As medical directors at LifeFlight of Maine, we eagerly read the article published recently in the Washington Post pertaining to the out-of-hospital use of blood products (“Easing EMS access to blood could save 10,000 U.S. lives, surgeons say,” Nov. 16).

As noted in the article, the literature continues to support the early initiation of blood products in resuscitation of patients before they reach the hospital, not only for those patients who have sustained life threatening traumatic injuries, but also for those who are suffering from hemorrhagic shock for other reasons, including gastrointestinal bleeds, complications from surgical procedures, and complications from other medical disorders (i.e. cancer, end-stage renal disease, etc.). Only 1% of emergency vehicles in the U.S. carry blood.

Since the inception of LifeFlight in 1998, our critical care teams have been using blood transfusion therapy successfully. During the initial setup phase of our program, agreements between LifeFlight and the surrounding healthcare infrastructure were developed to ensure that this therapy could be administered safely and efficaciously.

As with our in-hospital colleagues, the LifeFlight teams are subject to the same regulations and rules that govern the ability of healthcare systems to provide blood component therapy. Along with these regulations, cost and logistics limit many out-of-hospital EMS agencies from providing blood transfusions.

At LifeFlight, our response region covers Maine and much of Northern New England in a variety of transport vehicles including helicopter, airplane and ground assets. With these types of vehicles responding from three different bases, our system is complex and ever changing. We have had success in developing guidelines for out-of-hospital blood transfusions for both types of calls to which we respond.

The first type is an emergent “scene” call where our team responds directly to a location of an incident that left a patient ill or injured. Our clinicians will initiate care and then transport the patient to an appropriate hospital or trauma center in more metropolitan areas in Maine, including Bangor, Lewiston, Portland, or even out of state to Boston.

The other type of response that our team provides involves the provision of care and transport from smaller hospitals to larger medical centers. In most of these cases, care has been initiated by the staff at the sending facilities. Our clinicians will continue, and in some cases escalate, the care already provided so that the patient receives specialized care while en route.

As medical directors, we monitor the current health care trends in transfusion therapy, and we remain vigilant to ensure that we match the current protocols that are occurring in the most sophisticated hospitals in the nation.

At LifeFlight, our teams transport approximately 2,500 patients annually and, of these patients, we typically provide blood component therapy (packed red blood cells and never frozen plasma) to approximately 13% of those patients. Transfusion therapy is one of the many aspects of the care that we provide in our mobile intensive care units.

After 26 years of experience in transporting acutely ill patients ranging from the smallest neonates to those older patients who require specialized care, our teams have repeatedly observed that providing early blood component therapy has changed the outcome for patients before they arrive at our larger hospitals in Maine and beyond. The therapy remains efficacious and safe for critically ill and injured
patients.