In this episode of EMS One-Stop, host Rob Lawrence dives into the trending topic of pre-hospital blood administration with guests from New Orleans EMS: Tom Dransfield, the quality assurance and safety officer, and Dr. David Rayburn, deputy medical director.
This in-depth discussion explores the development and execution of the New Orleans EMS blood program, focusing on packed red blood cells (PRBC) and the challenges, successes and ongoing research surrounding cold blood administration in trauma and medical emergencies. New Orleans EMS is leading the charge in pushing the boundaries of pre-hospital blood, providing innovative solutions for penetrating trauma, GI bleeds and other critical cases.
Dransfield and Dr. Rayburn share the journey of New Orleans EMS in implementing the program, including their logistics, lessons learned and the vital impact of their interventions on patient outcomes.
The episode emphasizes the collaboration between EMS and trauma centers as well as blood suppliers to reduce mortality rates, while also tackling key questions, such as the supply chain, funding and future research.
Memorable quotes
“For every minute we delay blood administration, there’s an 11% increase in mortality – this isn’t just a theory; it’s life and death.” — Dr. David Rayburn
“We were topping the charts in the wrong categories – violence and stuff like that. So, our medics were frustrated with the old scoop and run. We’re not just scooping and running anymore. We’re providing definitive care.” — Tom Dransfield
“We’re seeing no change in temperature for patients receiving two units of cold PRBCs in the pre-hospital environment, and that’s groundbreaking.” — Dr. David Rayburn
“If we’re doing blood, we’re literally saving lives. But without reimbursement, it’s an uphill battle.” — Rob Lawrence
“Our paramedics are pushing the envelope – it’s no longer just about trauma; we’re now treating GI bleeds, OB cases and renal patients with blood administration.” — Dr. David Rayburn
| More: EMS1 Insider analysis: Colorado Springs leads the charge in whole blood transfusion
Highlights
- 02:20 – Dransfield shares the backstory of how New Orleans EMS started their blood program in response to the high trauma rates in the city
- 04:26 – Discussion on the decision to use packed red blood cells (PRBC) and the challenges of acquiring whole blood due to supply limitations
- 07:39 – Dr. Rayburn reveals ongoing research and their experience with administering cold blood, explaining that their data shows no significant temperature changes in patients
- 11:04 – Rob and the guests delve into logistics and challenges of ensuring a steady supply of blood, noting the importance of collaboration with local blood centers
- 14:51 – Tom discusses the funding for the program, revealing that each administration costs around $1,200 and is currently supported by city budgets and health departments
- 22:29 – Dr. Rayburn highlights the expansion of the blood program to include medical emergencies, such as GI bleeds and obstetric patients
- 28:07 – The importance of quality control, training and use of body-worn cameras to ensure proper administration and continuous learning is discussed
- 31:02 – Dr. Rayburn shares positive outcomes, stating over 90% survival to hospital admission in cases of penetrating trauma
- 34:26 – Final reflections on the impact of the blood program and an open invitation for other agencies to learn from New Orleans EMS’s experience
ADDITIONAL RESOURCES
- New Orleans EMS
- Contact Tom Dransfield
- Every minute matters: Improving outcomes for penetrating trauma through prehospital advanced resuscitative care
- Faster refill in an urban emergency medical services system saves lives: A prospective preliminary evaluation of a prehospital advanced resuscitative care bundle
- Impact of Prehospital Exsanguinating Airway-Breathing-Circulation Resuscitation Sequence on Patients with Severe Hemorrhage
