Blood on Board
Stanford Life Flight Adds New Resuscitative Capability

Marty Herman chose the middle of the day to return his son’s Harley Davidson motorcycle to his home across town. It’s when traffic is lightest on Highway 1 in Santa Cruz. But just blocks from home, Marty was struck by a motorist who failed to see him crossing an intersection. His right leg was crushed between his bike and the oncoming car. It was nearly severed and gushing blood from an arterial bleed.

Drawing on safety training he’d learned as a heavy equipment operator, Marty grabbed his thigh and coached nearby bystanders to pinch his leg and apply a tourniquet using just a t-shirt. “I remember telling them, as tight as you can, as tight as you can,” said the 60-year old former Granite Rock foreman. Marty was taken by ambulance to a nearby helipad where he was met by Stanford’s Life Flight team. During the 18-minute flight to Stanford, Life Flight nurses transfused Marty with two units of O negative blood. When he arrived at Stanford’s Emergency Department, he was transfused with two more units of blood.

“That blood saved my life,” said Marty, who spent eight days at Stanford Hospital after two operations—one to remove his right leg which was too severely damaged to function, and one to repair his left leg, which was also crushed.

On April 16, Life Flight became the only air medical program in California to carry blood products on every flight. That new capability may have been the difference in Marty’s recovery, and possibly his life, said Michael Baulch, RN, Program Manager, Stanford Life Flight. Stanford created its program using tested protocols developed by medical units in the military. Studies showed that survival rates were much better for soldiers injured in battle who received blood transfusions in the field, said Baulch. “We realized there’s something better we could be doing for our trauma patients.”

Stanford Life Flight now carriers two units of O negative blood, the universal donor, and one unit of plasma. Every morning, the Life Flight crew swaps out its supply of blood with Transfusion Services to ensure that the blood aboard the helicopter is viable, and that unused blood can be used for inpatients. Flight nurses use a small device that fits over the tubing to warm the blood as it is being rapidly transfused. And blood products are kept stable using temperature-controlled boxes.

“Bleeding and hemorrhagic shock are a frequent cause of death before reaching the trauma center,” said David A. Spain, MD, FACS, the David L. Gregg, MD Professor and Chief of Acute Care Surgery, and Medical Director for Trauma at Stanford. “Being able to administer blood in the helicopter will extend trauma care to patients before they reach our emergency room. This is a major advance for our Life Flight program and effectively extends our trauma care to the entire Bay Area.”

In the past, patients who experienced severely low blood pressure due to loss of blood were treated with IV fluids. While fluid resuscitation can stabilize a patient, being able to resuscitate with oxygen-carrying blood is a better option, said Baulch.

“Blood is such a necessary part of any transport or trauma service,” said Flight Nurse Emily Otto, RN, a former Navy nurse who served in Afghanistan. Otto cared for Marty with fellow flight nurse Randy Hough, RN. “If we hadn’t been able to give him blood products, his outcomes would have been much worse. His blood pressure was so low for so long that he may have gone into organ failure. Being able to give blood in a timely, effective manner is just truly life changing, especially for this patient.”

Since launching the program, the Life Flight team has administered in-flight transfusions to three trauma patients, all of whom survived.

“When I think about the possibilities of what could have happened, it brings tears to my eyes,” he said. “I’m still able to hug my wife, see my kids and enjoy my new grandson. Everything was in my favor that day. I am just so lucky to be alive.”