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Giving packed red blood cells in the prehospital phase of care... a good idea?

Marty Munro marty_munro at yahoo.ca
Fri Apr 6 21:45:45 BST 2012

Speaking as a paramedic, I would not want this responsibility. It's just one more thing to go wrong in an often unstable environment, and one more reason for me to lose my certification, job, or be sued. We are always taught to limit our scene times in traumas and provide required care en route, for obvious reasons. This means that often, we are unable to establish an I.V. due extreme movement of the vehicle, accessibility of available veins and the requirement to maintain a patent airway as a priority. Therefore, arriving at the emergency department/trauma room in a timely manner is a medic's priority. There is conflicting evidence as to whether or not a fluid bolus is even beneficial, and evidence that suggests it is harmful to the trauma patient. So now, if medics start carrying blood, will they be expected to always have blood running en route to the hospital? And when they are unable to, suddenly the topic becomes "the patient could have survived
 had the paramedics started an I.V. and given blood en route".  The law suit begins, the medics lose their certifications and become the subject of an investigation and inquest.  And if they do start an I.V. and give blood and the patient dies, the topic becomes "paramedics wasted time by starting blood en route to the hospital". I am all for progressive medicine in the pre-hospital care, but I think that those who choose to implement certain things should try this first. Next time a trauma comes in to the hospital, instead of going to the nice bright trauam room, the patient should be taken into a utility closet, with only one physician and one extra person and all the care should be provided in a cramped closet by the single person while the extra person continuously shakes the mattress of the bed. Then think about how realistic/beneficial adding in extra skills/procedures is to pre-hospital staff. That's just my opinion. 
Marty Munro
Advanced Care Paramedic
Ontario, Canada

--- On Fri, 4/6/12, Stephen Richey <stephen.richey at gmail.com> wrote:

From: Stephen Richey <stephen.richey at gmail.com>
Subject: Re: Giving packed red blood cells in the prehospital phase of care... a good idea?
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Received: Friday, April 6, 2012, 3:25 PM

For the most part, I would say no at least here in the US since the average
level of education for a paramedic leaves much to be desired (speaking as a
former EMS educator myself).  The issues with quality control, supply
maintenance, the need to determine clinical need (EMS providers tend to
massive over-estimate the severity of patients' conditions because most of
them are taught "cookbook" defensive medicine) and cost.  I am not sure how
the blood banking situation is in other countries but here there are often
region-wide shortages of blood products so the sequestration of a
significant amount in the hands of EMS providers would probably only
exacerbate the situation.

Also, the problem is worsened by the fact that the patients who would
probably benefit most from field transfusions are the ones in the areas
least suited to its use because of administration, training and supply
issues.  Rural EMS tends to be almost all volunteer and many of these folks
never even meet their medical director let along receive any meaningful
QA/QI feedback.  The idea of giving the blood to the local HEMS operators
and using them to deliver a higher level of care isn't going to work
because you're going to delay the arrival of the patient in the OR in all
but the most remote of areas.

In urban settings, you're not going to have that much need for transfusion
because of the proximity to trauma centers.  Here for example, it's
abnormal for EMS providers (such as my fiancee) to take longer than 20
minutes from call to arrival at the hospital.

On Fri, Apr 6, 2012 at 3:12 PM, Karim Brohi <karim at trauma.org> wrote:

> So our trauma helicopter emergency medical service recently started
> carrying packed cells:
> http://www.bbc.co.uk/news/health-17232529
> We'll obviously be auditing its use closely, but I'm interested in
> garnering the lists opinions on this:
> Who should get PRBCs?
> Should anyone get PRBCs?
> Why aren't we carrying plasma as well?
> There are a couple of prehospital services in the US carrying blood
> and plasma to my knowledge, and it is used by MERT teams in combat
> zones.
> So??
> Karim
> --
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Stephen Richey
Founder and Chief Researcher/Designer
Kolibri Aviation Safety Research
5174-B Winterberry Circle
Indianapolis, IN 46254

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