EMS Volunteers Beg For 'Life-Saving' Blood On LI Ambulances, Medevacs

LONG ISLAND, NY — A group of dedicated emergency services volunteers are working tirelessly to advocate for a new measure that could save countless lives: The North Fork Volunteer Firefighters Association has galvanized to shine the light of awareness on how transporting whole blood by ambulance or Medevac helicopters can mean the difference between life and death.

Transporting whole blood directly to the scene can be a game-changer across the board, health professionals have said: "Early blood administration by Emergency Medical Services (EMS) to patients suffering from hemorrhagic shock improves outcomes," the National Institutes of Health wrote.

A study by the JAMA Network showed that whole blood transfusions in trauma patients led to increased odds of survival not just in the 24 hours after the incident but in the 30 days beyond.

In 2021, New York State Governor Kathy Hochul passed legislation green-lighting the ability of rescue helicopters, or air ambulances, to carry blood.

That landmark decision came after Travis Flanagan was severely injured upstate in a farming accident. He was airlifted in an air ambulance based in Pennsylvania, which was allowed to carry blood, when those in New York could not.

New York, officials said, was the last state in the nation to adopt the ability for helicopters to carry blood.

On September 18, 2024, Hochul passed new legislation allowing ambulance services and advanced life support first response services to store and distribute blood and initiate and administer blood transfusions.

Uniformed EMTs, Paramedics & Inspectors-FDNY President Oren Barzilay said, of that measure: "Giving us the ability to carry whole blood on many of our ambulances and do transfusions in the field has been proven to save lives when seconds count."

Howard Waldman, who has served for decades as a volunteer firefighter and a member of the North Fork Volunteer Firefighters Association — the oldest firematic organization on the North Fork, encompassing Riverhead and Southold towns — is sounding the cry in Suffolk County for whole blood to be administered pre-hospital.

"We're talking about making a difference in trauma victims all across Suffolk County," he said.

Whole blood transfusions in the field have led to success stories nationwide, he added: One woman lost her leg in a motorcycle accident but was saved, he said. "She was bleeding out. She never would have made it to surgery," Waldman said.

His son, Cameron Waldman, an attending physician in the Department of Emergency Medicine with the Albany Med Health System, also discussed the successes, including one fire chief's young daughter in Florida who survived due to whole blood administered at the scene.

Despite the benefits, only about 1 percent of the country is utilizing whole blood out in the field, Waldman said, adding that if it were more widely embraced, tens of thousands of lives could be saved.

According to a post by NBC, currently, 99 percent of rescue operations nationwide don’t stock ambulances and helicopters with blood — meaning thousands bleed out each year from injuries they might have survived, according to those in the medical field.

Cameron Waldman came to Long Island recently to plead for action with his father; both spoke before the Suffolk County legislature to try and garner support for the life-saving mission.

Cameron told Patch that while there have been logistical hurdles to overcome, including how to maintain blood temperatures and adhere to blood standard regulations, the measure, "Makes sense. From our experience, it has been a really, really good intervention to have in a pre-hospital setting. I have seen it save lives."

Through his work in Albany, where emergency responders must travel long distances to reach trauma centers, Waldman said the ability to utilize whole blood at the scene has been invaluable.

"We've all seen firsthand how it has definitely helped patients in the field. One patient, who was involved in a really bad motor vehicle accident, came to us after having gotten blood in the field. It was definitely a situation where if the patient hadn't gotten that blood, they would likely have died before they got to us."

He added: "Medical intervention in a trauma situation can be complicated but in some ways, it's simple: If you have low blood pressure and are unstable due to trauma, the intervention is to get blood as soon as possible. These patients in trauma settings need blood, quickly. It just makes sense that intervention happen in a pre-hospital setting."

Cameron Waldman said two of his colleagues, Luke Duncan, an emergency and critical care physcian an Albany Medical Center, and Mike Dailey in Albany, have also been advocates for seeing the whole blood on rescue helicopters.

"Patients with blood loss need blood — not saline or salt water," Dailey said. "Blood is life-saving therapy for our trauma patients."

He added: "We must find ways to work together across a county or a region to assure that our patients can get the blood they need, but we protect the rare resource at the same time. Every EMS agency agency cannot carry blood — it must be a collaborative effort directed by the EMS physician leadership of the trauma centers."

And, said Dailey, blood donation at every opportunity is critical to ensure the resource for patients is available.

"The keys to this are collaboration, oversight, and assuring no waste of the blood. There are great models out there to emulate," Dailey said.

Duncan added that in the upstate region, where there is a "huge amount of ground to cover" for emergency responders trying to reach a trauma center, having blood at the scene makes all the difference.

He agreed that patients need blood, not fluids, in a trauma situation, because blood carries oxygen.

Those who receive blood in ambulances or on emergency aircraft see improved outcomes, he said.

But New York, which saw the ability to adminster blood in the field green-lighted far behind other states, has to catch up, and there are regulations that make it often a "huge lift," he said. In his area, while the ability for paramedics in ambulances to administer whole blood transfusions has been approved by Hochul, the actual implementation still needs to be rolled out in many instances, he said.

