[Music] foreign [Music] good evening I'm Dr Jeffrey Speer current president of the El Paso County Medical Society for 2022. we at the El Paso County Medical Society are very proud of this program we are certainly grateful for the collaboration of both Star City Studios and kcos for making this program a reality we're also incredibly grateful to miss Catherine Berg who has been such a terrific partner for the last 25 years being this program's host we hope you continue to join us each and every month for this fantastic program and please enjoy the presentation tonight thank you very much if we are ever in a serious accident and we need blood most of us just take it for granted that it's going to be there that's not necessarily the case there is the issue of what blood type you are and the hope that someone was kind enough to donate some blood for you before your accident ever occurred we are here this evening to explain the importance of blood donation and hopefully to convince you to donate some blood because you never know when you're going to find yourself in the need of a stranger's generosity during the next hour we have experts that are answering your questions about saving lives through blood donation it is all because of you um this program is underwritten by vitalant I say that right Blood Services uh we also want to say a big thank you to the El Paso County Medical Society for bringing this program to you it is the El Paso physician and I'm Catherine Berg and you are tuning in to the El Paso physician so thanks again for joining us this evening we have a program called Because of You life goes on that nice to know um it's your role in blood donation and so with vitala by Talent we have uh several people here and we also have a trauma surgeon here but directly to my left we have James Dugger and you are the manager of vitalant here currently and locally correct division vice president you're far more important you're the division hello sir thank you for joining us and then we also have Bradford Ray who is with UMC and then we have Dr Alan tyrock who is uh with UMC with also Texas Tech Paula Foster school of medicine and he's the chief trauma surgeon and you've been on here uh several times before and you're the guy that tells gross stories and it's really cool because we learn all kinds of stuff he and I can tell the girls story oh I'm sure and and often we have pictures is too but sometimes we need to let people know to look away look away look away um but James I'm going to start with you I know that you and I have talked a little bit over this last week on different things that we want the general public to know about about blood donations about services in general so I'd love for you to just say to the audience what you do all day every day it's kind of like my joke way of explaining what every person on the panel does because you wear a lot of different hats and for this program tonight what are we talking about what do you want to get across just kind of what your role is here in El Paso well my talent is is a non-profit blood center and the the service that we provide is we're that with the general Public's generosity of donation or that link between giving and living or the conduit to get blood from one individual to the places where it can be transfused into another individual it sounds like it would be fairly simple but in reality it's fairly complicated we rely it's a very personal ask because it's a very personal type of a process that you have to go through you kind of have to bury your soul to people that you don't know questions to be qualified to become a blood donor and then we will take and we're this and we're the only safety uh net between a donor and a recipient so we have to ensure uh 100 safety and top quality because that's the expectation of our hospitals and certainly the patients out there we try to inspire as much as we can people to give their time and leave us their blood as best that we can leave us their blood I like the way you say that and and the competing priority for people's time today seem to be more and more all the time there's no more than 24 hours in the day there's just a lot more things that are packed into those days for folks so that is definitely the the challenge patients are our purpose inspiring people to donate blood is our passion nice wow you sound like you have a mission statement right there I love it Bradford top ad no so uh with your role at UMC what is your specific role in dealing with Blood Services at UMC yeah I'm the director for patient blood management so I cover everything from massive transfusion all the way over to those that perhaps can't get blood because of antibody or some type of an infection and where blood is just not available for them or they just refuse transfusion so then we're able to assist those patients with other means so that we can help them Dr tyrock and I have worked very closely on this together over the five and a half years I've been at UMC in incorporating policies and procedures bringing in new products that by Talent has made available that have really helped the trauma patient so a lot of what I was looking into and researching for this evening is is the products and differentiations of what products are available what you can do with whole blood what can be separated and so that's always been a curiosity of mine so we're going to talk quite a bit about that this evening and Dr tyrock you're the guy that just needs blood I always