How ex-military surgeons are pushing for laws allowing ambulances to carry blood
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- Опубліковано 17 тра 2024
- A group of former military trauma surgeons are calling for first responders to carry whole blood on rescue vehicles to help save bleeding patients. NBC News' Cynthia McFadden reports on the small number of communities already seeing life-saving results.
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#Military #Doctors #Healthcare
"Where you live should not affect if you live!" Amen
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.
@@WELVAS. But why do MOST people love/Work remote? because the job they do demands that! - Most farmers in the USA work very remotely because the agraric land is in the middle of nowhere so that it is enough that not all americans starve (Extreme - example) or The people who work in mines for copper or in generaa raw materials - do they derserve less/Slower medical care even though they the ones with the realy important job?
Like without office jobs sure the economy would crash but what without farmers?
@@funfungerman8401 no one ever said they deserve it bro the consequence of living far away is that naturally, care will reach them slower
As someone who works on as a Paramedic, the reason that we don't carry whole blood is a lot more than just Money. The bigger issue is the logistics. If you knew how much medication is wasted over the course of a year, you would understand the bigger issue. It is not something that would get used every day, and the blood has a shelf life even when being stored properly. Unlike everything else we carry though, I can't just produce whole blood if we run low or something. Whole blood is a finite resource. Trust me when I say, I wish I had access to whole blood, but the logistics of being able to in so many areas is very complicated.
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.
I'm actually shocked that life flights and other non ground ambulances used for trauma response do not already have whole blood... And to find out that not all trauma centers have it on hand is mind boggling...
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?
It comes down to how many people are actually donating blood. How many times have you personally donated blood if you could?
I've donated over 240 units since 2011(over 75% of that is platelet/plasma units). That amount of units doesn't just will itself into existence. Since people normally don't donate blood, that is why the blood supply is chronically low.
The ambulance service I work for just put whole blood on our supervisors trucks. And within a week we have already used it.
That's an absolute MUST that you should see in the nearest future. Hope this initiative won't drown in bureaucracy.
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.
It’s easier said than them we already have a blood shortage in America. Imagine if we try to outfit every ambulance in America or just a majority of ambulances in major cities with blood. If we’re already running short, where are we going to get the blood from?
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.
I'm sure if they paid people to donate blood there wouldn't be a shortage
This makes sense, but there is a blood shortage. More people need to donate.
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 🤮
We all need to be donating more blood before this can happen. Red cross is struggling right now
when was your last donation?
Where I live in Canada, they stopped collecting blood in all but one city in the whole province. I'm O negative and would donate, but I'm not going to drive 7.5 hours to do so.
As someone who’s had to see fire and ambulance data by the millions for data science, responders could really use fresh blood on-scene. Would save a lot of time taking the trip to the hospital for just the transfusion. Imagine what it’s like to bleed out in traffic.
i think people need to realize the importance of donating blood-- the only reason they dont have it is due to worldwide shortages
This video makes me as an O negative blood type want to start donating blood again because I know I'm a universal donor and that blood could safe someone else's life.
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.
Blood availability is dependent upon blood donors. There are always shortages of blood, especially type O. It is NOT just a matter of money and insurance.
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.
@@Slagathor-uj9fs But it still comes down to the actual amount of blood bags actually collected, tested, stored, and transported first. Until we get more blood in circulation, it will have to be rationed. That's what many of us are saying... and some of us are actual blood/platelet/plasma donors. Some of us are even white blood cell donors too.
I have a doctor cousin that told me it looked like one of her patients was going to be in a much worse place because they didn't have the platelets. Thankfully her hospital got the platelets they needed(which is a hard thing to acquire when they only last 5 days). As a platelet donor that occasionally donates whole blood again, I was happy to hear it.
Until the blood supply gets to be where it needs to be, saying things like "Making someone who needs blood wait until theyre at the hospital to recieve blood is nonsensical" when there literally isn't that much blood in the total supply is in itself nonsensical too. Get your friends, family, and others to donate blood more and then we can plan the logistics better. How much blood have you personally donated if you didn't have medical issues stopping you? I've done over 240 units since 2011 so I can speak from experience it's not easy but I did it.
How will this be possible when there is already a worldwide shortage of blood???
I worked as an ER RN for 20 years, it's a great idea. I do wonder how it will be paid for and where all this blood is coming from. We really need to focus on WHY so many are bleeding to death in the first place. In our ER it was stabbings and gunshot wounds followed by drunk driving. Maybe eliminate the causes of bleeding first. Accidents do happen, but so many causes for ER visits are totally avoidable.
