A new tool to treat those suffering from trauma-related injuries in Brevard County is now available as they fly to the hospital.

Health First was the first hospital in the state of Florida to begin using what’s known as “whole blood” on its air ambulance helicopters. 

Rob Spivey, the trauma program manager at Holmes Regional Medical Center and First Flight nurse manager, said there is a growing movement in the U.S. to shift from using blood parts, which began in 2001, to now whole blood.

“What we used to carry then was packed red blood cells," Spivey said. "We have a blood transfusion and we have blood products that are able to spin down and separate into different components of whole blood — into packed red (blood) cells, into platelets and plasma and so forth."

“And then historically, we’ve used each part of that, depending on the kind of transfusion you need — whether you need to replace red blood cells to provide oxygen support or you get plasma or platelets to prevent clotting,” he continued. “The benefit of that is it’s safe, it’s effective. We can get more product with the blood that we collect with donation.”

One of the important things Spivey noted that he and other paramedics have to consider, though, is that with trauma cases, the blood loss can be so great and quick that a transfusion is needed.

With the blood separated into pieces, that means taking more time to essentially add all those components back together.

He said the military has shifted in recent years to carrying whole blood with their medical supplies in order to respond more quickly for injured service members. 

“For us, the benefit is we’re giving you all the components you need in one bag, versus where I used to have to give you four bags to get the same result,” Spivey said. “That whole blood just goes straight in and it’s ready to go.” 

Leading the state

Spivey noted that the path to get to this change wasn’t a quick or easy one — but he said it’s a growing trend across the United States. He pointed to Texas as a leader in emergency medical services, both on the ground and in the air.

“They’re also well integrated with military service," he said. "So, that idea sparked in the military moved right into EMS quickly, and they’ve had great results."

He said one of the challenges to rolling out the use of whole blood in Florida is that you need a steady and reliable supply for the helicopters. Spivey added that some additional screening that has to be done on the blood used in air ambulances. 

There also has to be considerations made for male and female patients when it comes to this procedure. He anyone not within child-bearing age (10 years old and younger or 55 years and older) would be able to get either the O positive or O negative blood without issue.

Spivey said the issue with potentially pregnant patients is not as much to do with the woman, but the fetus, which may have a conflicting blood type. The Rhesus (Rh) factor, or whether a blood type has a positive or negative sign next to it, is something that paramedics have to pay close attention to for women in the child-bearing age window.

“When they become pregnant, if their child happens to be the opposite of the type that they are in Rh or Rh-negative factor, it could create a potential infusion reaction with the child,” he said. “So, that’s why we screen those a little bit tighter.”

Health First works with OneBlood as its blood donor supplier. Officials said the blood bank was instrumental in setting up First Flight with a steady source of donors — which allows emergency workers to better address the high-impact need created by trauma causes.

The American Association for the Surgery of Trauma reports that trauma is the leading cause of death for individuals up to the age of 45. It’s also the fourth leading cause of death overall. 

“The No. 1 cause of death is bleeding, hemorrhage in all of these illnesses that originate out of trauma," Spivey said. "So, replacing blood is the primary way to help fix that problem, help reduce mortality. When we saw this and we saw the availability, we approached our organizational leadership and/or physician leadership and said, ‘Hey, we’d like to try and implement this.'” 

The process of getting whole blood onboarded began in December 2021 and by May 12, the program was up and running.

Impact of whole blood on the Space Coast and beyond

Since it’s been in use, Spivey said they’ve used whole blood four times aboard the aircraft, and four additional times within the Holmes Regional Medical Center trauma ward. 

“That doesn’t sound like a whole lot, eight times, but eight times in four months, where you’ve given a blood product that can potentially save someone’s life, is huge because on average, we give blood about once a month on the aircraft,” Spivey said. “And again, sounds low volume, but it really is high threshold for survival.”

As Health First paramedics get more comfortable with this system, they’re starting to look at how it can be expanded for use with children.

And asking questions of some of the other hospital systems thta deal with pediatric patients can also spark further dialogue on how Health First can start rolling out a similar whole-blood element with their paramedics on the ground and in the air.

“So, I think it’s starting to permeate out and we’re seeing a higher interest in how we can all get onboard and do this,” Spivey said. “Most of all, most of the air programs are really looking at trying to do it and they’re just trying to find a way to navigate it successfully without any problems.”

“We were fortunate enough, we just found the right niche," he added. "We had the right group of passionate people in our system that said, ‘Yes, this is important,’ and we were able to get it implemented.”