By Randy Royal
When Chelsea began having contractions late one evening last August, the first emotion she experienced was excitement for the impending arrival of baby No. 3. But soon, Chelsea began to worry that something was wrong. Her contractions were different from those she had experienced with her previous two pregnancies, and the pain was more intense, sharp and tearing.
Then she felt fluid. She first thought it was her water breaking but quickly realized she was bleeding vaginally. Chelsea tried different positions and techniques to try to slow the flow of blood, and reached out to her midwife. Chelsea sent a picture of the blood loss to the midwife, who told Chelsea to immediately call 911.
When the crew of Colorado Springs Fire Department (CSFD) Engine 11 – three EMTs and one paramedic – arrived on scene, they were taken aback at the amount of blood they found. Their first impression was that Chelsea was in critical and dire condition, and that both she and her unborn baby were on the verge of losing their lives.
An on-duty medical officer, Lt. Aaron McConnellogue, was contacted by the crew and quickly en route with potentially life-saving blood. Upon his arrival, McConnellogue also recognized the seriousness of the situation. Chelsea was pale and anxious, asking if she and her baby were going to die.
Without delay, whole blood was administered to Chelsea as she was being loaded into the ambulance, and care continued en route. Critical notifications were provided to the hospital during transport.
Upon arrival at UCH Memorial Hospital, Chelsea bypassed the emergency room and was taken directly to labor and delivery, where emergency care was continued, including the provision of additional blood. She then underwent an emergency C-section.
Chelsea was soon elated to hold her newborn daughter, Rosie.
The attending doctors shared that Chelsea had lost at least one-third of her blood volume, and that neither she nor her baby would have survived if they had not received blood in the field. They were amazed and thankful for the wonderful outcome in what could have been a tragic event. Chelsea was humbled and reflective when she learned that the blood that saved her would not have been available only a few months earlier.
CSFD’s whole blood program
CSFD began its whole blood program in May 2024. It was the culmination of a year-and-a-half-long effort that involved researching existing programs, developing policies and procedures, obtaining state medical waivers and getting the equipment needed to ensure the program’s success.
The teamwork among CSFD’s medical division staff, its physician adviser group and the UCHealth (UCH) nonprofit hospital system was key to getting this program off the ground. UCH provided the blood bank and support to enable a consistent supply of blood for the program, and the UCHealth Memorial Hospital Foundation generously provided the additional funding needed to purchase equipment to properly store, transport, reheat and transfuse the whole blood in the field. This was truly a community effort, and many community philanthropists embraced the vision and donated to the cause.
How it works
CSFD’s whole blood program equipment includes cooling and warming units, which keep the blood at 36 degrees while in the medical lieutenants’ vehicles. The unit can be safely warmed to 100 degrees in about six seconds when a transfusion is needed. Ultrasounds are used in certain cases to determine active blood loss. In the near future, every heavy apparatus will carry ultrasounds so crews can quickly make that determination.
The blood is obtained through a partnership with the UCHealth blood bank, which replenishes our stock after each call. The blood itself is whole blood, meaning it includes red and white blood cells, plasma and platelets. Low titer Type O blood (“universal donor blood”) has low levels of antibodies, making it safe to transfuse to a patient with any blood type.
Patients receive blood from the initial crew on scene and one of our medical lieutenants, who oversee our paramedics in the field. These lieutenants carry the blood and needed equipment and are a 24-hour mobile resource. They monitor the radio and respond when a call has a potential need for blood. Also, if a crew arrives on scene and determines that their patient could benefit from a blood transfusion, they can call and request a medical lieutenant. Transport is never delayed waiting for blood to arrive. If an ambulance is on scene, the patient will be loaded and head to the hospital. If necessary, the medical lieutenant will rendezvous with the ambulance en route, jump in the rig, and provide blood. Our goal is to further expand access to this needed treatment in the future.
