Thursday 19 September 2019

Rapid Response can now deliver blood transfusions at trauma scenes

Dr David Menzies will now be able to deliver blood transfusions to seriously injured patients before they arrive in the emergency department
Dr David Menzies will now be able to deliver blood transfusions to seriously injured patients before they arrive in the emergency department

Mary Fogarty

Blood transfusions can now be delivered at trauma scenes in Wicklow and Dublin thanks to a partnership between Wicklow Rapid Response and the blood transfusion laboratory at St Vincent's Hospital.

Prior to this new initiative, patients suffering from life-threatening bleeding following major trauma had to wait until their arrival at the emergency department before receiving a blood transfusion.

This is the first time in Ireland that blood will be available for pre-hospital transfusion and will provide a significant improvement in the care that can be delivered to patients immediately after a major trauma.

Wicklow Rapid Response (WWRR) is a pre-hospital critical care service driven voluntarily by Dr David Menzies, Emergency Medicine Consultant from St Vincent's University Hospital (SVUH), in partnership with the National Ambulance Service (NAS). It is one of a handful of services in Ireland where doctors are tasked by the NAS to serious medical and trauma emergencies where the patient may benefit from critical care treatment at the roadside.

To date the only method for pre-hospital medics to resuscitate bleeding patients has been to use saline solution but, because it doesn't carry oxygen or clot, it is not the ideal treatment.

Now, in the event of life-threatening bleeding, the WWRR critical care doctor will be able to deliver blood transfusions before they arrive at the Emergency Department.

'There is a group of patients who are so severely injured that we will have blood waiting for them on arrival in the Emergency Department for immediate transfusion,' said Dr Menzies. 'Pre-hospital blood transfusion will reduce significantly the time it takes to deliver this treatment.

'Our current case load indicates that a small but important number of patients may benefit from this every year. The facility to administer life-saving transfusions in the pre-hospital setting is already the standard of care for pre-hospital critical care services in the UK, Northern Europe, Australasia and the USA. It's fantastic that we can now offer it here in Ireland for the first time.'

Mr Martin Dunne, Director of the NAS said, the service was delighted to support this project and to expanding it in the future. 'The patient is at the heart of our work and the NAS values greatly the contribution of the voluntary pre hospital critical care services make to patient care,' said Mr Dunne.

Dr Joan Fitzgerald, Consultant Haematologist at SVUH, said the project was several months in the making and will make 'a real difference' to seriously injured patients.

'The Medical Scientists in the Blood Transfusion Laboratory have worked closely with the Emergency Department, the National Ambulance Service and Wicklow Rapid Response to ensure the system is safe and secure with no wastage of blood products and full traceability 24/7 including holiday periods,' said Dr Fitzgerald.

In addition to red cells, WWRR will be carrying two units of plasma to promote blood clotting. While the red cells carry oxygen, transfusing plasma in a 1:1 ratio with red cells is the current best evidence for promoting blood clotting, a recognised problem in major trauma patients. The emergency blood and plasma are supplied every 48 hours from the blood transfusion laboratory at SVUH and replenished as required. If unused, the products are returned within 48 hours to the laboratory for use elsewhere, preventing wastage.

When the blood is required, it must be warmed to body temperature which is a key step in preventing hypothermia and other complications in patients receiving blood products. Thanks to fundraising and donations, the St Vincent's Foundation was recently able to purchase a portable blood and fluid warmer for pre-hospital use.

Dr Stephen Field, Medical and Scientific Director of the Irish Blood Transfusion Service said: 'The IBTS are delighted to support this initiative, which will be life-saving. There is good scientific evidence for pre hospital transfusion and it is the norm elsewhere. Blood products are always in demand, if people would like to support this, one of the best ways they can do so is to donate blood themselves.'

Wicklow People