Blood and trauma

[RedAirplane]

I'm wandering in the wrong forum again, but curious about how ALS providers treat trauma.

I was reading something about the recent trend not to bring trauma patients up to normal blood pressure, but rather to use intravenous fluids to keep the pressure around 80 mmHg.

Presumably this is because you're replacing blood with water.

So, why not give blood on the ambulance? If they're bleeding out so much, wouldn't blood be a better replacement than water? Or am I being naive and missing something obvious?

 

[squirrel15]

How do you type someone's blood in the field?

 

[NomadicMedic]

And how do you stock blood in a medic unit for long shifts with no idea if you're going to ever need it?

On the helo, I know they occasionally grab blood from ED when doing a trauma scene flight.

NS seems to be the only viable option til they come up with a colloid that doesn't kill people.

 

[RedAirplane]

How do you type someone's blood in the field?

Isn't there universal donor blood?

 

[RedAirplane]

And how do you stock blood in a medic unit for long shifts with no idea if you're going to ever need it?

On the helo, I know they occasionally grab blood from ED when doing a trauma scene flight.

NS seems to be the only viable option til they come up with a colloid that doesn't kill people.

How about a freezer?

 

[Flying]

Blood is the best possible substitute you can give to a trauma patient for... blood!

However, the logistics and technical requirements of keeping blood around trumps the benefit of having them around.
- Highly variable demand
- We don't have enough of it
- You need to wait for it to thaw
- Even matched blood carries risks that one wouldn't want to deal with out of a hospital
- One must ask, if we can't stop the bleeding in the first place, is it worth having around? Is it even a meaningful intervention for anyone but prehospital physicians with a timely arrival?

 

[Tigger]

Blood "goes bad" fairly quickly I am told. It's also extremely valuable and waste needs to be minimized. Our flight services bring a cooler of O- on any trauma call or based on request.

 

[EpiEMS]

Blood "goes bad" fairly quickly I am told. It's also extremely valuable and waste needs to be minimized. Our flight services bring a cooler of O- on any trauma call or based on request.

Certainly seems like something a hospital-based ALS service could do...wonder if any do?

NS seems to be the only viable option til they come up with a colloid that doesn't kill people.

I remember some talk of Hextend at one point in time...is that still in use?

 

[Brandon O]

All of the above. Anywhere except the absolute most fun bits of the country, it'd sit there on every unit until it went bad and we'd waste a whole lot of it.

Efforts to produce a non-blood oxygen-carrying substitute continue.

 

[Ensihoitaja]

How about a freezer?

We're part of the COMBAT study. We're carrying fresh frozen plasma (or saline for the control group) and the logistics of it were very complicated. We don't have a freezer, we check out a cooler at the beginning of every shift. We only have to worry about keeping things cool for a 10-hour shift, it would probably be even more complicated with longer shifts. It was even harder to find a way to thaw the plasma that was compatible with the electrical system of the ambulance.

 

[squirrel15]

Isn't there universal donor blood?

Yes but its in very high demand and there is not enough of it to just sit in trucks until its needed.

 

[squirrel15]

We're part of the COMBAT study. We're carrying fresh frozen plasma (or saline for the control group) and the logistics of it were very complicated. We don't have a freezer, we check out a cooler at the beginning of every shift. We only have to worry about keeping things cool for a 10-hour shift, it would probably be even more complicated with longer shifts. It was even harder to find a way to thaw the plasma that was compatible with the electrical system of the ambulance.

How did you find a way to thaw it? If you are SSM system always idling, your engine compartment would probably be warm enough to thaw it fairly quickly

 

[Carlos Danger]

When I was flying we carried 2 units of O-neg in a cooler everywhere we went. We had to monitor the temp continuously and trade it out with the blood bank every two weeks so it could be used before it went bad.

Would be logistically prohibitive for more than a few vehicles to do this. And most don't see nearly enough major trauma to justify it.

 

[Ensihoitaja]

How did you find a way to thaw it? If you are SSM system always idling, your engine compartment would probably be warm enough to thaw it fairly quickly

Gigantic lithium ion batteries and a Plasmatherm hard mounted in every ambulance. The Plasmatherm will thaw a unit of FFP in 3 minutes, 20 seconds.