UPDATE: ON AUGUST 25, 2017, CCEMS BEGAN TRANSITIONING FROM BLOOD PRODUCTS TO WHOLE BLOOD. READ ABOUT THAT HERE.
In another lifesaving first, Cypress Creek EMS is now the only standalone ground EMS system in the U.S. carrying and transfusing Packed Red Blood Cells and Fresh Plasma in the field. CCEMS field supervisors began carrying the blood products at 5:30 pm Wednesday, August 24, 2016. Just nine hours later, our District 51 Supervisor along with Medic 57 was first to successfully transfuse blood products in the field. The patient’s injuries were such that surviving the ride to the hospital was doubtful without transfusion.
In the first two months, CCEMS transfused blood products a dozen times.
Here’s the breakdown:
8 trauma cases:
1 Fall from height
1 Gun Shot Wounds
1 Motor vehicle incident with entrapment
1 Laceration from an assault
4 medical cases:
1 Cardiac arrest from bleeding related to cancer
3 Cases of hemorrhagic shock related to internal/GI bleeding
The patients ranged in age from 16 to 91 with a median age of 34. Most of the administrations were to men in their 20s and 30s.
Of the 12 patients, 11 arrived at the hospital alive. One, whose internal bleeding was caused by terminal cancer, did not survive. Six were transported by ground. Six were transported by Memorial Hermann Life Flight.
As of November 30, 2016, blood had been transfused in 16 cases, ten of which were trauma. The other six were medical in nature.
The ground program follows five years of success by Memorial Hermann Life Flight carrying and transfusing Packed Red Blood Cells and Fresh Plasma in its helicopters. Life Flight did not experience any cases with adverse reactions to the universal donor blood products. Now, the same lifesaving protocols are being used on the ground in Texas for the first time.
Only a handful of EMS systems in the country transfuse blood products including Washington County (Texas) EMS but Cypress Creek is the only standalone EMS System and Harris County ESD 48 is the only Fire Department/EMS in the U.S. to carrying blood products in the field 24/7/365. In addition, Cypress Creek’s Tactical Medic Team is the only such team in the country to carry blood products on missions and during training exercises.
The protocols were approved by CCEMS Medical Director Dr. Levon Vartanian. Specialized equipment to make this innovation possible was funded by Harris County Emergency Services District (ESD) 11, including two clinical grade refrigerators, four clinical grade coolers and portable devices to warm the chilled blood products up to body temperature as it’s being transfused and hemoglobin meters. That’s an investment of just over $27,000.
The protocols were piloted by Harris County Emergency Services District (ESD) 48 beginning in February 2016. Now, Cypress Creek’s Field Supervisors are carrying universal donor plasma and packed red blood cells 24/7/365. They also carry portable warming units that bring the chilled blood products up to body temperature as they are being transfused.
ESD 48 serves more than 130,000 people in a 45 square mile area. Between the start of its program in February and August, ESD 48 transfused blood products in six cases. Most have been medical in nature but in early May HCESD 48 was on scene and prepared to transfuse blood products at the Knight Transportation Active Shooter Event at the request of Westlake Volunteer Fire Department.
CCEMS serves more than half a million people in a 177 square mile area, which is larger in population and land mass than the city limits of Atlanta, Georgia. Based on data from 2015, we estimate CCEMS will transfuse blood products up to 10 times a month.
Based on the experience of Memorial Hermann Life Flight, it is a certainty that more lives will be saved by having blood products available on the ground.
Deaths due to extreme blood loss are usually the result of trauma including vehicular accidents, industrial accidents, shootings, stabbings, and accidents involving power tools. It can also be the result of undetected internal bleeding due to various medical conditions.
Sometimes the only way to save a bleeding patient is to replace blood cells to carry oxygen and nutrients to the body cells. Fresh Plasma replaces volume and facilitates clotting. In more serious bleeds such as a compromised artery, a patient can be unconscious in less than a minute and dead in less than 5. In most cases, an ambulance can’t even get to the scene in 5 minutes.
