Canada’s first pre-hospital blood transfusion trial could be a ‘lifeline’ for trauma patients
Dr. Brodie Nolan’s latest study takes scientific research into the air to bring hospital-quality care where it’s needed most for patients with traumatic injuries.
Nolan, a trauma physician and scientist at St. Michael’s Hospital, a Level 1 trauma centre, and physician with Ornge, Ontario’s critical care transport and air ambulance service, is leading the Study of Whole Blood in Frontline Trauma (SWiFT Canada). He is working in partnership with Ornge, Sunnybrook Health Sciences, Canadian Blood Services, and four other lead trauma hospitals across Ontario to study the optimal method for delivering blood transfusions to patients before they arrive at hospitals.
“In an ideal world, nobody would get injured or sick outside of a hospital,” said Nolan. “But we know that is not the real world. The role of prehospital care is to bring meaningful interventions that will help save lives as close to the place and time of injury as possible.”
The current standard of care for prehospital blood transfusion is component therapy, which requires paramedics to give patients red blood cells that have been separated from other components like plasma and platelets. The SWiFT Canada study intervention involves the use of whole blood, which contains red blood cells, plasma and platelets all in one bag, on board Ornge helicopters in Toronto. Whole blood is easier to transport and store, and is effective in situations with limited resources, which could make it easier to deliver care at the site of traumatic events.
Whole blood has only recently become available for use in civilian populations, having historically been used exclusively by the Canadian Armed Forces. This is the first clinical trial looking at the use of whole blood in Canada and the first prehospital trauma transfusion study in Canada.
Nolan says that, despite trauma and severe injuries being a leading cause of death among young Canadians, research has typically been quite siloed. The goal of Nolan’s work and collaborative research like SWiFT Canada is to bridge the gap between the prehospital and in-hospital environment and leverage the interconnectivity of Ontario’s trauma system to get the best insights.
Evidence shows that patients with massive bleeding have significantly better chances of survival if they get blood transfusions early. And while having the Ornge blood-on-board program has already cut down this critical time to transfusion for patients greatly, the goal of SWiFT Canada is to find out if there’s an even more efficient and beneficial way of doing things.
In trauma care, the first 60 minutes are considered to be the “golden hour,” the time when patients have the best chance of survival. It’s why Nolan and his colleagues at St. Michael’s Hospital call their research collective First60.
Ontario’s trauma system is unique because of the province’s geography. As Nolan points out, 40 per cent of patients live further than a 60-minute drive to a lead trauma hospital, and 15 per cent are more than a 60-minute flight from a lead trauma hospital. Bringing in-hospital care – like blood transfusions – to these patients living in suburban and rural communities adds a layer of health equity to a system challenged with long distances and inherent delays to accessing trauma specialists.
Nolan says that Ornge, with its ground and air transport services, is like a “lifeline” for these patients. The goal with SWiFT Canada is to make that line even stronger.
By: Olivia Lavery
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