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.
There's blood shortage and I don't think having them on ambulance would get used
Think about what you just said. Our demand outpaces our supply and moving the supply closer to the most critical time sensitive patients I don’t think it would be utilized!!!
is there no brain in there? it won't be used in an AMBULANCE? lol
Good guys with goodness on their minds.
This could save many additional lives in places where stabbings and shootings are extremely common.
Whole blood is VERY different than the components. Many people think whole blood is used for transfusions, but it is really the components (red blood cells, plasma, cryo). I worked in blood bank and hospital in transfusion. There are so many factors beside just the blood type. Whole blood transfusions are more likely to have negative reactions. What about antibodies? What if the patient was pregnant? Blood O- is at a shortage and there is not enough for everyone. How do you make sure the temperature for blood is correct? How do you pick which ambulance gets first choice? Blood transfusions are very expensive and we need to make sure the price doesn't increase (from insurance). This needs to be studied more.
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
i run as an emt in loudoun county virginia, and our ems supervisors (certed as critical care medics and flight medics) carry whole blood products. Transport units do not yet, but emts and paramedics are trained to assist in blood transfusions. Aside from the fire department, AirCare HEMS carries whole blood as do most of not all of the hospitals we transport to. I believe fauquier county to the south of us is starting to adopt blood transfusion protocols for their ems supes as well.
good ole loudoun
There's already a massive blood shortage. While this sounds great, and yes would be helpful, it's just not really possible. I am a volunteer fire fighter/ems. I will keep an ear out for how this turns out.
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.
@@SmallSpoonBrigade Build up the supply to what? Blood can be utilized in big chunks at a time(one patient for example can use 40 blood bags and that needs to be set aside for them) so stockpiling it isn't always easy. If you have patients scheduled surgery months in advance, they must have blood or its components ready within a few hours of the surgery. While a hospital can do what they want or need to prior to that surgery, they are obligated to fulfill their promise at the moment of surgery.
Blood also has a shelf life of around 30 days so it's going to be used within that period anyway. Platelets are only 5 days(which I regularly donate) so that supply can't be "built up". I believe only plasma can be stockpiled since that can last 100+ days.
While I agree there are other issues with logistics, having either 15/30 blood bags or 45-75 makes a pretty big difference when divided among 10-20 patients. You can't exactly give someone a partial amount of blood materials they need otherwise it's wasted on their treatment. Also someone else is not getting treatment. That's why it's difficult to decide which patient gets blood or its components when more adequate amounts still aren't coming.
Problem with whole blood is: While O- is the universal red cell donor, AB+ is the universal plasma donor.
I’m shocked they don’t!
And this the current problem. Politicians who have no medical background are the ones dictating medicine
or the lobbyists paying them(big pharma) are the ones dictating medicine
We have been pushing for this for years but you must understand that the way the laws work around Paramedic scope of practice vary from state to state and are often incredibly difficult and slow to change.
As to the logistical side, you NEED cooperation from the hospital system for prehospital blood transfusion to work, Austin Travis County EMS (Texas) proved definitively that blood will not be wasted prehospital and now ATCEMS is one of the largest users of whole blood in the region!
As a civilian im surprised this isnt already a thing
Almost got unalive from losing blood twice… once when recovering from getting surgery for diverticulitis was hemorrhaging from the bottom end and another when got tonsils out was vomiting blood… I don’t remember much but know that blood saved my life… I am O +… I hope ambulance will start carrying blood everywhere… These people are amazing…
Put on the EMS supervisor unit
They’re too busy looking to discipline EMTs.
Big problem in the US. Paramedics in states, counties, and cities have widely different protocols and different capabilities. You could be getting 2024 care in one place, and 1989 standards in another. As a paramedic, kind of terrifying. It needs to be standardized. I realize blood can’t be carried on every single ambulance for logistic issues, but it needs to be a resource available in the area AT LEAST. At least one unit (either a SUV or special unit) should carry.
Remember, this is science.
Not magic.
This is something every American should care about and stand behind
Patriotic enough to donate blood?
Use the units 30-60 days from expire only on the appropriate ER vehicle units that have responded to trauma involving a loss of blood within the last 30.
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.
I'm not in the industry but my guess for the best solution would be to have a separate vehicle unit specialized in carrying blood, amongst other things. They could then be dispatched to an area whenever they are needed. Would diminish logistics problems by a lot.
The only issue I see is that there's already a shortage of blood, there's simply not enough O- blood to have on most ambulances...
