By Helena Oliviero
The Atlanta Journal-Constitution
ATLANTA 鈥� During a recent 24-hour period at Grady Memorial Hospital, ambulances carried four critically injured patients: three with gunshot wounds, and one from a car crash.
All four patients were bleeding profusely and at risk of dying without immediate help.
But what transpired in those Grady ambulances in the streets of Atlanta is a first-of-its kind for the city: These patients received whole blood transfusions before they arrived at the emergency room, which likely saved their lives, according to Dr. Ryan Fransman , a trauma surgeon at Grady .
Details of the patients鈥� conditions were not released but Fransman said all four patients had lost too much blood and were at risk of dying before they could reach the hospital. Instead, the patients received immediate transfusions and by the time they arrived at the hospital, they were more stable, according to Fransman.
鈥淎 huge game changer,鈥� said Fransman.
Grady joins a small number of hospital and ambulance services around the state and country with the training, equipment and coordination needed to perform the transfusions.
Uncontrolled bleeding is the No. 1 cause of preventable death from trauma. Nationally, it accounts for 35% of deaths from trauma before a patient can reach a hospital, according to the Mayo Clinic .
A person with uncontrolled bleeding can die in as little as five minutes, according to the Mayo Clinic .
鈥淲hen you get to the hospital, it鈥檚 almost like a NASCAR pit crew approach. They鈥檙e stopping the bleeding. What we are doing is bringing this outside the hospital to get things started faster. Health care starts when you call 911 and not just when you enter hospital doors,鈥� said Lekshmi Kumar , medical director of EMS at Grady . What we trying to do is advance care earlier.
Most people who suffer a traumatic injury don鈥檛 need a blood transfusion before getting to the hospital. Candidates for this procedure are patients losing so much blood they鈥檙e showing signs of 鈥渉emorrhagic shock,鈥� a medical emergency that includes dangerously low blood pressure and a rapidly increasing heart rate as the body tries to pump more blood to vital organs.
Grady is the only remaining Level 1 trauma center in Atlanta , meaning it鈥檚 capable of providing care for every aspect of the most complex traumatic injuries and medical emergencies without the need to transfer patients elsewhere.
Kumar estimates the blood transfusions could help as many as 300 of Grady鈥檚 trauma patients every year.
Response times for a 911 call asking for an ambulance can vary. Grady declined to share specifics on its ambulance wait times, saying several factors at are play, including distance from Grady , and traffic. But a June 2022 investigation by The Atlanta Journal-Constitution found for the first five months of 2022, Grady鈥檚 monthly average response times for life-threatening calls ranged from 10.5 minutes to 13.6 minutes.
Northeast Georgia Medical Center started a pilot program by partnering with EMS services in four counties 鈥� Dawson , Habersham , Jackson and White counties 鈥� for ambulances to administer emergency blood transfusions for those who might need them during ambulance rides.
More may soon follow. Kim Littleton , executive director of the Georgia Medical Association , said other emergency medical providers are also considering administering whole blood transfusions because early results are showing 鈥渁mazing results.鈥�
Giving patients a blood transfusion before arriving to a hospital marks a major change in care. Historically, EMS teams, including those at Grady , used IV fluids to treat hemorrhaging patients until they get them to the hospital.
Whole blood was the main option for patients needing a transfusion after surgery or major trauma for over 100 years. But there was a major change in the 1960s, when an innovation allowed blood to be separated into its different components: red blood cells, white blood cells, platelets and plasma. This allowed blood banks to serve more patients from each blood donation, and made preserving the blood easier.
But compelling research has emerged showing whole blood works better on trauma victims than IV fluids or components of blood.
A study in the when compared to transfusions using other blood components in patients experiencing hemorrhagic shock.
The blood transfusion program at Grady comes after several months of research planning and training. Kumar said the whole blood must be kept cool and stored in a special cooler until it鈥檚 needed.
The science behind the transfusions gained momentum on the battlefield. Military conflicts in Afghanistan and Iraq , 鈥� a discovery that captured the attention in the world of trauma and surgery.
Fransman, who has to share knowledge and advances in care in combat, said there are many parallels between trauma injuries in combat and the violence unfolding on the streets of Atlanta .
鈥淚t鈥檚 extremely important for Atlanta to know that injuries we are seeing here at Grady are injuries that are battlefield medicine,鈥� he said. 鈥淲e鈥檝e seen the assault rifles, we have seen high-powered weapons, we are seeing massive tissue destruction. We are seeing high-speed motor vehicle accidents,鈥� he said. 鈥淵es, we are not seeing (explosions), but the rest of the penetrating stuff, and the bleeding out and the low blood pressure and the shock and instability we are seeing, is similar.鈥�
With the American Red Cross declaring an emergency blood shortage earlier this year, having enough blood could be challenging. Kumar said they have plans in place to ensure zero waste of the blood donations. She and Fransman also made a plea for people to donate blood.
漏2024 The Atlanta Journal-Constitution.