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Unfortunately, traumatic injuries—both intentional and unintentional—impact the lives of thousands of people every day. Whether due to falls or traffic crashes or other reasons, the numbers are staggering. In 2022 alone, nearly 50,000 people in the United States died from just guns (including homicide, suicide, and accidents).

Among the most common causes of death following these injuries is hemorrhage.¹ It is also one that we may have many tools to treat, but only if they’re used quickly in the right patients. Stopping external bleeding with direct pressure and tourniquets, for example, is critical. Administering drugs like tranexamic acid (TXA) can also be helpful, though more research is needed on optimal timing and dosing.

But even when we can stop the bleeding, or in those cases where we can only slow it down, the next step is to prevent the organ damage that comes from low perfusion. More and more, it’s recognized that prehospital resuscitation to slow or reverse the onset of hemorrhagic shock, even when transport times are short, can give patients a better chance at survival and a better quality of life when they do leave the hospital. A recent presentation by Broome et al. highlighted the positive impact that an advanced resuscitative care bundle, including prehospital blood, is having for New Orleans EMS.²

That’s why so many EMS organizations–both ground and flight, fire and hospital based, public and private–have started carrying blood or blood products and using LifeFlow to administer them safely and quickly in the field.

Case Presentation & Challenges

A 42-year-old woman was shot in the chest. Local fire and EMS responders immediately recognized the severity of her situation and began treating her wounds; they also called for a helicopter to transport her quickly to a trauma center. When the flight crew arrived, the patient was alert and talking to them, but as they assessed her, she quickly began to decompensate. She sounded confused, her skin was pale and cool, and her heart rate increased to 111 as her blood pressure plummeted to 63/49. The crew recognized that although she had minimal signs of external bleeding, she appeared to be in severe shock, possibly from internal hemorrhaging. They didn’t waste any time moving her to the helicopter and notifying the trauma center that they had a patient who needed to go directly to the operating room from the helipad.

Management

The two flight nurses on board knew they had to act fast. Fortunately, the initial EMS crews had established a few IVs prior to the transfer of care. Even more fortunate for the patient, the University of Chicago Medicine Aeromedical Network–known as UCAN–stocked whole blood and packed red blood cells on their helicopters. Using the LifeFlow PLUS rapid infuser, the crew administered 500 mL of whole blood in three minutes, followed by another 350 mL of packed red blood cells in two minutes–all through a 20-gauge IV line in the patient’s arm. Thanks to the QinFlow Warrior warmer also on board and readily compatible with LifeFlow, they were avoiding the dangers of hypothermia while addressing the potential hypovolemia. The patient’s skin color and mentation improved almost immediately, and her pulse was now 99, with a blood pressure of 95/76. The crew initiated a second unit of whole blood and administered TXA prior to arriving at the hospital and bringing the patient directly to the OR.

Discussion

Every prehospital clinician knows that severe trauma patients need rapid transport and, typically, surgical intervention. But there are critical treatments that they can make in the field to increase the likelihood that a patient will arrive in the OR stable enough to get the care they need and have a positive outcome. In this case, the patient had a single gunshot wound, but it did a significant amount of damage–she was later found to have a pericardial effusion, hemothorax and pneumothorax. In the operating room, she received two chest tubes and a pericardial window.

But what if she had arrived at the hospital with an even worsening blood pressure and poorer mental status? Would she have not survived these procedures? Or maybe lived, but with significant brain or other organ damage thanks to an extended period of poor perfusion? Thanks to the quick thinking of the initial EMS responders and the flight crew, the patient arrived at the hospital in better condition than she’d been in on scene. Just two nurses in the cramped patient compartment of a helicopter were able to use the LifeFlow and QinFlow to give the patient what she needed–safely and quickly. It also gave them control over the situation–they were completely aware of how much blood they’d administered over how much time, without the delay required to set up a complicated electronic pump or the ineffectiveness of a simple pressure bag. They gave the blood. They then paused to reassess and recognized that it had helped, but that the patient still showed signs of shock. So they continued their treatments.

The UCAN team’s ability to use LifeFlow to give blood in the field and en route to the hospital, even with a transport time of only ten minutes, may have made a significant difference in this woman’s life–and the lives of her family and friends.