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.
AWESOME
ngl it baffles me mobile ICU units don't already.. It's literally in the name.
If you were surprised by the fact that not every ambulance carries blood, then you would be really surprised to know that not all states consider EMS (Ambulance or first responders) an essential service. Without this a lot of agencies do not get the funding (taxes, grants, etc.) to provide services such as blood or the best treatment prior to hospital, that could save a life. Take Iowa as an example, you are guaranteed a police and fire department response, but you are not guaranteed for an ambulance to show up at all. Iowa EMS agencies tried to push to make it essential across the state, but municipalities and counties still have to individually vote to make EMS essential, when so many people depend on these services.
When I was sixteen I donated blood like 4 times in one year just because lol. I’m in Japan so they take out less blood than the US. It might also have been less because I was 16. No parental consent required to donate at 16 in Japan.
I just looked it up and they only take 200ml. At 18 they can go up to 400ml.
Ever got money for it?
I live in a larger city where this could be useful for shootings and other trauma. Our ambulances get tied up with homeless people faking illnesses during the winter so they can get a ride to a warm hospital. The time spent transporting these people would waste the shelf life of blood. I see ambulances transporting patients without lights and sirens, obeying traffic laws, so obviously the patients conition isn't that life threatening. I once had a coworker who treated ambulances as a free taxi for his family to visit the hospital for the most minor symptoms, as it was cheaper than public transit (Symptoms most would treat with Advil or Peptobysmal)
The whole expectation for care provided by ambulances needs to be redesigned. There should be a second transport option for people with less life threatening needs, and ambulances with blood reserved for actual life threatening emergencies . Blood does no good if it sits on an ambulance that spends the entire day transporting people with coughs, headaches, stomachaches, and minor cuts.
I'm absolutely surprised that whole blood isn't already carried. Replacing blood with blood is basically just... the best way to treat a major hemorrhage besides stopping the bleeding itself. I do understand the logistical issues with preserving and not wasting blood by letting it expire, and the extra cost, but it can't possibly be worth more than the lives saved.
Hems and mert teams in the UK have been carrying blood for around 15 years or so normally two to 4 units of prc and ffp in a one to one mix there's a entire complex issues with normal crews carrying blood it costs money to carry in special fridges and cool bags transfer it to the station etc and if you are sick enough to need blood in the uk you will get a highly trained trauma and critical care surgeon to your side at the site of the accident site and a highly trained advanced critical care practitioner with training at the masters or higher with significantly higher than a us paramedic if you are bleeding out you don't need a normal paramedic you need a doctor and at site of wounding surgery and flying to hospital
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 don't understand how the Seattle area is farther than an hour away from a trauma center since Harborview Medical Center has a level 1 certification. 5:16
The real question to ask is... How much could/would be wasted if we do this? We already have shortages reported all the time... That's the cost benefit analysis I want to hear. I do donate my blood which is O+ and very sought after because most people have or can take that blood type. It's an incredibly important thing to do but with so few already doing it, what's the best use of it?
I'm fine with water if the paramedic thinks it's good enough, but the insurance companies should absolutely not be the ones making that call.
My concern is the little rural squad that’s staffed exclusively by volunteers…maybe they get two of three calls a month…everyone thinks HEMS or all paid Fire Rescue…problem is…this just isn’t practical for the majority of EMS squads…what about the extra burden of still more education and legal liability for medics and EMTs who volunteer because they want to help their community but EMS just doesn’t pay enough outside big cities to make a livable wage…vs costs. Until Paramedic is a licensed independent medical profession, it won’t…but then it puts a burden on the small communities. We need more than volume expanders too. We need synthetic blood, but they’ve been futzing with that since I became an EMT in the 80s. I was an ED/Trauma nurse that had to retire due to an accident and I’ve heard idea before…and it didn’t go anywhere due to insufficient blood donation, fear of HIV and other blood borne diseases, legal liabilities for small communities and the providers, lack of training…and research that showed survival differences were minimal…
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)
They need the Lucas device also! So many changes need to be made to American healthcare ❤
What's the shelf life for this whole blood? And is it good for all blood types?
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.
“Could” “no, WOULD”
They had just enough blood to save my brothers life. He lost almost 2 liters from a window glass slipping and slitting his arm/wrist. Luckily a guy nearby had a tourniquet since it was the county dump. He still lost almost 2 liters though and was on verge of death. He thought he was going to die in a dump and says that was worst part about it all. Haha 4:55 No, we need to force insurance to reimburse for freaking blood in an emergency situation. It only takes ONE small cut in the RIGHT place and you're done in minutes.
