Rapid Re­sponse al­lowed to de­liver blood trans­fu­sions at trauma scenes

Wicklow People (West Edition) - - NEWS - By 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.’

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

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