A woman had been shot in the abdomen in Southeast Washington, D.C. this past April. Her condition was rapidly deteriorating when Dan Lottes, a Local 36 member, arrived on scene and performed a life-saving procedure.
It was Lottes’ first time using the city’s new whole blood transfusion program.
“It was incredible how fast she regained consciousness and was able to answer questions,” Lottes said. “The hospital was prepared to give her more blood when she arrived, but she didn’t need it. And she was able to recover much more quickly, so she was able to return home after a couple of days. It was quite amazing.”
About 180 U.S. fire agencies and departments are currently performing whole blood transfusions during prehospital care for the most critical patients. Many face challenges, however, in securing funding for these procedures and ensuring a reliable blood supply across states.
The Prehospital Blood Transfusion Initiative Coalition (PBTIC) – comprised of several emergency service-related agencies and associations, including the IAFF – is working to solve both challenges.
The coalition seeks to secure coverage through the Centers for Medicare and Medicaid Services (CMS). Since procedures needs a billable code, the coalition has petitioned the CMS to add whole blood transfusion to the ALS 2 reimbursement independent category.
Whole blood refers to blood that has not had anything, like plasma, removed from it. These transfusions are best used when a significant amount of blood has been lost.
The CMS has approved funding for O+ blood, a universal blood type. However, other blood products, such as packed red blood cell (PRBC) transfusions (used to improve blood oxygen-carrying capacity and restore blood volume, or plasma) and plasma transfusions (used for patients with liver failure, severe infections, and serious burns) are not covered.
The PBTIC is actively developing strategies to address any challenges obtaining a supply of whole blood. In the meantime, departments are getting creative. Washington, D.C.-area departments receive a regular blood supply through a partnership with the American Red Cross.
Currently, not all medic units in Washington, D.C., carry whole blood; only areas that data predicts as having the t highest likelihood of medical emergencies, specifically central D.C. and areas east of the Anacostia River. The blood, which has a shelf life of 21 days, is sealed in cooler boxes to ensure proper preservation.
“We have transfused nearly 130 units in the field so far and have a patient survival rate of 90 percent,” Lottes said. “These incidents were not all crime-related. These transfusions are lifesaving for patients with hemorrhaging as with OBGYN patients and anything that causes internal bleeding.”
Meanwhile, the San Antonio (Texas) Fire Department collaborates with the South Texas Blood and Tissue center on the Heroes in Arms whole blood program.
The program has administered more than 1,500 prehospital transfusions and doubled the number of lives saved since launching in October 2018.
One of the most notable incidents occurred in January 2019 when San Antonio resident Tiffany Kieschnick suffered a mini stroke driving home from work. She lost consciousness, causing her car to overturn and land in a ditch.
Kieschnick sustained multiple injuries and was losing blood rapidly. Local 624 paramedics transfused her with a full unit of blood before the helicopter arrived to transport her to the nearest trauma center. Doctors later told her that, without the transfusion, she would have likely died.
“These transfusions have been instrumental in cardiac patients making full recoveries and kept hemorrhaging patients from bleeding out,” William Bullock, medic officer and Local 624 member, said. “But supplies are limited so we must reserve this procedure for the most critical of patients.”
Bullock says they take pride in ensuring that none of the blood goes to waste, returning any unused blood to the blood center within 14 days. This ensures the center has sufficient time to use the blood before it must be discarded.
These transfusions have been instrumental in cardiac patients making full recoveries and kept hemorrhaging patients from bleeding out. But supplies are limited so we must reserve this procedure for the most critical of patients.
William Bullock, medic officer and Local 624 member
The San Antonio program is also equipped to respond to mass casualty incidents, such as the elementary school shooting in Uvalde in May 2022. The program successfully delivered 40 units of blood to the school within an hour.
Through its collaboration with the PBTIC, the IAFF will continue to support Locals, departments, and agencies in funding and supplying these life-saving procedures.
