Montana Creates Emergency ‘Drive-Thru’ Blood Pickup Service for Rural Ambulances – KFF Health News

Crystal Hiwalker wonders if his heart and lungs would have kept working if the ambulance crew had been able to give him a blood transfusion, as he lost blood during the stormy 100-mile trip.

Because of the 2019 snowstorm, it took 2.5 hours to drive from her small town of Lame Deer, Montana, to the advanced trauma center in Billings.

Doctors at Billings Clinic Hospital revived Hiwalkar and stopped the bleeding from her ruptured ectopic womb. They were amazed that she not only survived after her heart stopped beating and she lost almost all of her blood, but that she recovered without any brain damage.

The Montana State Trauma Care Committee, which works to reduce the incidence of trauma and improve care, later learned that the ambulance in which Hiwalker was transported had passed by two hospitals that had stockpiled blood. Committee members asked what if Hiwalker had gotten that blood on his way to Billings?

This realization and question inspired committee members to create the Montana Interfacility Blood Network, which they say is the first program of its kind in the U.S. The network allows ambulance crews to pick up blood from hospitals and give it to transfusions for patients going for advanced care.

“We came up with the idea of ​​a blood transfer — like going through the drive-thru at a fast-food restaurant — and getting blood on the way,” said Gordon Riha, a trauma surgeon at the Billings Clinic Trauma Center where Hiwalker was treated. Riha said a timely blood transfusion can prevent death or permanent brain damage.

The network focuses on rural patients who Facing higher rates “This is a situation where the likelihood of traumatic injury and death is very low,” said Alyssa Johnson, the trauma system manager for the state of Montana.

“We have to be more creative. We don’t have a blood bank on every corner, and we don’t have a Level 1 trauma center on every corner,” Johnson said.

Network leaders say the program has helped at least three patients since it launched in 2022. They expect more will use it in the future.

Hiwalkar is excited about the programme.

“I’m so glad something like this started because it will save a lot of lives where I live,” she said.

Hiwalker said she has heard of people bleeding to death after car accidents, shootings and stabbings in her rural community. Johnson said work injuries, cancer, gastrointestinal problems and childbirth can also cause severe bleeding.

The Montana Trauma Committee began discussing the blood network a few months after Hiwalker’s death. made a map Out of 48 blood bank facilities. Guidelines were created How hospitals, blood banks, ambulances and laboratories should communicate, package, transport, document and bill for blood.

This network is only used in emergencies, which means there is no time to check patients’ blood types. So it only uses type O red blood cells, which can be safely transfused into most patients.

The hospital receiving the blood, not the one providing it, is responsible for billing patients’ insurance for the blood. The cost depends on how much blood patients need, but it typically ranges from several hundred dollars to more than a thousand dollars, said Sadie Arnold, who manages the blood bank at Billings Clinic.

Arnold said the blood should be stored in a laboratory and administered by professionals with specific degrees, clinical experience and board certification.

Arnold said some rural hospitals don’t have the lab space or money to hire these specialists. Or they don’t need blood often enough to be able to store the product, which can expire and — especially during the current national pandemic — Blood loss — is needed elsewhere. The network uses blood that has a maximum shelf life of 42 days.

Rural hospitals may have very limited amounts of blood available from blood storage facilities. One rural Montana resident experienced this due to severe bleeding when he went to the nearest hospital, where only one unit of type O blood was available. Report on the blood networkBut thanks to the new program, ambulance medics were able to drive 80 miles to a trauma hospital and get more blood than halfway to the hospital.

Ideally, rural patients with severe bleeding would be transported by medical helicopters or airplanes equipped for blood transfusions. But, as was the case with Hiwalker, flying during bad weather may be impossible. That could mean hours-long ambulance rides. For example, some towns in northeastern Montana are more than 250 miles from the nearest advanced trauma center.

“It was really designed to be a last-ditch effort,” Johnson said, when “we have no other options, we have to transport the patient to a bigger facility, and we can’t fly.”

Johnson said the ambulance might have to stop at another hospital to hand over the blood. But during one incident, a police officer picked up the blood and delivered it to the ambulance at a highway exit, he said.

Ambulances also may carry a paramedic or nurse to give blood transfusions en route, as many rural ambulance crews are staffed with emergency medical technicians, who are not authorized to do so in Montana.

Doctors in other cities and states, rural areas also includedhas started to do blood transfusions Ambulances And HelicopterClaudia Cohn, chief medical officer of the National Association for the Advancement of Blood and Biotherapies.

He said the researchers are also interested in the possibility of using frozen and freeze-dried blood products, which could be helpful in rural areas because they are easier to store and have a longer shelf life.

Johnson said the Montana Interfacility Blood Network is the only program she knows of that is specifically for rural patients and involves ambulances picking up blood from hospitals along their route. She said the network is also receiving interest from other states with large rural areas, including Oregon.

Hiwalkar said receiving a blood transfusion in the ambulance would have saved her from a near-death experience and saved her husband from the trauma of seeing her suffer while travelling with her in the ambulance. She is happy that her ordeal led to an innovation that is helping others.