Eureka-Goodfield EMS is the first in Illinois to offer a pre-hospital blood transfusion program for its ground ambulances. The partnership with Impact Life will allow two ambulances to carry two units each of O-positive red blood cells and plasma.
Dr. Matthew Jackson is the medical director of pre-hospital and emergency medical service [EMS] at OSF HealthCare. He helped shape the first-in-the-state program.
Often, blood is needed when a patient experiences a hemorrhagic shock, resulting in significant blood loss, while in route to the hospital.
“Whether it be from a trauma or something potentially medical, so that we could actually start the life saving measures early in the field and then get those patients stabilized by the time they get to the hospital, or at least help stabilize them,” Jackson said.
Similar programs exist in other states and in different kinds of populations. OSF already uses pre-hospital transfusion for its flight programs.
Reducing hospital stays and improving patient conditions
For Eureka-Goodfield, it is especially important for the rural population.
“We’ve shown…if we can stabilize these patients in the field with blood and get them blood early, it actually decreases the amount of blood that they need in the hospital, and also potentially can make a huge outcome difference in these patients as well,” he said. “So, by the time that they get to the emergency department, that resuscitation has already been initiated and they’re already on the road to stabilization.”
In transit to a hospital, every minute counts and the longer a patient goes without blood, the likelihood increases of their condition worsening.
In an event like hemorrhagic shock, or a low-blood state, this is such a case.
“If you were losing blood, you’re losing the ability to not only take oxygen to the organs that is very vital for survival, but you’re also losing things such as coagulation products and other coagulation proteins that actually helps blood clot,” he said. “You end up in a state where you’re not getting oxygen to the tissues.”
Prior to the program, Jackson said EMS would give patients IV fluids, but research found that it was diluting those important products of the blood. So, giving fluids proved harmful at times.
By giving blood and plasma, EMS is able to help bring back the body’s ability to deliver oxygen.
“And so those organs, if they’re not getting that oxygen carrying capacity to them through the blood, they have a metabolic switch where they go into anaerobic metabolism,” he said. “So, they don’t use oxygen, so they start building up these things called lactic acid. Lactic acid actually worsens the patient’s outcome.”
Jackson said lactic acid leads to many symptoms, among the most consequential is organ failure.
“The body wants to heal. What we’re doing is giving it tools to heal itself, or at least start healing itself until either surgical intervention can be undertaken or we need to do more medical intervention when we get into the emergency department,” he said.
Developing the program
Jackson was a pivotal player in developing the first-in-Illinois program. He was aware of the program in other states but only started to seriously consider it for OSF at the request of his EMS chief, Randy Wolf.
“Anytime you’re the first in an area to do something, it becomes just sort of a logistical problem,” he said. “[With Wolf], we started really working together to see what that would look like, what the cost of not only the products would be, but also the turnover of the blood products we looked at, and what are the equipment costs and that sort of thing.”
Through meetings with medical departments across the country, including flight and ground crews, Jackson started to put together a “labor of love” that took about six months to finish.
“…trying to get this protocol and multiple revisions up and done and submitted to the state,” said Jackson. “And, of course, the state had rightful concerns to make sure that it’s done safely and within scope of practice. So, we worked together with the state of Illinois, worked together with our EMS partners, also a blood supplier to really come up with a robust program.”
Jackson considers the work a growing area of patient care at the intersection of emergency medical service and transfusion medicine. He said to move forward, his department is always looking to stay up to date with medical practices.
He would like to see the program expand to other parts of the state, despite its slow adaption.
“I’ve actually heard that there’s a couple other programs that are starting to form in Illinois, too, so we’ll be watching them closely as well, and I’m sure there’ll be some data sharing and things like that as we move forward,” Jackson said.
