transfused into a patient.
Branney said getting blood to emergency sites in the mountain communities poses different challenges for providers.
Weather can be a problem, medics have to travel further to emergency scenes and there are fewer trauma centers, so Clear Creek and Grand counties provide a good testing ground, he said.
“We have 800,000 people who live in rural and frontier counties and we’re trying to develop a process that works and is equitable for those individuals so that it's not just ‘you live within five minutes of a trauma center, you get this very much lifesaving procedure,'" he said.
