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The United States has the highest number of gunshot wound (GSW) deaths among all high-income countries—and that figure continues to rise.^1,2 In both military and civilian trauma cases, hemorrhage is among the leading causes of preventable deaths.³

Tourniquet application and combat gauze are effective techniques to control bleeding. However, providers must then focus on stabilizing crashing vital signs and reversing the effects of shock. More EMS organizations are adopting advanced resuscitative care bundles, which include pre-hospital blood transfusions, to address this need. Studies show that these interventions can significantly improve hemostasis and perfusion while decreasing mortality from hemorrhage.⁴ This approach is critical for improving outcomes for individuals suffering from severe traumatic injuries after bleeding is controlled.

The following case illustrates the effectiveness of LifeFlow PLUS, a novel handheld rapid infuser, in stabilizing a patient with multiple GSWs and an open femur fracture during airlift transport.

Case Presentation

Ochsner Flight Care was called for rapid airlift transport of a 27-year-old male patient who had suffered bilateral gunshot wounds (GSWs) to the upper legs. The patient presented with an entry wound to the right thigh and an open femur fracture to the left thigh with active bleeding.

Prior to the flight team’s arrival, EMS first responders applied tourniquets to the patient’s bilateral upper thighs. They also obtained peripheral IV access with an 18-gauge catheter in the left and right AC.

Initial vital sign measurements revealed a systolic blood pressure in the 70s and an SPO2 of 85%. The patient also appeared pale and diaphoretic with delayed capillary refill lasting longer than three seconds. He remained awake but agitated and maintained a patent airway. He also admitted to ingesting alcohol that evening.

Noting signs of severe hemorrhagic shock, the EMS team administered a 1L bolus of LR and a 100 mcg dose of IV fentanyl while waiting for the flight team to arrive.

Management

Upon arriving at the scene, Ochsner flight nurses noted continued bleeding from the left leg wound. They promptly tightened the existing tourniquet and applied combat gauze to the wound, which subsequently controlled the bleeding.

Vital sign assessment at this time revealed blood pressure 125/75 (MAP 92), heart rate 95, and SPO2 99% on a non-rebreather mask. Due to the patient’s extensive blood loss, a transfusion of one unit of O- packed red blood cells (PRBCs) was initiated using the LifeFlow PLUS rapid infuser.

The unit of blood was successfully administered over two minutes. Following the transfusion, the team also used LifeFlow to rapidly deliver 500mL of normal saline.

Following this resuscitation, the patient’s vital signs remained stable at blood pressure 130/73 (MAP 92), heart rate 92, and SPO2 97% on the non-rebreather.

The patient also received another 100 mcg dose of fentanyl and 1 g of TXA. His vital signs remained stable during transport, and he was handed off to the trauma team at the destination hospital.

Discussion

Rapid transfusion is paramount in the treatment of hemorrhage, particularly in trauma cases involving significant blood loss from firearm-inflicted injuries. Timely and controlled administration of blood products helps ensure adequate perfusion and mitigation of shock symptoms during critical moments.⁵ However, typical methods of mass transfusion, including pressure bags and rapid infusers, often fail to efficiently deliver the volumes needed to stabilize patients in severe hemorrhagic shock.⁶

The LifeFlow PLUS rapid infuser is designed to deliver controlled, efficient transfusions of blood products and crystalloids up to three times faster than a pressure bag. It is also quick to set up and can be operated with one hand, leaving the provider free to perform other tasks to stabilize the patient simultaneously.

Mark McCormick, Chief Flight Nurse, commented, “We’ve given 19 units of blood in the last 8 months. The LifeFlow rapid infuser changed our workflow. It’s made the difference in some critical situations.  I’ve seen a lot of products marketed in my 34 years of Emergency Medicine. This one works.” 

In this case, LifeFlow PLUS enabled the flight team to safely administer both blood and fluids in minutes, eliminating the delays of setting up more complicated infusers and the ineffectiveness of a pressure bag. The intervention enabled the team to maintain the patient’s perfusion and prevent further deterioration enroute to the hospital. The ability to efficiently and effectively deliver rapid transfusions pre-hospital is an invaluable asset for trauma care of hemorrhagic shock that improves outcomes and saves lives in critical situations.