I know a couple patients I’ve hauled to the ED that could have benefited from whole blood while en route.
Not EVERY ambulance. But maybe a few strategically placed ambulances with crews specially trained to not give the wrong blood type to the few patients a day who need it out of the thousands of 911 calls that don't.
There's at least 3 levels of "ambulance" and actually more. But for starters, there is EMT that gets 4 months of schooling and thats not near enough for all the things they have to learn as it is. Paramedics that get 1 year of schooling and again, thats not enough time to learn everything they are supposed to know. Then there is CC or Critical Care medics that is another level above paramedics. They may be good candidtes for this whole blood idea. But they may also push back because they are also responsible for too many other things already.
Critical care paramedic in NY/VT. NY is one of the states that does not allow blood on ground-based ambulances (unless it has already started and we are taking a patient out of the hospital). It was only legalized for helicopters in 2021, and despite pushes from the EMS community, as well as the actual Bureau of EMS, it still was not legalized for ground ambulances. Working out of Vermont, we are thankfully able to carry blood products, unfortunately not whole blood (yet).
As plenty mentioned, there are plenty of logistical issues, but not issues that can't be overcome. Putting blood on every ambulance is not feasible, nor is it necessary. There is a shortage of blood, so unless everybody who can is donating or we make synthetic blood, we cannot overcome that shortage. Even then, we carry blood but rarely have to administer it. With a shelf-life of 21 days to a month and a half, blood expires quickly and must be frequently rotated, as well as consistently remain refrigerated. There are also plenty of ambulances responding with EMTs or AEMTs who would not have the training to administer blood (with exceptions, whether I agree with them or not). Blood would typically be reserved for special units staffed by paramedics, and this leads to a healthy balance of minimizing wastage while still ensuring the blood comes to the patient quickly.
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.
They better be paying the EMTs more money for this training. Also, how will they be testing blood types? Are we giving O- blood to everyone? They have shortages of O- blood…what about transfusion reactions? Will you be premedicating to prevent reactions?
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!!!
People gotta donate blood if they want it available. I donate almost every two months minus the few times I reschedule due to work. But even then donation centers are always in need. Can’t supply a resource they don't have.
Im wondering if ambulances carried all that blood would people try to steal it? 1:47
Way to go, Birmingham, Alabama. UAB is a Level 1 Trauma for those injured in accidents. Now Huntsville, Alabama, needs to get on board.
It is actually illegal in many places for anyone besides a nurse to hang blood. Even if they are in the ER under Dr supervision. Hospital ERs that use Medics as nurses won't even allow them to hang it. As a medic of 20 years, yes whole blood would absolutely be helpful. But there are barriers and there are also pitfalls.
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.
As a er trauma nurse good idea. Tired of “we gave a 500cc bolus and patient remains hypotensive” h/h comes back as a 4 and 12
There’s gotta be a way to make artificial blood for transfusions so they can be more practical and effective
You'd think with how much an ambulance costs there would be
This is going to require ALOT my donations. O Neg is the universal donor blood type and only 8% of the population is O Neg.
LTO+WB opens up a whole new donor base.
Thanks your government for not having universal healthcare to cover the cost.
So Ill will pay $1400 for a 12mile ride to be given the knock -off version of treatment?
Whole blood doesn’t grow on trees doc. I’m sure carrying a personal supply of whole blood in my trunk would also increase my survival odds.
We needa accelerate the creation of artificial blood already
Its so hard for them to keep blood on hand and available there's a whole section of healthy Americans willing to donate so they can have the blood the people need but they won
't change outdated rules. Watched a singaporean documentary about how there isn't enough blood or skin banks around the world for major disasters .
i see alot of issues with this and don't think it's a smart idea. people will be going off of word of mouth in some cases leading to the wrong blood being used. there will be a shortage and what company will you trust to give you clean blood and when that blood comes to be known as dirty what will come from that
we still have people contracting stuff from blood transfusions this process will only increase the issue
This is all well and good but we NEED make laws to make health insurance cover the costs of the ambulance service and ride 100% without having to meet the deductible
why?
@@sarahschreffler5407 guess you’ve never received a bill for an ambulance ride!?!? When you do, then you’ll understand why!
As a former Jehovah’s Witness I am glad that the benefits of whole blood transfusions are being supported with evidence.
