Paramedics in the Philadelphia area begin to carry blood in their ambulances

Paramedic Leonard Brown knew the patient ― a pale, Berks County man who could barely speak after days of internal bleeding ― needed a blood transfusion fast.

But Brown did not have blood on his ambulance. On that day in April, the TowerDIRECT paramedic had to wait for dispatchers to send to the scene a critical care transport, a specialty truck staffed with a nurse and equipped with blood units.

Once the nurse delivered the blood, the patient rapidly improved. “By the time we got him to the hospital, his color returned and he was much more alert,” Brown said. “He was talking.”

The next time Brown has a patient who needs blood, he will be able to provide the lifesaving resource himself.

TowerDIRECT paramedics last month became the first in the Philadelphia area to carry blood for patient transfusions on their ambulances ― and are among the first in Pennsylvania to do so. They have expanded access after the state last year started allowing more health-care providers to give blood. This allows patients to receive blood earlier, which studies have shown improves survival and other outcomes.

“You should have all the tools in your tool kit to give the patient the best care,” said Brian Lahmann, chair of emergency medicine at Tower Health. “If there is significant blood loss, now there is blood available.”

Blood transfusion used to be considered risky and too logistically complicated to perform outside the hospital walls and without a physician present. But the experiences of military medical units who carried blood in recent decades, as well as medical air transport programs, showed that blood could be delivered safely by paramedics in the field.

Emergency medical services, or EMS, around the nation have been pushing state regulators for permission to carry blood. Ambulances in Texas have done so for years, and multiple cities have joined in recent months, including Washington, D.C., Indianapolis, and Atlanta.

Research on these programs has found that giving blood before a patient arrives at the hospital can be the difference between life and death. One study found that each delayed minute in giving blood increased mortality rates for trauma patients by 11%.

In Pennsylvania, paramedics until this year could have only treated such emergencies with other types of fluid, such as saline, to increase the volume of the blood.

“We gave them a fancy fluid,” Lahmann said. “But what they really needed was blood.”

Blood has been used in air transports for decades in Pennsylvania, according to the state’s Department of Health. Registered nurses with specific certification and physicians were able to give blood outside the hospital as their scope of practice.

Last year, TowerDIRECT equipped its nurse-staffed critical care transport with blood for the first time.

In the year since, the critical care transport has administered blood to 22 patients, said Brad Cosgrove, Tower’s chief of emergency medical services. Patients with internal bleeding, gunshot wounds, or injuries from accidents had better outcomes.

“Hey, this works. Can we make this more readily available?” Cosgrove’s team wondered, he said.

So when the health department updated its protocols in December last year to allow paramedics to also give blood, TowerDIRECT moved quickly to expand.

In January, the state approved Tower Health’s EMS responders to carry blood, the first in the state. EMS in the Pittsburgh area are also among those also now approved, and Southern Chester County EMS are hoping to roll out blood on their trucks soon.

TowerDIRECT waited until April to equip its ambulances with blood to have time to train staff.

TowerDIRECT has specialty trucks that carry whole blood, which is the same as the blood that circulates in the body. A paramedic truck in Reading and the one in Phoenixville carry two units of packed red cells. This is the part of the blood that carries oxygen.

The blood type on the trucks is O positive. While O negative is the “universal donor,” it is in short supply and O positive is a close runner-up in emergencies.

The TowerDIRECT paramedics carry the blood in red cooler bags. Each bag has a quality assurance sticker with a flower that changes color if the blood has been out of the cooler for too long to signal that it can’t be used.

The TowerDIRECT initiative has protocols to reduce the risk of wasting blood units, which are in high demand. A blood unit can be stored in a blood bank for up to 40 days, Cosgrove said. But it can only stay in a cooler for 48 hours — and the paramedics aren’t expecting to use the units so frequently.

To prevent the risk of a blood unit going bad on ambulances, the blood supply is replaced every 24 hours. At 8 a.m., the paramedics drive the mile and a half from the fire station to the nearby Phoenixville Hospital. There, they drop off the bag with the old blood units and pick up a new batch.

“It’s like it never left the shelf at the blood bank,” Cosgrove said.

But even without waste, blood is a limited commodity, the chief said. Before rolling out blood units on the ambulances, the fire station held a blood drive to boost supplies. Cosgrove and the paramedics stretched out their arms and donated as well.

“We got to put our money where our mouth is,” he said.