Blog of Bloodworks Northwest

"Transfusions in the Field Part 1: Dr. Michael Sayre, Harborview Medical Center" (S3 E32)

Ever wonder what happens to your blood once you donate? Well, as Bloodworks 101 producer John Yeager found out, sometimes it goes to the front line where seconds count in the battle between life and death.

Today, in the first of a special two-part series about Transfusions in the Field, you’ll meet Dr. Michael Sayre from Seattle’s Harborview Medical Center who plays a crucial role in making sure your blood get to where it needs to be. Listen to the episode here and transcript below.

Dr. Sayre: Can you hear me okay?

John: I got you loud and clear. So could you tell us who you are and what you do?

Dr. Sayre: Yeah. My name’s Michael Sayre, and I’m an emergency physician at Harborview Medical Center in Seattle and also the medical director for the Seattle Fire Department and its Medic One program.

John: So what we’re talking about Michael is a trend across the country involving transfusion in the field, right?

Dr. Sayre: Yeah. So about August of 2018 or so, we were approached by John Hess, who’s the director of transfusion medicine at Harborview who suggested to us that it might be possible for the paramedics to be able to get whole [inaudible 00:01:37] blood. And this was pretty exciting for us because we had seen evidence from use in the military that whole blood could really be lifesaving, but the logistics and the supply really were the barriers to fully implementing. And it took a year but we got it done. And so in late August of 2019, the paramedics were ready to go. And we’ve been going ever since.

John: Tell me how it works. Who’s involved with all of this. It’s a coalition, it’s not just one organization.

Dr. Sayre: It certainly isn’t. So we have a large group of people that are involved in this. So important components includes the blood bank [SP] at Harborview, which is the Level 1 trauma center in Seattle. And they helped us learn what the supplies we needed were, the EMS system needed to devote a person who in our case is a paramedic supervisor who takes responsibility for the blood. They check it every day. They make sure to…they’re the ones who make sure it stays cold and at the right temperature and check the temperature and make sure it’s all kept at the proper temperature.

And then they bring these small coolers that look a bit like a cooler you’d put a six-pack of beer in, only they’re fancier. And they bring that with them whenever they leave the station in case they get a call. And then there’s the Bloodworks Northwest that has done a terrific job in making sure that we have access to the bags of blood that go in these coolers.

John: You know what, I don’t think people, I guess, nor should they really understand how difficult this all is to put together. It just has to be there when it’s needed.

Dr. Sayre: Yeah. So this blood when we get it is fresh. It’s been donated recently. And it’s kept in the cooler at a temperature that’s pretty close to about 34, 35 degrees Fahrenheit. So it doesn’t freeze and it doesn’t, you know, get too warm. So it doesn’t spoil and this blood is kept up to a week. Sometimes we go a week without using any blood, in which case, we turn it back into blood bank at Harborview and it’s used on a different patient in the building. So we’ve wasted close to zero units of blood during the almost three years we’ve had this program.

So it is a pretty amazing thing to work to watch happen and the amount of organization effort that goes into it is significant, but I think now it’s just part of doing the job.

John: So tell me, we’re talking life and death stuff, do you have any stories that you can share with me about, you know, how it made a difference in that golden hour?

Dr. Sayre: Yeah. I think one of the early patients that we had really illustrates how this works. So this was someone who had been shot in the groin and was bleeding to death from his femoral artery, the big blood vessel that takes blood into his leg. And as is often the case in gunshot wound situations, the police go in first because they gotta make sure there’s no one that’s gonna shoot the firefighters and the paramedics and took care of that problem. And then the police then turn their attention to the victim, the person that’s been shot and they put pressure on the groin to control the bleeding, put a tourniquet on the leg.

Meanwhile, the paramedics were arriving and were able to…you know, this guy had really bled a lot, even in this maybe five, six, seven-minute period from when he got shot, there was a lot of blood on the ground around him. But the good work of the police officers to control the bleeding was step one. And then we had to replace the blood that had been lost. So the paramedics were able to establish an IV, get the blood out, get it hooked up all while moving the patient up to their paramedic unit.

And we have a warmer, so this blood’s kept in this cooler, but we don’t wanna give it to the patient cold because it doesn’t work very well when it’s cold. So we have a warmer that’s battery-powered that warms the blood without slowing down the flow rate so the blood’s given quickly and it’s warm when it hits the patient. So they were able to get all that done in the middle of downtown Seattle and deliver this blood unit into the patient before they even arrived at Harborview.

And the patient then needed surgery to fix these holes in his femoral artery. And a few days later was able to get discharged home. So I’m not sure any of that would’ve happened but for this blood. I mean, it’s hard to know for sure. But it sort of felt like to me like this strategy really worked and helped saved his life.