look at you and my gosh we've been doing this forever my daughter's 25 and I remember when you and I and my daughter who was still in her car seat we were talking about how to buckle up kids because of car crashes and I remember you saying to me maybe 23 years ago Catherine they're not car accidents they're car crashes and it immediately just put me into a serious mode of wow we really need to talk about life and death situations and in the situation that you see you need and require a lot of blood talk about that a little bit and what your role is with this so blood saves lives I can tell you that for the trauma patient most definitely but we actually use blood for other things like surgical surgical procedures cancer patients people with leukemia lymphomas but I'm a trauma surgeon predominantly and I use a lot of blood uh so do my colleagues you know we can have a patient that may require 30 to 50 units of blood in one day go back when you say unit how much is a unit of blood once it's roughly a pint okay roughly a pint okay one patient it's going back to August 3rd 2019 we at UMC alone on that Saturday a terrible day we had 14 patients come in in 34 minutes that afternoon we used 59 units to pack red blood cells we use 39 units of what we call plasma or ffp fresh frozen plasma and we use a large amount of platelets and something also known as cryoprecipitate so we use a ton of blood that day now remember that weekend including that Saturday uh vitalington was hosting blood drives and people were lined up down the uh I remember the blog doing that so we really appreciated that I can remember going back to 911. we had no blood in the region because what happened for about three days after that date no flights we ran out of blood or we were close to running I should say we ran we were very close so we as a city had to stop all elective cases finally around September the 14th they allowed I think border patrol or Customs to bring us some blood from the Tucson area just so we would have more on Supply so that's just how important blood is to us so we use platelets for clotting plasma for clotting red blood cells we call it packed red blood cells and we use crop precipitate which is a more condensed version of clotting factors to help us but what we're doing now I think when do we start Bradford about two years ago now with the whole blood yeah they're about something known as whole blood and that has made a market difference I used it today on somebody I used it on a young child on Sunday night and it's really only resuscitated fluid I used on those patients well on the child I used to myself I'm a lady but in the past we give a lot of crystalloid which is salt water essentially we use leaders and leaders but we learned from the Afghanistan war the Iraq War stuff that we actually had learned in the Vietnam war in World War II but we forget things after Wars and that's a really good thing from war you learn how to learn your medical stuff again is to give whole blood so the military actually has a walking blood bank and they just they donate the site okay when you say whole blood okay as a layperson I'm just thinking well it's the full-on whole blood that's taken out nothing separated nothing's you know separated you know put into products is that what you're talking really what it is from a basic standpoint so when uh I again I was trying to do some research so years and years ago it was about the shelf life if I remember correctly correct about whole blood having a certain shelf life which was less than when you separate blood out if I'm wrong tell me you're pretty right I'm trying to understand why it was that in the old days whenever the old days were that everybody used whole blood because it was whole blood and then somewhere along the way things started separating and again well we can keep maybe plates platelets for a longer time maybe we can keep um you know whatever the plasma uses yeah exactly the way things are packed so explain and whoever it is on this table who does that and maybe they probably know just as much as I do but yeah the whole blast sort of came out in the World War II era okay the Korean Vietnam era but then when they brought it to the civilian sector it made more sense in a way to separate it to the various components so you could store the plasma I think you could actually freeze it for a while a year yeah you can freeze it for a year a year and some patients just did not need the red cells they just needed the platelets because they had a low plate account because of their cancer or whatever so they would just get the platelets I used to joke I need the plasma where I need the red cells because I need you to quit bleeding that's what the plasma does right so but now we come around what gums old is now new again so we've been using hopeless we were the first hospital in El Paso in the region to use whole blood they watered to others in the region Now using it a little bit but we're using a ton of whole blood and it I can tell you it's a better resuscitative fluid by far but you can elaborate more no I like this and James if I can bring this to you so when we're looking at um asking people to give because that's that's the charge the mission is let's get people to donate it's going to save lives when someone comes in you were talking about you know they bear their souls and questions and what is the explanation that your staff gives to someone who is donating blood is it is do they go through the quest