More evidence for prehospital transfusion? A very timely paper on prehospital transfusion, with all of the recent conversation around SWIFT. This study compared WB to PRBC’s across 9 prehospital transfusion programs in the US. Note the difference in mortality between UK HEMS study and US ground EMS: 27% vs 12.7%. Prehospital time in SWIFT 67 minutes vs median 23 in the US study (34 min total from 911 call to ED arrival!). WB associated with lower in-hospital transfusion requirements and improved survival for blunt injury patients, with a trend toward improved survival in the total cohort. Key lessons learned from this paper: 1) prehospital transfusion is possible and effective in ground EMS agencies, even with short transport times 2) whole blood may be better, particularly for blunt injury 3) earlier resuscitation for hemorrhagic shock improves outcomes (which may be why neither SWIFT nor RePhill showed any difference) 4) availability of whole blood should not be the rate limiting step in getting a prehospital transfusion program started pubmed.ncbi.nlm.nih.gov/4156…

Prehospital blood is increasingly common. Is permissive hypotension in trauma a thing of the past? @JakeBroome @SydneyCaputo @markpiehl #WTA2026

Is the Surviving Sepsis Campaign fluid recommendation of 30mL/kg safe & effective? Turns out it is. Not every patient with sepsis may need 30mL/kg, but for septic shock (SBP < 90 and/or lactate >4), 30mL/kg by 3hrs is associated with lower mortality and less mechanical ventilation. And 20-30mL/kg in the 1st hour may be the optimal volume and timing for these patients. Check out our observational study of 1600 patients @WakeMed here: journals.lww.com/ccejournal/… #sepsis @SCCM #CritiCareExplore

Thank you @DrJeffJarvis for a thoughtful review of our Faster Refill paper! You do make some fair points about potential methods improvements while acknowledging the strength of the results, which are the first ever to show a trauma survival benefit for blood in urban EMS @HandtevyMD @JakeBroome

The @dcfireems team under the leadership of Holly O’Byrne and @EMSPhysician David Vitberg has saved many lives, again disproving the myth that urban agencies with short transport times shouldn’t carry blood. This will be an incredible webinar!

Exactly @HandtevyMD! This paper nicely addresses Myth #1 in the prehospital trauma debate: we are too close to the trauma center to bother carrying blood. Well, the data here show that for penetrating trauma with hemorrhagic shock, every single minute of delay in starting blood (and delivering an adequate volume to reverse shock) increases mortality by 11%. We don’t magically start effective resuscitation the minute a patient hits the trauma bay doors, therefore our EMS colleagues can do a whole lot of good getting that resuscitation started closer to the point of injury!

Our data suggest that prioritization of prehospital transfusion improves survivability in patients with severe hemorrhage despite a modest increase in transport time. @Tulane_Surgery @MarkPiehl @JakeBroome journals.lww.com/jtrauma/abs…

Thanks @FireMedic40NJ it was a total privilege to join Mike Carunchio and @HandtevyMD on Okayest Medic! We discussed the recent @AcademicEmerMed article suggesting there isn’t enough evidence for blood in ground EMS, and our editorial challenging the authors. onlinelibrary.wiley.com/doi/… onlinelibrary.wiley.com/doi/… If you can’t access our letter, here’s the basic summary: Schoenfeld & colleagues analyzed three RCT’s on prehospital blood including: PAMPer - an air medical trial of plasma for trauma COMBAT - an urban EMS study of thawed plasma, and RePHILL - a UK air medical trial comparing blood products to crystalloid Only PAMPer showed some benefit during 40 minute transports, and in RePHILL resuscitation wasn’t actually started until about 50 min after EMS arrival. None evaluated the “advanced resuscitative care” package of blood, TXA, and calcium currently administered fast-paced ground EMS agencies, which is the new damage control resuscitation: immediate hemorrhage control where possible, basic airway support, and rapid hemostatic resuscitation with blood to reverse hemorrhagic shock en route, then advanced airway only when necessary after transfusion. Outcomes from @NewOrleansEMS, @dcfireems , Grady EMS, @TidewaterEMS, Orange County (Fl), Palm Beach County Fire Rescue, BSO, and so many others tell the story. Importantly, the Faster Refill study from New Orleans showed an odds ratio of 0.2 for mortality among patients who got blood, a huge survival benefit. We conclude our letter by countering the Schoenfeld, et al claim that there is still equipoise on prehospital transfusion vs the old standard of care. Many details still need some good research, but we know now that early transfusion in the field saves lives @SPARC2024

Does every meaningful clinical innovation really require an RCT before it's widely deployed, as Schoenfeld & colleagues suggest in their meta-analysis on prehospital transfusion for trauma? Our editorial questions the relevance of the studies they review and points to evidence, and to the recent experience of many urban and rural EMS agencies, supporting early resuscitation with blood closer to the point of injury. onlinelibrary.wiley.com/doi/… onlinelibrary.wiley.com/doi/… @HandtevyMD @ResusOne

I spy ⁦@LifeFlow__⁩ in action! D.C. medics save trauma victims with on-site blood transfusions - The Washington Post washingtonpost.com/dc-md-va/…

.⁦@HandtevyMD⁩ sets the example of why it is so critical to appraise the literature yourself. Ex: importance of inclusion criteria: recommendations for fluid resuscitation in peds shock based inappropriately study of children with malaria in Africa. #NAEMSP2022

Episode 34 of @littlebigmed is up! Taking a device from concept to commercial production with @markpiehl littlebigmed.com/medical-dev…

Yes thoughtful early fluid resuscitation still matters in #sepsis: lower mortality, shorter ICU stay, less intubation, especially in those who would seem to be at risk of complications: elderly, CHF, ESRD. Just like Leisman et al showed last year bit.ly/2lYnryr

Congrats to the folks at 410 Medical and Dr. @markpiehl 410medical.com/2019/03/27/tw…

kids that are big sick and need intubated to save them, in which intubation can also kill them, think deep sedation intubation (4mg/kg ketamine) HFNC, without paralytic @markpiehl #FAST19

Dr Mark Piehl @markpiehl fluid resuscitation in pediatric patients the pitfalls and the priorities. Heart rate is the warning vital sign. #FAST19

@HandtevyMD replaying the response to the Parkland shooting. Thanks for sharing the experience with us so we can learn from this horrible situation. #FAST19

#EMSToday2019: @paulbanerjee & Polk Co EMS dramatically improve pediatric cardiac arrest survival using @Handtevy, on-scene management, targeted training bit.ly/2txVy0u

Great talk on sepsis and resuscitation from true innovators who are improving pediatric care in the prehospital setting and beyond! Thank you for what you do! @markpiehl @HandtevyMD #EMSWorldExpo2018

Totally agree, but would add pearl #9: “resuscitate before you intubate” from awesome #RebelEM post rebelem.com/critical-care-up… Hypotension is the biggest risk factor for peri-intubation cardiac arrest, a small but truly rapid fluid bolus can fix that