One August afternoon in 2023, Angela Martin\u2019s cousin called with alarming news. Martin\u2019s 74-year-old aunt had been mauled by four dogs while out for a walk near her home in rural Purlear, North Carolina. She was bleeding heavily from bites on both legs and her right arm, where she\u2019d tried to protect her face and neck. An ambulance was on its way.<\/p>\n
\u201cTell them she\u2019s on Eliquis!\u201d said Martin, a nurse who lived an hour\u2019s drive away in Winston-Salem. She knew the blood thinner could lead to life-threatening blood loss.<\/p>\n
When the ambulance arrived, the medics evaluated Martin\u2019s aunt and then did something few emergency medical services crews do: They gave her a blood transfusion to replace what she\u2019d lost, stabilizing her sinking blood pressure.<\/p>\n
The ambulance took her to the local high school, and from there a medical helicopter flew her to the nearest trauma center, in Winston-Salem. She needed more units of blood in the helicopter and at the hospital but eventually recovered fully.<\/p>\n
\u201cThe whole situation would have been different if they hadn\u2019t given her blood right away,\u201d Martin said. \u201cShe very well might have died.\u201d<\/p>\n
More than 60,000 people<\/a> in the U.S. bleed to death every year from traumatic events like car crashes or gunshot wounds, or other emergencies, including those related to pregnancy or gastrointestinal hemorrhaging. It\u2019s a leading cause of preventable death after a traumatic event.<\/p>\n But many of those people likely wouldn\u2019t have died if they had received a blood transfusion promptly, trauma specialists say. At a news conference<\/a> last fall, members of the American College of Surgeons estimated that 10,000 lives could be saved annually if more patients received blood before they arrived at the hospital.<\/p>\n \u201cI don\u2019t think that people understand that ambulances don\u2019t carry blood,\u201d said Jeffrey Kerby, who is chair of the ACS Committee on Trauma and directs trauma and acute care surgery at the University of Alabama-Birmingham Heersink School of Medicine. \u201cThey just assume they have it.\u201d<\/p>\n Of the more than 11,000 EMS agencies in the U.S. that provide ground transport to acute care hospitals, only about 1% carry blood, according to a 2024 study<\/a>.<\/p>\n The term \u201cblood deserts\u201d generally refers to a problem in rural areas where the nearest trauma center is dozens of miles away. But heavy traffic and other factors in suburban and urban areas can turn those areas into blood deserts, too. In recent years, several EMS agencies throughout the country have established \u201cpre-hospital blood programs\u201d aimed at getting blood to injured people who might not survive the ambulance ride to the trauma center.<\/p>\n With blood loss, every minute counts<\/a>. Blood helps move oxygen and nutrients to cells and keeps organs working. If the volume gets too low, it can no longer perform those essential functions.<\/p>\n If someone is catastrophically injured, sometimes nothing can save them. But in many serious bleeding situations, if emergency personnel can provide blood within 30 minutes, \u201cit\u2019s the best chance of survival for those patients,\u201d said Leo Reardon, the Field Transfusion Paramedic Program director for the Canton, Massachusetts, fire department. \u201cThey\u2019re in the early stages of shock where the blood will make the most difference.\u201d<\/p>\n There are several roadblocks that prevent EMS agencies from providing blood. Several states don\u2019t allow emergency services personnel to administer blood before they arrive at the hospital, said John Holcomb, a professor in the division of trauma and acute care surgery at UAB\u2019s Heersink School.<\/p>\n \u201cIt\u2019s mostly tradition,\u201d Holcomb said. \u201cThey say: \u2018It\u2019s dangerous. You\u2019re not qualified.\u2019 But both of those things are not true.\u201d<\/p>\n On the battlefields in the Middle East, operators of military medical facilities would maintain that only nurses and doctors could do blood transfusions, said Randall Schaefer, a U.S. Army trauma nurse who was deployed there and now consults with states on implementing pre-hospital blood programs.<\/p>\n But in combat situations, \u201cwe didn\u2019t have that luxury,\u201d Schaefer said. Medical staff sometimes relied on medics who carried units of blood in their backpacks. \u201cMedics can absolutely make the right decisions about doing blood transfusions,\u201d she said.<\/p>\n A quick response made a difference: Soldiers who received blood within minutes of being injured were four times as likely to survive, according to military research<\/a>.<\/p>\n Civilian emergency services are now incorporating lessons learned by the military into their own operations.<\/p>\n But they face another significant hurdle: compensation. Ambulance service payments<\/a> are based on how far vehicles travel and the level of services they provide, with some adjustments. But the fee schedule doesn\u2019t cover blood products. If EMS responders carry blood on calls, it\u2019s usually low-titer O whole blood, which is generally safe for anyone to receive, or blood components \u2014 liquid plasma and packed red blood cells. These products can cost<\/a> from $80 to $600 on average, according to Schaefer\u2019s study. And payments don\u2019t cover the blood coolers, fluid warming equipment, and other gear needed to provide blood at the scene.<\/p>\n On Jan. 1<\/a>, the Centers for Medicare & Medicaid Services began counting any administration of blood during ambulance pre-hospital transport as an \u201cadvanced life support, level 2\u201d (ALS2) service, which will boost payment in some cases.<\/p>\n The higher reimbursement is welcome, but it\u2019s not enough to cover the cost of providing blood to a patient, which can run to more than $1,000, Schaefer said. Agencies that run these programs are paying for them out of their own operating budgets or using grants or other sources.<\/p>\n Blood deserts exist in rural and urban areas. Last August, Herby Joseph was walking down the stairs at his cousin\u2019s house in Brockton, Massachusetts, when he slipped and fell. The glass plate he was carrying shattered and sliced through the blood vessels in his right hand.<\/p>\n \u201cI saw a flood of blood and called my cousin to call 911,\u201d Joseph, 37, remembered.<\/p>\n The ambulance team arrived in just a few minutes, evaluated him, and called in the Canton-based Field Transfusion Paramedic Program team, which began administering a blood transfusion shortly thereafter. The program serves 30 towns in the Boston area. Since the transfusion program began last March, the team has responded to more than 40 calls, many of them related to car accidents along the ring of interstate highways surrounding the area, Reardon said.<\/p>\n Brockton has a Level 3 trauma center, but Joseph\u2019s injuries required more intensive care. Boston Medical Center, the Level 1 trauma center where the EMS team was taking Joseph, is about 23 miles from Brockton, and depending on traffic it can take more than a half hour to get there.<\/p>\n Joseph was given more blood at the medical center, where he remained for nearly a week. He eventually underwent three surgeries to repair his hand and has now returned to his warehouse job.<\/p>\n Although Boston has several Level 1 trauma centers, the region south of the city is pretty much a trauma desert, said Crisanto Torres, one of the trauma surgeons who cared for Joseph.<\/p>\n Boston Medical Center partners with the Canton Fire Department to operate the field transfusion program. It\u2019s an important service, Torres said.<\/p>\n \u201cYou can\u2019t just put up a new Level 1 trauma center,\u201d he said. \u201cThis is one way to blunt the inequity in access to care. It buys patients time.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n