questions of well do you want my Plaza do you want my blood is that even a thing it just all gets donated and gets separated somewhere else along the way what is that communication and that narrative between the general public and by Talent well once we determine that donors will and healthy and and can donate and eligible to donate blood then knowing their blood type kind of then leads into another conversation a different different blood types are are better for transfusion because they need to be matched to the recipient whole blood is no different because there's antigens on that just like anything so there's OA B types so depending on the donors depending on the donor's blood type we will Target Their donation to what we believe is the most needed in this case if we have orders from our from our hospitals when they want whole blood we will Target those donors that are best suited to offer those whole blood donations other donors depending on their blood type we may want plasma from them or we may want platelet products from them others we may want to do pack red blood cells which is which is transfused more than whole blood whole blood's fairly new and and most of the bigger facilities like like University Medical Center will be will view facilities that will use whole blood more than other hospitals as many for the trauma patients that we use our whole blood and you were talking about different blood types so the O positive is the universal donor and is that also the universal receivers I know you've got the ABS and the maybe talk through the different types of blood types different types of blood types um because there are universal donor is what the universal donor that can go to anybody is is onag oh negative I thought it was positive okay um and then the blood type that is the rarest and the most difficult to get a B negative is an A B negative so my first boyfriend um was an AB negative guy and he got called every three months to give blood and he did he did it like clockwork but I remember that being such and that's when I started learning about how this was I'm an O positive so I feel like I'm just you know around the mill um on that note do you have a for the lack of a better word a donor list of people that we know that these people usually give and we know that we need this type of blood and you make phone calls and this is a great time to talk to our audience about hey we need some more types A B C and D the for I guess for clarity a b negative is is the rarest blood type Type O Negative is the and type obla is the type of blood that we look for the most because it's the one that's transfused the most anybody can get it okay anybody can oh negative anybody can receive that's correct omega's four percent six percent of the population World pauses 38 of the population um crh Factor owner that makes the difference um so we have it so we keep up with a list if you are typo we'll we'll call you looking our blood inventories every single day we will match our calling strategy or our contact strategies to those inventory needs and and those demands we try to keep in contact with our hospitals to see what their demand looks like and certainly what their Hospital shelves are looking like when it comes to supply and then we will Target uh messaging to those donors to try to get them to come in and then there's that whole group of folks that haven't come in that we don't know that's exactly Target exactly so say we've got 20 of those guys tuning in right now what are you saying to them can they come anytime is there um the the blood mobile I remember that you know in high school you get out of class for two hours if you donate blood that's kind of a cool thing um but what are some of the the people that have not given blood before that thought oh this is kind of cool I should I should do this for the better kind well I would say I don't know of something that you can do in an hour's an hour out of your day that can be as impactful to somebody else's life than sitting and giving a unit of blood as Dr Tyrone mentioned there's a lot of things that can't be done without blood they can't be as effective as a medical in a medical community as they as they are without blood and there is no substitute for it right if it's not if it doesn't come from humans then we don't have it and so if you're looking to get engaged if you want to do something that's extremely impactful it doesn't really cost you any money it'll it'll it'll take a little bit of time to come in and we always like to see if you come see us you can get a prick a poke a cookie and a coke very nice we're going to prick in the finger to test how much the test or hemoglobin then we're going to poke in the arm and draw the blood we're going to give you a cookie and Coke on the way out and ask you to come back and see us in eight weeks and it's a free way to see if your blood's okay that's right you know why not I kind of like that Bradford let's move things over to UMC for a little while um and as the Director there of everything that that deals with blood and blood management you've got but you've got several different areas within UMC that the blood goes to and can people give blood there at UMC as well or is that not specifically okay we have to have somebody like by Talent come in okay and then they set up a location for those individuals the employees to go to to donate blood okay but we don't have a in-house blood bank at this time okay so when you work with the medical