'Minutes truly count': Why Delaware paramedics now carry blood for trauma patients

Blood can buy time.

That's what Delaware paramedics are hoping to achieve by carrying units of blood in the field, which will be used on trauma patients who are being rushed to the hospital.

This week, paramedics in Sussex and New Castle counties launched a new initiative intended to save more lives following traumatic incidents such as shootings, stabbings and car wrecks.

By carrying low titer, O-positive blood, which patients of any blood type can receive, those who have suffered traumatic injuries and are showing signs of hemorrhagic shock can receive an infusion before reaching the hospital.

This, New Castle County Paramedics Capt. Kelli Starr-Leach said, might mean the difference between life and death.

"Minutes truly count," Starr-Leach said. "And when you're faced with a life and death situation on the street, every minute is critical."

How does it work?

In both counties, paramedic supervisors carry the blood in their vehicles, which is stored in a medical-grade, biothermal cooler specifically designed to keep the blood at the correct temperatures. Supervisors can monitor the cooler's temperature remotely by using an app on their phones.

In New Castle County, one supervisor in the northern part of the county will carry one unit of blood, while another supervisor in the southern part of the county will carry a second unit. Depending on the location of the call where blood is needed, one of the supervisors will respond to the scene.

Once at an emergency, an IV will be administered − if responding units have not already set one up for fluids − and the blood will be warmed as it's infused into a patient.

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While one unit of blood, or about a pint, is much less than most trauma patients need, it can help stave off hemorrhagic shock, which is the depletion of blood to the point where a person's organs no longer get the oxygen needed to survive.

Though paramedics in Delaware and across the nation carry fluids to replace blood volume if a significant amount is lost, those fluids do not have the same oxygen-carrying capabilities as blood does. By potentially preventing tissue death, patients are given a little extra time to get to trauma surgeons, the experts who perform life-saving care.

Is it really needed?

Each year, more than 150,000 people in the U.S. die from injuries, making it the leading cause of death for those 45 and under, according to the American Association for the Surgery of Trauma and the U.S. Centers for Disease Control and Prevention.

Of that 150,000, 20% of preventable deaths are due to hemorrhagic shock, Starr-Leach said.

In New Castle County alone last year, nearly 100 patients could have potentially benefited from a pre-hospital blood transfusion, she said. Given Delaware's gun violence epidemic and the "epidemic of vehicle collision and pedestrian and cyclist deaths," said New Castle County Executive Matt Meyer, this potentially life-saving measure "is vitally important."

Why didn't paramedics previously carry blood?

The use of blood in pre-hospital settings is not common nationwide, though research has increasingly shown its benefits.

In part, it's not more widely used because of the logistics of carrying and storing blood, as well as its cost and how long it can be used. The blood used by paramedics in Delaware can be stored for up to 21 days.

While Kent County and Delaware State Police's aviation unit have not yet signed onto the program − dubbed the "whole blood initiative" − the hope is that those agencies, too, eventually begin carrying blood.

What does it cost?

In New Castle County, the initial cost to get the program up and running was $18,500, and it will cost another $50,000 to $60,000 annually to keep it going.

New Castle County Public Safety Director Vaughn Bond said the cost is justified, however, because a single life "is worth a lot more than $50,000."

Meyer echoed Bond, though added that curbing gun violence in Delaware must also be a priority given that victims of gun violence who make it to the hospital need about 10 times more blood than survivors of other traumas.

That blood is expensive, according to the Association for the Advancement of Blood & Biotherapies’ Transfusion Journal. The average cost of transfusion for a gunshot patient is a little more than $11,000, while transfusions for any other type of trauma patient is about half, or $5,700.

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