Emergency Responders Should Carry Blood Products

Researchers at the UK Defense Science and Technology Laboratory (Dstl; Porton Down, United Kingdom), Queen Mary, University of London (United Kingdom), and the Royal Center for Defense Medicine (RCDM; Birmingham, United Kingdom) conducted a study to compare the potential impact of emergency resuscitation using combined packed red blood cells and fresh frozen plasma (PRBCs:FFP) at a 1:1 ratio; PRBCs alone; or standard of care 0.9% saline during severe injury.

To do so, 24 terminally anesthetized pigs received a controlled soft tissue injury and controlled hemorrhage of 35% of their blood volume, followed by a 30 minute shock phase. The animals were then allocated randomly to three treatment groups during a simulated prehospital evacuation phase. The first group were allocated to hypotensive resuscitation using 0.9% saline, the second to PRBCs:FFP, and the third to PRBCs alone. Following this phase, in-hospital resuscitation to a normotensive systolic blood pressure target of 110 mmHg using PRBCs:FFP was performed in all three groups.

The results showed that considerable coagulopathy developed in the first group, which persisted for 60–90 minutes into the in-hospital phase. The coagulopathy was significantly reduced in groups 2 and 3, but not significantly different from each other. Finally, the volumes of resuscitation fluid required was significantly greater in group 1, compared with groups 2 and 3; this difference was principally due to the greater volume of saline used in group 1. The study was published in the August 2015 issue of Shock.

“Badly injured people often lose the ability to form a blood clot properly, just when they need it most,” said senior author Emrys Kirkman, MD, principal scientist at Dstl. “Our research provides the scientific foundation for the premise that giving blood products before seriously injured patients reach hospital could help save lives, as it improves the ability to form blood clots.”

In 2008 the medical evacuation response team in Afghanistan started carrying blood products to injured personnel on the frontline, thanks to the development of special refrigeration units on the Chinook helicopters. The emergency care procedure, among other measures, has been credited with saving a number of lives in Afghanistan. It could also have an impact for civilian first responders,, but currently only a few air ambulance services in the UK have the mandate, staff, and systems required to carry blood products.

Related Links:
UK Defense Science and Technology Laboratory
Queen Mary, University of London
Royal Center for Defense Medicine