PAX Centurion - Spring 2019

www.bppa.org PAX CENTURION • Spring 2019 • Page 29 (Photo: JEMS, “Whole Blood in EMS May Save Lives”) prescribed to females with heavy menstrual blood loss and to patients with hereditary bleeding disorders. Soon the indications were widened to elective surgery because of its blood-saving effects” (Tengborn). Without getting too far into pharmacokinetics, the drug works by blocking enzymes produced by the body designed to break down clots. Since clots are one of the ways the body tries to prevent blood loss, dissolving clots during uncontrolled hemorrhage has disastrous effects. Trials of the drugs’ efficacy in trauma patients suffering from severe blood loss revealed a reduction of almost one-third of mortality. “In summary, we consider tranexamic acid is a drug of great value to reduce almost any kind of bleeding; it is cheap and convenient to use and has principally few contraindications. It may be added, that tranexamic acid is included in the WHOs list of essential medicines” (Tengborn). This drug therapy is currently stocked on all Boston EMSALS units. Along the lines of life-threatening bleeding comes the topic of whole blood or blood products being delivered in the field. While civilian EMS agencies have several means of stopping external bleeding such as: tourniquets, hemostatic gauze, wound packing and the above listed TXA, prehospital providers have no way of stopping internal bleeding. In an urban environment such as Boston with relatively short transport times to Level 1 Trauma Centers we can usually get critically injured patients to an operating theater well within the “Golden Hour”. “The term “Golden Hour” is widely attributed to R. Adams Cowley, founder of Baltimore’s renowned Shock Trauma Institute, who in a 1975 article stated, “the first hour after injury will largely determine a critically injured person’s chances for survival” (Nickson). However, a term analogous to the “Golden Hour” also exists and is known as, “The Platinum 10”. This term is more relatable to an urban EMS system such as the one that exists here in Boston. Arrival on scene, initiation of treatment and beginning transport to an appropriate trauma center, in under ten minutes. But what if we are faced with a patient requiring a long extrication from a confined space, motor vehicle, or in building being constructed 25 stories in the air? What if we are presented with a shooting victim during rush hour traffic, at the furthest ends of the city with no means of stopping internal bleeding? Why not have life-saving blood being infused into the patient from point of injury to the doors of the operating theater? Three EMS agencies in the country have begun to combat patients dying from uncontrollable hemorrhage, all located in the state of Texas. If they cannot stop the bleeding that will certainly kill the patient before arrival at the hospital, they have started to replace the blood being lost. That’s right, EMTs and Paramedics are providing blood transfusions to patients meeting strict transfusion guidelines blood and blood products in the back of an ambulance. As early as November of 2018 SanAntonio paramedics were crediting several lives being saved due to whole blood administration. Many factors come into play when it comes to performing prehospital transfusions, mainly related to cost effectiveness and its’ relatively short shelf life. This innovation is still in its infancy in the civilian sector but early reports show it is making a positive impact in patient outcomes. Is this something that could prove useful to all EMS agencies, including large urban settings such as Boston? Updated Technology Calls for Updated Training T he need for new and innovative technologies also comes with the need to educate and train those who will be tasked with their use. Depending on how you view these changes this could be an exciting new change and a chance to feel advancement in your field; a chance to perform a new procedure or use a new tool to confirm a diagnosis you suspected from sound clinical judgement. Effective training and continuing education is imperative and new ideas and technology can make what was once a struggle to keep your eyes open, an eye opening experience. One might think that Boston, being the mecca of universities and medical facilities, would have a state-of-the-art training facility for its EMTs and Paramedics. This is far from the truth. While the knowledge that is being shared within the walls of the current “academy” is top tier, the walls themselves are weathered and outdated. If you can’t put a price on a human life, why would you not want to invest in training those responding to a life-threatening medical event? New recruits trained for the fire service report to the fire academy on Moon Island, police recruits report to the police academy in Hyde Park. EMS recruits report to a floor in an office building shared with command staff, BPHC offices and gym members of the BPHC’s South End Fitness Center. Fire recruits are trained in a burn building, police recruits are trained at a firearms range, EMS recruits are trained in a room with banquet tables and chairs. Does EMS not respond to the same types of incidents as our other public safety entities? Why should EMS not be alloted the same dedicated training centers to prepare new recruits with the vast variety of incidents they will face in the field? Why should EMTs and Paramedics have to utilize a gym at the police academy (very generously made available to us by BPD and their academy staff) when we could have our own, geared towards the physical aspects of EMS? Why should EMTs and Paramedics be forced to train in a second-rate environment to provide first-rate care? Citations Nickson, C. (2015, April 3). Trauma Mortality and the Golden Hour. Retrieved February 2, 2019, from https://lifeinthefastlane.com/ccc/trauma-mortality-and-the-golden-hour/ Tengborn, L. (2014, May). Tranexamic acid--an old drug still going strong and making a revival. Retrieved February 1, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/25559460 White,Daniel. (2012, November). Back Pain and Injury in EMS. Retrieved February 8, 2019, from https://www.ems1.com/ems-products/patient-handling/articles/1371825-A- virtual-plague-could-be-coming-to-EMS/ . Lerner EB, O’Connell M, Pirrallo RG. Rearrest after prehospital resuscitation. Prehosp Emerg Care. 2011 Jan-Mar;15(1):50-4 Salcido DD, StephensonAM, Condle JP, Callaway CW, Menegazzi JJ. Incidence of rearrest after return of spontaneous circulation in out-of-hospital cardiac arrest. Prehosp Emerg Care. 2010;14(4):413-8 (Photo: Source: Wikimedia Commons and Mark Oniffrey)