"We have to figure out how to operationalize it," he said. "There are plenty of systems that exist, we just have to do it."

What needs to take place, he said, is the training of thousands of paramedics, as well as efforts to ensure blood is not wasted and is folded back into the blood supply if not used, within the 28 days of its shelf life. Also, Duncan said, there is a need for blood sharing agreements, and other "big system issues" that need to be navigated.

But the end results are life-changing, he said. "Getting patients blood actually improves their outcomes," he agreed.

Cameron Waldman said coordination with private entities, as well as blood banks, EMS, hospitals and others is key. "A good amount of coordination has to happen between several different agencies for a pre-hospital blood program to be successful," he said, adding that training an EMS crew is also critical.

"In the places that it’s been rolled out it, it just seems like the solution — where you are actually having results and saving lives. In the world of medicine interventions, those that are simple and work — those are the ones we really, really love."

He added: "I know there are logistical issues and understand that, but the motivation to get it done is important. This is one intervention that saves lives. In a trauma situation, from a medical standpoint, you need, blood, blood, blood."

On Long Island, Howard Waldman and his son appeared before the Suffolk County Legislature in recent months to plead for change.

But, so far, Suffolk County is still weighing the decision, with both Stony Brook Medicine and Suffolk County Police necessary in a collaborative effort to see the vision become reality.

Stony Brook Medicine officials spoke to Patch: "As a leading integrated healthcare system, Stony Brook Medicine is committed to working with organizations to provide the highest level of patient care to address the health needs of the Long Island population that it serves. As a Level I Trauma Center, we applaud the New York State legislative decision to provide pre-hospital blood. We await regional discussion, approval and guidance from Suffolk County. With this in mind, our healthcare system and Stony Brook University Hospital's blood bank have begun to develop a review of an internal process to evaluate carrying and administering blood pre-hospital and ensure supplies are readily available utilizing properly trained staff. "

Suffolk County Police said they were unable to respond.

Michael Martino, communications director for Suffolk County Executive Ed Romaine, told Patch: "The county executive has always pledged to make Suffolk County safer and will provide law enforcement with all of the tools necessary to help them save lives."

Suffolk County Legislator Dominick Thorne of District 7, the chair of the Suffolk County legislative committee of fire rescue and emergency services, outlined the steps needed before the idea of whole blood on rescue helicopters and ambulances could become a reality

"You would need the doctor that writes the prescriptions for EMS to write that prescription," he said.

Thorne agreed: "Blood is the only thing that carries oxygen." IV fluid, which is given in trauma situations now, "does not have the capability to carry oxygen."

Thorne said in areas such as Albany, where there is a great distance between only three trauma centers, the blood is critical; in Suffolk County, he said, there are several trauma centers scattered in close proximity to most trauama situations.

However, he pointed out, in areas such as Fire Island or on the East End, "it becomes tricky," just as it does in situations where there are prolonged extrication times. "In those cases, at the end of the day, how are we going to keep them alive to cut them out of the vehicle? Those are the areas, and the cases, where it would be beneficial."

Thorne, who said he has 27 years of EMS history, added that he is "imminently familiar with the needs and the risk benefit."

Next steps would include having the measure cleared regionally through the Regional Emergency Medical Servicess Council. Once that happens, the next challenges would include handling the logistics of how the blood will be stored and the "chain of custody of the blood."

Stony Brook Medicine already is a licensed emergency blood transfusion center, he said; the blood then would be transported to trauma scenes on Suffolk County police ambulances or medevec helicopters.

But blood temperature and storage must be considered, he said. "This is not lidocaine or Narcan. You can't leave it in the box, it has to be specially stored at the right temperature."

Thorne added: "The overall plan of having blood in a pre-hospital care environment is not a bad idea, when you get through all the logistics."

He also said that legislative approval on the county level is not needed; as New York State has already given the okay. "We just have to decide regionally if it makes sense to us."

The only legislative action needed would be in authorizing the contract with the SCPD, which operates the helicopters, he said.

As it stands, Thorne said there is an "ongoing conversation" between Stony Brook Medicine, which supplies paramedics to Suffolk County Police headquarters, "about whether it is or isn't beneficial. And secondly, what are the logistics that have to be worked out. I wouldn't not be in favor of this — I'm always in favor of more care than less."

Suffolk County Legislator Catherine Stark, within whose district the North Fork Volunteer Firefighters Association operates, said she was moved by the testimony by both Waldman and his son. "It sounds like an incredible, life-saving opportunity," she said.

She added that the idea was already under consideration by Stony Brook and SCPD.

When the Waldmans spoke before the county legislature, Stark said she was moved. "I would support it," she said. "Several legislators all support this. I didn't see anybody that didn't support it."

The examples she heard about lives saved, she said, "were really incredible stories".

Stark added: "Any effort that we can take to support local ambulances to save a life, to me, it's a no brainer."