One of the two women shot in the 500 block of Bourbon Street late on Nov. 6 was in bad shape when paramedics arrived, Capt. Janick Lewis said. Wounded high in the leg, she was in shock and becoming increasingly sweaty, pale and unresponsive. Paramedics gave her a blood transfusion right there, under neon signs advertising daiquiris and pizza by the slice.
The effect was immediate.
“It’s phenomenal,” Capt. Holly Sherman said. “To see them go from half dead to talking is something you can’t replicate. … Pre-blood [transfusion program]we would have lost those patients and been wheeling a dead body into the trauma center.”
A year ago, New Orleans Emergency Medical Services became the first agency in the region — and one of a handful of emergency medical services in the United States — to provide pre-hospital emergency blood transfusions to patients with traumatic injuries. The woman shot on Bourbon was the 100th patient to receive a whole blood transfusion in the field.
University Medical Center is studying the program to assess its effects on mortality. Preliminary results are promising, said Dr. Jennifer Avegno, an emergency room physician and New Orleans’ health director. She said patients who receive blood in an ambulance and make it to the hospital have a much higher chance of survival than those who don’t have the intervention: Only 10% of patients in critical condition who don’t receive pre-hospital blood transfusions live, versus 40% of those who do receive blood.
“The results are really spectacular,” Avegno said. “That’s a huge, huge jump.”
Decreasing the murder rate
As violence persists in a city with a per capita murder rate that leads the US, medics say the transfusion program is making a noticeable tooth in the fatality rate. As of Nov. 25, New Orleans had logged 239 murders for the year, a number medics say would be even higher if not for the groundbreaking intervention.
“We are decreasing the murder rate in New Orleans,” Salmeron said at a recent City Council budget hearing. “These are patients [who] would otherwise perish.”
The program is so new it can’t be billed to health insurance, Lewis said, so EMS covers the $1,100 price tag for each transfusion. EMS is a revenue-generating department that does not rely on tax dollars; it bills about $22 million a year for its services, and spends $20 million, EMS chief Bill Salmeron said.
A grant from the New Orleans Health Department covered the initial costs of the transfusion program.
New and promising
Other agencies that administer whole blood transfusions in the field include Harris County Emergency Services District, Cypress Creek Emergency Medical Services and San Antonio Emergency Medical Services in Texas, and Loudoun County in Virginia. They served as models for New Orleans EMS, Lewis said.
The San Antonio region implemented pre-hospital transfusions after two mass casualty incidents — the shooting at Robb Elementary School in Uvalde and the 2017 shooting at First Baptist Church in Sutherland Springs — according to the San Antonio Express-News.
Joe Cooper was among the high-profile recipients in New Orleans, said Paul Adams, a spokesperson for The Blood Center, which provides blood to EMS. In May, Cooper was shot in the abdomen defending his wife, WWOZ disc jockey Leslie Cooper, from an attempted invasion at their Gentilly Terrace home.
“He was shot multiple times,” Adams said. “He received his first transfusion at his house and received another en route to University Medical Center. I talked to some medical professionals at the hospital, and they all told me one reason he is around is because of that transfusion. He probably would not have made it if not for that quick response.”
‘Buying us time’
Blood is expensive and scarce, so it is deployed strategically to patients who really need it and who continues to exhibit signs of shock after reversible causes have been treated. The blood is stored in a special refrigerator at EMS headquarters until a call comes in, when a “blood medic” grabs the small cooler, which keeps the O-positive blood at 35 to 43 degrees Fahrenheit. Two sprint units are equipped with two units of blood each at any given time, and 53 paramedics are trained to administer it.
Administering blood in the field is expensive, poses logistical challenges and requires special training, which are a few reasons that the new intervention is not yet widespread, although helicopter EMS units have long been equipped with blood.
HAS 2017 study of blood transfusions in combat casualties in Afghanistan, published by The Journal of the American Medical Association, found that pre-hospital transfusions administered during the “golden hour” — the 60-minute window for providing definitive care after traumatic injury — resulted in better survival at 24 hours and 30 days compared to patients who received delayed transfusions or no transfusions.
“The blood is making a difference. It’s buying us time to get [patients] to the operating room,” said EMS supervisor Kevin Hoag, who added that a patient can bleed to death in less than two minutes.
Lt. Titus Carriere, a paramedic trained to administer blood transfusions, said he’s seeing more shootings and stabbings now than at any other time in his 17-year EMS career. One of the standout blood transfusions he’s administered in the past year involved a 9th Ward stabbing that exposed the victim’s intestines. The man was in critical condition and bleeding rapidly when Carriere arrived, but after receiving blood, he underwent surgery and survived.
A 10-minute procedure
“There’s been a very, very incredible amount of violence in the past year,” Titus said. “We see a lot of shootings with military-style rifles that tend to do a lot of damage. … You don’t have a lot of time to waste when you have somebody bleeding like that.”
According to New Orleans EMS data provided during the first three months of the program, it takes 9.7 minutes to administer blood in the field. During the first three months, 21 patients received pre-hospital blood transfusions. Of those, seven died in the emergency department, and 14 made it to the operating room and were eventually discharged.
Of those who received blood transfusions, 86% percent were Black males, 14% White women, according to the EMS report. Of these patients, 81% had been shot, 14% stabbed and 5% had blunt trauma injuries. The report’s authors, Dr. Meg Marino and Tom Dransfield, concluded that the ability to reverse shock quickly in the field is improving patient outcomes.
The forefront of trauma
The transfusion program, first suggested by UMC’s Dr. Juan Duchesne and EMS Director Emily Nichols in 2019, reflects a dire need for pre-hospital interventions as care shifts toward damage control resuscitationwhat Avegno described as a “more military approach.”
“The military is all about intervening quickly, getting them to the operating room to fix what needs to be fixed,” Avegno said. “If somebody is critically ill and it’s trauma, they almost always need blood, so how can we get blood and definitive care to people quicker?”
Transfusions are at the forefront of that evolution, and New Orleans has historically sat at the forefront of trauma treatment, Lewis said.
“Trauma is our specialty because this city is af—ing war zone,” said Sherman, the EMS captain. But she can’t imagine doing any other job, and the blood program has amplified her favorite part of her work.
“Saving a life is a high you can’t replace,” she said. “We save lives like baristas sling coffee out here.”