Why it matters
Dr. Matt Angelidis, co-chief CSFD medical director with Dr. Stein Bronsky, said, “Hemorrhagic shock – bleeding to death – is the leading cause of death for people age of 45 and under, and we know that upward of 40% of these patients could survive with immediate blood transfusion in the field. First responders bringing blood to the scene of an injury will save lives. I have sat in too many after-action reviews where firefighters and first responders tearfully ask what they could have done differently, knowing if they could have transfused blood the outcome might have been different.”
Some additional facts that motivated CSFD and UCH to move forward with this project:
- Uncontrollable hemorrhage is the No. 1 most preventable cause of death in the U.S.
- There is a 20-fold increase in survival benefit when blood is given in less than 34 minutes.
- In Colorado Springs, one patient bleeds out every 48 hours.
- There is a three-fold increase in long-term survivability in the first 30 days post incident.
Additionally, the American College of Surgeons held a press conference last fall to emphasize the positive impact of more whole blood availability in the field. It was reported there that the mortality rate for hemorrhagic shock is 70%, and with the ability to provide this treatment in the field, at least 10,000 more lives could be saved each year.
Seeing these benefits, CSFD sought to bring the program to fruition with the steadfast efforts of our physicians, medical division staff and community collaborators. And the work has paid off. In our experience, a wide range of patients have benefitted from the whole blood program, including those in hemorrhagic shock from shootings, stabbings, traffic accidents with and without ejection, falls and various other multi-system trauma situations. Patients with GI bleeds and labor and delivery complications, like Chelsea, have also benefitted from the program.
Paying it forward
An initial step in getting the CSFD program off the ground involved reaching out to the San Antoino Fire Department in Texas, which began its whole blood program in 2018, to learn from their experience. This included a site visit, where our staff met with San Antonio’s staff and medical directors, and attended an academy that provided further training. Staff from our UCHealth blood provider, Vitalant, also attended. This was invaluable to our success and is reflective of the benefit of collaborating with our fire and EMS partners.
When we initiated our program, there were a few others providing similar care, including Palm Beach, Florida; Howard County, Virginia; and Orange County, California. Others have since come on board, including Washington, D.C.; Canton, Massachusetts; and Crawfordsville, Indiana. It should be noted that the Canton and Crawfordsville agencies are smaller than the others listed, underscoring that these programs benefit all communities. In fact, the American College of Surgeons said these programs are even more essential in smaller and more rural communities.
Impact in Colorado Springs and beyond
This treatment regime has been used by the military since 1917, but fewer than 2% of departments, including fire, EMS and flight programs, currently carry whole blood. Raising that percentage should become a priority across the nation.
Here in Colorado Springs, we are elated at the success of this program and the positive impact it is having on the public safety of our community, the lives already saved and those that will be saved in the future. As of the last data drawn, we have provided 72 units of whole blood in the field to 63 patients. Forty-three of them were able to walk out of the hospital. This is an additional save rate of about 68% based on survival rates for these types of incidents. We also have seen a 60% increase in 30-day survival. Another benefit: The UCHealth blood bank has had to dispose of fewer units of blood each month – from 13 to 20 units wasted each month to 6 or 7 since the program started.
We have had many more incredible stories of our patients that were in a critical state and now can continue with their lives, much like Chelsea. The future of the CSFD whole blood program is looking “Rosie” for years to come!
About the author
Randy Royal is the fire chief for the Colorado Springs (Colorado) Fire Department. Royal has been a member of the department since 1987 and has worked in emergency services for more than 40 years. During his career, he has been involved in many CSFD programs and projects including the initiation of the tactical emergency medical program, working in the early hazmat and tox-medic programs, managing the medical division, helping develop the awards and recognition program, chairing the department’s rebranding committee, and leading the pandemic taskforce. Royal has been recognized over his career with numerous awards, including two Medals of Distinguished Service and the Firefighter of the Year award. He was also named the IAFC Fire Chief of the Year (Career) in 2024.