That’s why these new protocols are so critical. It’s also vitally important to train firefighters, police officers, and the general public how to stop bleeding and make the training as common as classes for CPR. See more on the Stop the Bleed program below.
Trauma is the # 3 cause of death after Heart disease and Cancer and it’s the #1 cause of death among Americans younger than 46 year years old. It’s estimated that about one-third of the 200,000 trauma deaths in the U.S. each year are due to extreme blood loss, which starves the body’s cells of life-sustaining oxygen and nutrients.
The reason for carrying two different blood products is that they have different functions. Packed Red Blood Cells replace lost blood cells and carry oxygen to the body’s organs. Plasma replaces lost volume and contains clotting factors.
The blood products are carried in a field supervisor’s vehicle and are kept at the proper temperature in a special clinical cooler. Because blood products have a limited shelf life, the stock is rotated by the Gulf Coast Regional Blood Center and are stored in special clinical grade refrigerators that are so sophisticated that they can send texts and emails and even make a phone call to designated staff if a malfunction is detected.
CCEMS Field Supervisors, Paramedic III’s and Tactical Medics were recently trained in the proper protocols by ESD 48 Assistant Chief Eric Bank. In addition to Field Supervisors, the CCEMS Tactical Medic Team will carry blood products while providing medical support for high-risk missions with local, state and federal law enforcement agencies and during training exercises.
Having blood products immediately available in the field will no doubt save lives, but it is imperative that whoever is first on the scene know how to stop the bleeding.
For years, members of the CCEMS Tactical Medic Team have been training firefighters and police officers how to stop bleeding with tourniquets and bandages. As a result, many police officers and firefighters now carry Combat Application Tourniquets. CCEMS trains every police cadet class at the University of Houston-Downtown. That’s 480 cadets a year.
Now, under the Stop the Bleed program, endorsed by the Department of Homeland Security, Cypress Creek is teaching civilians under the Bleeding Control or B-CON program. The goals are to make the training as common as CPR training and have a Bleeding Control Kit mounted right next to every AED (Automated External Defibrillator) in the country, complete with pressure bandages and Combat Application Tourniquets.
CCEMS Special Operations Director Wren Nealy says, “Since civilians are usually present at EMS scenes, it’s critical for them to know what to do to stop the bleed while our medics are on the way. We’ve already trained many firefighters and police officers in case they reach a scene first. Adding civilians to the training is the next logical step along with having blood products available in the field.”
The Stop the Bleed program in our region is made possible through a partnership that includes the South East Texas Regional Advisory Council (SETRAC), the SETRAC Trauma Committee, the Memorial Hermann Red Duke Trauma Institute and Cypress Creek EMS.
The recommendation to train civilians and all first responders how to stop bleeding came out of the Hartford Consensus, a joint committee of the nation’s leading trauma experts formed to recommend ways to increase survivability in mass casualty incidents such as active shooter situations. The formation of the committee was in direct response to the 2012 mass shooting at Sandy Hook Elementary School in Newtown, Connecticut which left 20 children and six staff members dead.
Stop the Bleed is supported by the Emergency Services Sector Coordinating Council (ESSCC) which advises the U.S. Department of Homeland Security on important issues concerning emergency readiness. Cypress Creek EMS Special Operations Director Wren Nealy is Vice Chair of the council.
The first delivery of blood products occurred on August 24. It was deployed shortly after delivery at 5:30 pm. Before sunrise on Thursday, August 25, packed red blood cells and plasma were transfused into a trauma patient on the way to the hospital. The patient survived, but our medics believe the patient would not have made it to the hospital alive without the transfusion.
The first CCEMS team to use blood products in the field included Samuel Kordik (District 51 Field Supervisor), In Charge Paramedic Jessica McClosky, Joel Kordik, Volunteer Jeremy Claxton and James Burton.