PBCFR Blood Program Gives Time, Hope To ‘The Hopeless’

Emergency Medical Services Chief Charles Coyle (right) leads a PBCFR training session on using a whole blood transfusion. Photo courtesy Palm Beach County Fire-Rescue

Imagine glass and metal and plastic parts scattered, glistening under the moonlight on Seminole Pratt Whitney Road, Forest Hill Blvd. or out on an empty stretch of Southern Blvd. near 20-Mile Bend. There has been a crash, and you’re bleeding. Your heart’s beating fast, your blood pressure is dropping, and the nearest trauma centers are many miles, and too many minutes away in West Palm Beach and Delray Beach.

That’s when a new whole blood transfusion protocol implemented by Palm Beach County Fire-Rescue can make all the difference, the department’s Emergency Medical Services Chief Charles Coyle said.

“It allows us to give back a little time,” even as someone is being extricated from a crash or waiting for transport, said Coyle, a 20-year PBCFR veteran. “It gives hope to the hopeless.”

Among trauma patients, uncontrolled bleeding is the primary cause of preventable deaths, according to the American Association for the Surgery of Trauma. In fact, trauma is the No. 1 cause of death, period, in individuals 45 and younger.

Julian Martinez, a PBCFR driver/operator and a member of the Westlake City Council, said having whole blood available for serious trauma cases is an exciting step forward.

Since the whole blood transfusion program was made available in the western communities in February 2023, it has been administered some 14 times, according to PBCFR. The program’s area hub is Fire Station 28 at the corner of Royal Palm Beach and Okeechobee boulevards.

Because of the semi-rural nature of the area — especially throughout The Acreage and the Indian Trail Improvement District — and the considerable distance and time to a trauma center, the transfusions can be particularly critical and valuable, Coyle said.

While PBFCR cannot disclose exact outcomes due to privacy concerns, a study published in 2022 by the Journal of the American College of Surgeons showed that patients suffering hemorrhagic shock — severe blood loss — have a 60 percent better chance of 30-day survival post-incident when given whole blood as opposed to other protocols.

Whole blood has been used by the U.S. military for years in combat and other trauma situations, but it is still “cutting edge” among civilian first responders, Coyle said.

After extensive training and overcoming several legal and political hurdles, in July 2022, PBCFR joined the Broward County Sheriff’s Office Air Rescue as the only departments in Florida doing on-site or in-transport whole blood transfusions.

“It’s an overwhelming thing to take on,” Coyle said. “It’s a big thing to accomplish.”

Whole blood is natural blood that has not been separated into red and white cells, platelets and plasma. And in situations of serious blood loss, it’s far superior to the sodium lactate solutions often called for by actor-portrayed paramedics in movies and on TV, Coyle said.

Sodium lactate solutions don’t encourage clotting or transfer oxygen, he pointed out. “If you bleed blood, you should get blood,” Coyle said.

Here’s how it works.

One unit of whole blood is carried in special, refrigerated, temperature-controlled containers in the vehicles of the county’s six on-shift EMS supervisors and aboard each of the county’s two Trauma Hawk air-rescue helicopters, Coyle explained. The EMS supervisor on scene makes the call as to whether a transfusion is needed based on vital signs such as blood pressure and heart rate.

It all happens while the situation is in motion, noted Coyle, who has served as an EMS training captain, operational captain, lieutenant, flight medic and firefighter/paramedic. It might happen while someone is being cut from a shattered car, bleeding out from a gunshot wound or bleeding internally from some post-surgical issue and waiting for Trauma Hawk or on route via ground transport.

“We stabilize what we can and give them back a little time,” Coyle said. “It’s really making a difference in the community.”

If used, the units of blood are replaced quickly, he said. If the blood goes unused for 15 to 18 days, it’s also replaced.

“The logistics of [the program] alone are very labor intensive… and continuous training is required,” said Coyle who was, at one point, responsible for the continuous department-related EMS training of all the PBCFR’s 1,500 firefighter/paramedics.

EMS captains are now doing the whole blood training.

The possible life-or-death decision about whether to transfuse “is a lot to bear,” said Coyle, but after extensive training, it’s a responsibility that the seasoned paramedics that makes up the department’s EMS supervisors appreciate because they know it can save lives.