John: Do you have any numbers that you share with people about how successful it’s been or how many patients have been saved because of this?

Dr. Sayre: Yeah. As of today, I believe, I’m just checking, double-checking the numbers, I think we have about 120 patients that have gotten blood in Seattle that we’ve also expanded the program outside Seattle into the suburbs of King County. So there’s more patients outside Seattle, and I don’t have the numbers at the tip of my tongue on that. We’re currently measuring to see exactly what the impact has been. The most thing we’re gonna be able to say is that we’re able to start the blood [inaudible 00:07:17] significantly earlier.

It takes time to drive to the hospital, takes time for even after you get to the hospital for things to happen. And we’re carefully measuring to say, okay, you know, how much time did we save between when the blood would’ve gotten started at the hospital versus when the paramedics were able to start the blood. And I’m pretty confident that we’re doing it faster than it would’ve happened in the hospital. I’m not sure yet how much faster.

John: So across the country, this is new technology. It’s a new use of, you know, just the basics that we have in front of us. We have helicopters and we have mobile units. This is relatively new across the country though, isn’t it?

Dr. Sayre: It is. There’s whole-blood strategy that we adopted in 2019. We learned a lot from our colleagues in San Antonio. They had the program before we did. They had learned from their military hospital that’s right there in San Antonio how to do this. And the military doctors were really pushing it in San Antonio. So we borrowed many of their guidelines about how to do this, learned a lot from them. We also had experience working with Airlift Northwest in the coolers and they were carrying blood products. They were carrying packed red blood cells and plasma, their whole blood is divided into different components.

But we have reason to think that the whole blood all put together is better than the components are split apart. So, you know, learning how to do the whole blood and get the whole blood was key and that Bloodworks Northwest was able to supply the whole blood is unusual. There are many blood banks in the country that are not able to do that even now three or four years later. So there are more programs today than there used to be, but it’s still not common across the U.S.

John: And I keep thinking that the American Red Cross called this the worst blood shortage in the last 10 years. And there’s a platelet shortage across the country, and yet you need both of those things to save those people when seconds count, right?

Dr. Sayre: Yeah. So one of the things that we are looking to measure with our program and that we hope is true is that by giving the blood early, we actually can make better clots form in the holes that the patient has and that maybe eventually, they actually need less total blood. So we hope that by giving blood early and giving whole blood early, that has really good clotting ability that will actually save the blood banking system the use of blood in general because we’ll have patients that then need fewer units of blood later in their course. So we’re optimistic that this program actually helps address some of the shortage.

John: Is there anything you’d like to advocate for, any kind of message you’d like to get across, you know, when you talk to people about this?

Dr. Sayre: Well, one message is that we need O-positive blood for this program. That’s the universal donor blood that we’re able to use. O negative is the true universal donor, but that is in such short supply that we can’t get that. So we use the RH positive, the O positive blood, and it works great. We have a strategy to work through a problem if we have a young person who is type RH negative to mitigate the risk in that individual.

But, you know, you have to survive to have that problem. And by getting this blood in early, we’re able to make that happen. So if there are people out there that are type O and particularly type O positive, we would love to have them donate and to help us address this blood shortage.

John: And as you know, you know, I’m involved with outreach to media all the time, and that is the one type of blood that, you know, we’re right at critical. We’re just above the treetops many weeks. And in your case, that’s what you really need.

Dr. Sayre: It is because we don’t have any way to know what the person’s blood type is. And even if they tell us, we really can’t believe them and like, what if they’re wrong? And then they would get the wrong kind of blood and that would be bad. So we have to assume that we know nothing about their blood type and just give them O positive, plus we can’t really carry more than that. We don’t have rooms. We can’t carry a whole blood bank supply with us. We have one little cooler that has two bags of blood in it.

John: But, you know, tell the guy that, tell the woman that whose life was saved, there’s 120 right there. Tell him that that’s all you got, but they made it because you guys had it.

Dr. Sayre: Yeah. I think, you know, there’s certainly patients that have died. I mean, we’re not gonna…there are some people that have just lost too much blood and there’s nothing that you can do, but we make the effort, right? We’re giving them a chance to survive. And I think we are making a positive difference, I’m sure.

John: Anything else that I haven’t asked you that you feel is important to add at this point?

Dr. Sayre: Well, I just wanna thank [inaudible 00:12:29] donated the blood to date. We appreciate your making the effort to come and do that.

John: Could you start that again? There’s a little bit of a phase shift, so if you could start that answer again.

Dr. Sayre: We really wanna thank donated blood and the blood that we’ve used has made a difference. And so we appreciate the effort that they put into coming to donate. And so thank you.

John: And thank you for your time. I appreciate it.

August 17, 2022 2:49PM

Tell Us What You Think!