U of A study tests giving blood to trauma patients before hospital

For Tucson and communities across Arizona, a new University of Arizona led study could determine whether trauma patients who are losing blood need transfusions before they arrive at a hospital, even when the ambulance ride is only a few minutes. The project will train participating paramedics to administer blood products at the scene of an injury or during ground ambulance transport, then compare that care with the current use of crystalloid fluids, such as saline. Researchers want to learn whether giving blood sooner can prevent deaths from traumatic hemorrhagic shock, a medical emergency caused by rapid and massive blood loss.

The U of A has been approved for $30.6 million in research funding from the Patient Centered Outcomes Research Institute, or PCORI, a nonprofit organization that supports comparative clinical effectiveness research designed to help patients and caregivers make informed health care decisions. The award remains subject to PCORI’s business and programmatic review and the issuance of a formal award contract. If completed, the project will run for more than six years and include nearly 2,000 trauma patients treated by more than a dozen participating emergency medical services agencies.

The university will work with the Arizona Department of Health Services to evaluate the safety and effectiveness of prehospital blood transfusions across the state. Dr. Joshua Gaither, a University of Arizona emergency medicine professor and co principal investigator, said the study will include advanced training for selected paramedics. The initiative represents a new addition to the responsibilities of participating paramedics in Arizona, although some EMS agencies in the state and elsewhere already provide blood before patients reach a hospital.

The central question is especially important in urban areas, including Tucson, where a trauma patient may be only minutes from hospital care. Prehospital blood transfusions are used by some ground ambulance systems, air medical services and military emergency teams. They have also shown benefits in situations where injured people are far from a hospital. But it is less certain whether the same approach improves survival when transport times are short. Gaither described the issue as a practical question: If a patient will receive blood at the hospital five minutes later, can providing it in the ambulance during those minutes save a life?

Researchers will compare blood or blood components administered before hospital arrival with standard treatment using crystalloid fluids. Saline and similar fluids can help support circulation, but they do not replace the oxygen carrying capacity of lost blood. The study will focus on outcomes for patients in traumatic hemorrhagic shock and examine whether earlier blood administration reduces deaths and other effects associated with severe blood loss. Chengcheng Hu, a professor of biostatistics in the U of A’s Mel and Enid Zuckerman College of Public Health and the project’s other co principal investigator, will lead the analysis of the study data.

Gaither said bleeding is the most common cause of death after trauma, making blood transfusion an intuitive treatment for patients who have lost large amounts of blood. When blood loss becomes severe, the body can enter a worsening cycle in which circulation declines, organs receive less blood and additional damage develops. Giving blood earlier could help restore circulation, improve the delivery of oxygen to organs and reduce the damage caused by that downward spiral. The researchers will assess whether those potential benefits translate into better survival in everyday ground ambulance care.

At the same time, the program must account for the limited availability of blood. Gaither said there is not enough blood to place supplies on every ambulance throughout Arizona, which means the state needs evidence about where it can be used most effectively. One goal of the initiative is to help determine whether blood should be kept primarily at hospitals, carried by selected EMS units, or distributed according to the circumstances of a particular community. The study will also examine safety as the approach expands across a large statewide population rather than remaining limited to specialized teams or remote areas.

Severe hemorrhagic shock is uncommon among ambulance calls. Gaither estimated that only about one in every 1,000 cases handled by paramedics would require a blood transfusion. That rarity makes it difficult for individual EMS agencies to determine on their own whether carrying blood is worthwhile, especially when they must weigh storage, training, supply and transportation concerns. By involving more than a dozen agencies and almost 2,000 patients, the U of A and state health officials hope to produce evidence that reflects real world care rather than results from a narrow hospital or military setting.

The project builds on the U of A’s existing work in emergency medicine and public health, according to university officials. Senior Vice President of Research and Partnerships Tomás Díaz de la Rubia said the study is intended to connect the university’s emergency care expertise and research infrastructure with a question that has direct consequences for patients. PCORI Executive Director Nakela L. Cook said the project addresses an important evidence gap in ground ambulance care for traumatic hemorrhagic shock. For Tucson residents and other Arizonans, the eventual findings could influence paramedic training, ambulance equipment and statewide decisions about how to get a scarce but potentially lifesaving resource to trauma patients during the minutes before hospital care begins.