Crystal Hiwalker ponders the possibility of her heart and lungs continuing to function if the ambulance crew had been able to administer a transfusion as she bled during a stormy 100-mile journey.
Due to the 2019 snowstorm, it took 2.5 hours to travel from her small town of Lame Deer to the advanced trauma center in Billings.
Doctors at the Billings Clinic hospital successfully revived Hiwalker and managed to stop the bleeding from her ruptured ectopic pregnancy. They were astounded by her survival, considering her heart had stopped and she had lost almost all her blood, yet recovered without any brain damage.
The Montana State Trauma Care Committee recognized that the ambulance transporting Hiwalker had passed by two hospitals equipped with blood supplies. This raised the question of what could have happened if Hiwalker had access to that blood en route to Billings.
This realization led the committee to establish the Montana Interfacility Blood Network, the first program of its kind in the U.S. This network allows ambulance crews to acquire blood from hospitals and administer it to patients on their way to receiving advanced care, reports KFF Health News.
“We came up with the concept of a blood handoff, similar to driving through a fast-food drive-thru and picking up blood along the way,” said Gordon Riha, a trauma surgeon at the Billings Clinic trauma center where Hiwalker was treated. Riha emphasized that timely blood transfusions can prevent death or permanent brain damage.
The network specifically targets rural patients who face increased risks of traumatic injuries and fatalities, as stated by Alyssa Johnson, the trauma system manager for Montana.
“We need to get more innovative. We don’t have a blood bank or Level 1 trauma center on every corner,” Johnson explained.
Network leaders have reported that the program has already assisted at least three patients since its launch in 2022 and hope it will be utilized more in the future.
Enthusiastic about the program, Hiwalker expressed, “I’m so relieved that something like this was initiated, as it could save numerous lives in my area.”
Hiwalker mentioned hearing about individuals bleeding to death due to various causes in her rural community. Johnson added that work-related injuries, cancer, gastrointestinal issues, and childbirth can all lead to severe bleeding.
Following Hiwalker’s close brush with death, the Montana trauma committee started discussions on the blood network. They initially developed a map of 48 facilities with blood banks and subsequently created guidelines on how hospitals, blood banks, ambulances, and labs should coordinate, package, transport, document, and bill for the blood.
Due to the emergency nature of the network, patients’ blood types cannot be tested. Therefore, only type O red blood cells are used, as they can be safely transfused into most patients.
The receiving hospital, not the blood provider, is responsible for billing the patient’s insurance for the blood. The cost varies depending on the amount of blood required but typically ranges from several hundred to over a thousand dollars, according to Sadie Arnold, the blood bank manager at Billings Clinic.
Arnold highlighted the necessity for blood storage in a lab and management by qualified professionals with specific certifications and experience. She mentioned that some rural hospitals may lack the resources to store blood adequately.
Rural hospitals that do store blood often have limited quantities at their disposal. This issue was encountered by a rural Montanan with severe bleeding who visited the nearest hospital, which only had one unit of type O blood available, according to a report on the blood network. Thanks to the new program, the ambulance crew collected more blood from a hospital midway through an 80-mile journey to the trauma hospital.
In an ideal scenario, rural patients with severe bleeding would be transported by medical helicopters or airplanes equipped for transfusions. However, adverse weather conditions can render flying impossible, resulting in lengthy ambulance rides. Certain towns in northeastern Montana are over 250 miles away from the nearest advanced trauma center.
“This was truly designed for kind of that last-ditch effort,” Johnson noted. When “we’re out of options, we’ve got to get the patient moving towards a larger center, and we can’t fly.”
Johnson explained that the blood handoff might involve the ambulance stopping at the second hospital. However, during one incident, a police officer fetched the blood and delivered it to the ambulance at a highway exit.
Ambulances may also bring along a paramedic or nurse to administer the transfusion en route since many rural ambulance teams are staffed by emergency medical technicians who lack the authorization to do so in Montana.
Furthermore, medics in other cities and states, including rural areas, have commenced blood transfusions in ambulances and helicopters, according to Claudia Cohn, the chief medical officer of the National Association for the Advancement of Blood & Biotherapies.
Cohn mentioned researchers are exploring the potential of frozen and freeze-dried blood products, which could be beneficial in rural areas due to easier storage and longer shelf lives.
Johnson emphasized that the Montana Interfacility Blood Network is the only program she knows of that specifically targets rural patients and involves ambulances picking up blood from hospitals along their routes. She noted that the network is generating interest from other states with extensive rural areas, including Oregon.
Hiwalker expressed that receiving a blood transfusion in the ambulance could have precluded her near-death experience and spared her husband the trauma of witnessing her suffer during their ambulance journey. She is grateful that her ordeal led to an innovation benefitting others.