Clinton County EMS Moves Toward Blood Product Implementation On Ambulances Through New Partnership

Clinton County EMS is eyeing the implementation of blood products on its ambulances with a partnership with the Versiti blood bank to benefit trauma and medical patients in need of red blood cells and plasma in emergency scenarios aboard the transportation vehicle.

Clinton County EMS Director Steven Deckard approached the Clinton County Board of Commissioners on Tuesday to discuss the updates with bringing blood products to the ambulances of the EMS fleet. Deckard explained that the initial talks with local hospitals failed to yield results, but recent talks with Versiti proved promising for the department.

“Discussions with Ascension and IU Health have failed for the whole blood initiative,” Deckard said. “We’re currently exploring Versiti.”

Deckard continued to state that through the partnership with Versiti, the department will receive units of red blood cells alongside plasma to carry on the ambulances in the instance of an emergency requiring blood products. Deckard stated that while the partnership will not yield whole blood for utilization, the two components will aid in emergency medical scenarios despite the lack of other components of the blood.

“What I believe is going to end up happening in the next few weeks is we’ll start carrying two units of packed red blood cells and then liquid plasma,” Deckard said. “It’s going to be more cost-effective for us. We can’t afford the whole blood, and also we can’t be as good of stewards as we are expected to be because of the national shortage for it.”

In July 2023, Clinton County EMS moved toward becoming one of the only ambulance services in the state to hold blood products and, at the time of Deckard’s presentation, the only service to implement i-STAT equipment.

After receiving approvals from the Clinton County Council and Board of Commissioners in 2023, Deckard moved to implement blood products on emergency response vehicles alongside new supplemental equipment to better utilize the blood products. EMS received a delivery of a blood refrigerator with intentions to become a more impactful service between pick-up and check-in at the hospital. Deckard stated that transport times may require upwards of 45 minutes from rural areas to trauma centers, which could result in complications without the implementation of blood products on the ambulances.

“When we think of blood product administration, we all think of severely injured patients, but medical people need blood products too,” Deckard said. “We’ll be able to assess this in the field and aggressively resuscitate these patients.”

Deckard stated in early June 2023 that the EMS team was seeking to collaborate with IU Health to establish a trade system for the blood products. When the blood products near their expiration date, the EMS team can transfer the products to one of the IU Health hospitals for immediate use to not waste any blood products. Since talks with the hospitals fell short, the partnership with Versiti may provide a solution.

“Blood products are a precious item,” Deckard said. “You see requests for blood drives frequently, and we don’t want to be wasteful at all.”

Alongside the blood products, Deckard was approved to purchase i-STAT equipment intended to better assess the needs of the patient and determine whether the blood products are necessary.

Deckard stated that near the end of 2022, he received a call from one of his crew members requesting his assistance and interception of a patient experiencing symptoms stemming from unknown causes. Deckard attempted to formulate a solution over the phone but the team was unable to develop an effective course of action with the available equipment. Deckard intercepted the ambulance at the Mulberry station where he found the patient critically ill with extremely low blood pressure and heart rate readings. The team attempted to utilize different medications to increase the patient’s heart rate and blood pressure that were unsuccessful.

“We put the pads on the station, and we start beating the patient’s heart for them, and it’s still not working very well,” Deckard said. “We exhausted all of our efforts, and we can’t figure out why the patient is in this condition and what is going to be the effective treatment strategy. We get to the hospital, and within minutes, the patient goes into cardiac arrest and dies.”

Deckard stated that the hospital labs showed that the patient’s potassium levels were greater than 9. The normal range for potassium levels is 3.5 to 5, and levels greater than 6 could cause the patient to experience abnormal effects centered primarily around the heart. Deckard stated that the team was working efficiently to counteract the symptoms and save the man’s life, but due to the absence of i-STAT equipment, the team was unaware of the magnitude of the patient’s potassium levels, eventually leading to his death.

“I can just tell you that this piece of equipment is super important for us to have, but I don’t think that necessarily does it justice,” Deckard said. “That device would have told us in Mulberry, sitting on the side of the road, that this patient’s potassium was critically high, and we could have treated him more effectively and maybe potentially prevented him from going into cardiac arrest.”

Deckard was approved for the purchase of the equipment for $13,000 each, totaling $52,000 from the jail LIT fund and public safety fund in 2023. Council President Alan Dunn stated that the funds were in excess of $100,000, and the purchase of the equipment would still allow for the fund to continue to build back toward the excess amount for future projects.

“I want us to be an extension of the emergency department,” Deckard said. “I want us to be an extension of the ICU. I don’t want to just be a load and go transport to the hospital kind of service. This enables us to treat our patients significantly more effectively.”

The proposed partnership with Versiti is expected to allow for the department to utilize red blood cells and liquid plasma on its ambulances for emergencies, such as the emergency detailed by Deckard in 2023 from Mulberry.