This already happens in the uk. Specialist/highly Critical care teams carry blood, enhanced care paramedics carry lyoplas. These teams are only dispatched to jobs where their skills are required and I’ve seen multiple occasions where the use of prehospital blood saves lives. To prevent waste, blood is delivered daily and any unused blood is taken back to blood banks to be used elsewhere. No need for it on every ambulance thou
How is the blood typing done in the ambulance. There are blood expanders that can substitute for blood for vascular volume increase, until typed blood is available.
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
This seems to be a federal government issue because of insurance policies. The question then goes to which administration do we as country think will address this solvable issue. The current administration or the previous administration. Choose your local representatives carefully, they inevitably affect all of our fellow countrymen.
First off its Republicans that don't want to do anything.
I was today old when I learned that my country doesn’t have blood on board EMS. Shouldn’t this be on all ambulances in a country that has mass shootings
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.
I didn’t realize they couldn't carry blood.
Hopefully they also increase the pay with all complex things they ask us to do.
Great idea in theory, but with the blood shortage that's been on a steady increase since covid (at least on the east coast) A LOT more awareness needs to be done and high volume donation centers/events need to be opened, especially for O neg donors. Idk how much O neg blood places can spare at this point.
LTO+WB opens up a whole new donor population.
so much blood is going to go to waste :(
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.
As a blood donor, I would prefer for people to get that life-saving blood when they need it. I don’t donate blood to have it sit around in a refrigerator not being used.
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!
Only about 3% of eligible people in the USA donate. Donate Donate Donate!
I’m shocked that they haven’t done that yet but then again where is all the blood gonna come from? That means more people will have to donate blood.
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.
How much blood is available to replace the chrystaline stuff? Hopefully enough that this lobbying won't be shut down so easily
The Red Cross is about to make even more money
Only if there are enough people donate their blood. Blood didn't come out of thin air. It's not just about bureaucracy and money.
And some folks are barred from giving for reasons that are no longer relevant. It's also a matter of bureaucracy.
Couldn't they just carry O- blood since it is universal?
It comes down to $$$$ and of course shelf life , plus does America have enough Blood donors to have stocks of whole blood on hand ??. What is the next best thing other than the saline drip, Could dried plasma help???
If infected blood then expect a lawsuit
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.
Good and great but you need certified people to give it and how often would it go bad?? The questions that need to be asked. Who’s going to be certified to give it?
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.
They should only carry o+ and o- since those types of blood can be used for just about any/all blood type. Blood has a shelf life and being in a vehicle with constant changing temps and moving more violently than other vehicles will cause the blood to expire way quicker. Blood is a finite resource. Theres not alot of it amd people die even in hospitals because they dont have the quantity of blood they need to save a persons life. Which is why ambulances carry saline solution which is basically as close as we can get to making blood artificially and all blood types can accept the solution and it has a wayyy longer shelf life. so yeah blood shouldnt really be on ambulances unless we have so much of it that we can afford blood being thrown in the trash instead of being put into another human being.
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.
I don't know, american paramedics have very little training in comparison to the rest of the world. I don't think it will be safe to let them deal with these complex tasks.
The only thing is, you’d need a universal blood donor that can give blood to everyone, since some can only have certain types etc. I do wonder about that
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-.
I thought ambulance were already required to carry blood in case of every situation impossible.
💯💯❤️
We should not even have to be paying for an ambulance ride... this should be indiscriminately available anywhere in the US and funded by tax dollars.
Why not carry the universal donor “O” blood type… maybe it’s too hard to find 🤷🏻♂️
1:36 i think thats what theyre pushing for
@@yungphame 😆 sorry…. I did a classic comment before the video ending syndrome 🙏🏼
another case of innsurance being for profit instead of patient care- and insurance companies being legalized extortion!
NOT GOING TO SAN FRANCISCO.
I would suspect most of the blood would be used for gun shot wounds. This may be a good idea for the United States because theres enough trauma. It wouldn't make sense in most countries....
Gelatinous blood?
They already carry blood in the Hamptons.
Pay medics more this is surgeon level stuff yet working for private companies the most they make is like 35 an hour
….they don’t carry blood? I feel like a back alley parademic could provide more service
……hmmmmm…sounds like a bad idea for me. Blood is a highly regulated product with strict temperature and time requirements which I’m skeptical that you can maintain on a rig. There should be a fluid replacement alternative or blood substitute that’s more stable to carry on ambulances. In a combat zone, understandable but the risks of adverse effects in giving someone tainted blood or the wrong blood….is it worth it to carry on ambulances?
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