staff so when you work with Dr tyrock and uh and his colleagues what is the planning and the strategy stages that you go through with Dr tyrack and so that you can come back to James and how how do you do your your everyday planning it can be quite complicated and it's convoluted but at the same time a lot of this has to be done beforehand because if I'm saying to Dr tyrock in the middle of a trauma he's not he doesn't want to talk to me right he's interested in trying to save that patient's life so we have these special meetings where we talk about the latest in research that's coming up from other University Hospitals things that we are doing at the University ourselves to come up with battle plans you might say to reduce blood one of those is a drug called transamic acid and I remember when yesterday three years ago I got a text from Dr Tyron get to the hospital and manage the blood supply if you're available so I ran to the hospital and was in scrubs and we saw these people coming in and we I was in the operating room and I went room to room to room to room to room to room to room to room and made sure that some of these additives were being given to the patients because tranexamic acid slows down the need for blood hmm and it allows the body to hold the clot without your body trying to break it down okay so it's a very important drug and they line item these according to different societies as level one a level 1B level 1C transamic acid is the highest at level 1A I see so we have a policy that we use where I have badge cards that I hand out to the attendings and to the residents that are in surgery that indicate to them what should you do in the event of a massive bleed and one of those is if they've been given a gram of tranexamic acid in the field which we are doing now in the ambulances that's been an ongoing process but it's working then we'll give them another gram of transamic acid in the hospital if they arrive at the hospital without having had anything we just changed our policy where we're giving two grams right up front and that way we don't have to worry about Pharmacy sending something up later and that helps reduce the need because we don't have a lot of blood right now we've got to be very honest about this right so because of that we're doing everything in our power to reduce the need to just empty the blood bank on one patient that's not fair to everybody else so that's what happened yeah that has happened I remember one of the times I was here we gave a patient 320 units of blood it's like when do you stop though yeah yeah right that guy didn't survive then we had another young person come in that was inebriated a car rolled over he was extricated the car rolled over on him and injured himself he got 220 units of blood and he survived he survived which was unique but we we did all of these preemptive things to try to help him another thing we'll do is we'll use the cell saver where we'll try to collect the blood that the patient is losing clean it and turn around and give back to him his current patients yeah his own blood yes his own blood right interesting and that way we're able to save his blood along with any donated blood he's been given without relying on again draining the blood bank trying to just let it wash down the drain that's not fair to anybody of course we try to do that and that's worked out extremely well another thing to help clotting Dr tyrock mentioned cryoprecipitate a new product that we're involved with quite heavily and they've asked us to do some additional research is a vibrinogen concentrate say that slowly fibrinogen concentrate okay and what that does is that replaces a lot of the fibrinogen in the body that acts as the main aspect for clotting so platelets are number one fibrinogen attaches to the platelets the red cells come behind that and you have a plug okay and that becomes very important but if you don't have a rich concentration of these Hooks and ladders to because a platelet for lack of a better expression runs around your body like a closed fist and then when it's needed it opens and gets sticky um so the fibration when it comes it attaches to this and it gets sticky the red cells come and attach that and you have a plug I see and the blood the blood is that the same idea I'm just trying to picture it in my head is a blood clotting type of a drug yeah that's the same idea yes it greatly in a good way okay yeah so if we're looking for like a hemorrhagic stroke type situation I know that's not trauma but the idea is you want to give something that doesn't allow the blood to get thinner or if you're about to go into surgeries right exactly and we're the only mentioning that there's there's drugs that are called Factor 10A inhibitors and they're I don't want to use the word the enemy of what we do but they're necessary to help people from clotting if they have stancer or other scenarios in their body from Strokes perhaps but when you reduce the 10A in the body you will continue to eliminate or reduce the effectiveness of the platelets in the body we're the only Center in El Paso of all the hospitals that are here we're the only hospital that has this index in it Alpha which reverses these Factor 10A Inhibitors in less than two minutes cheese and it's an expensive drug it's not given all the time but when it's needed we need it right now and it works very well so what we see is trauma everything's trauma some young guy getting shot or stabbed is really not 90 of our patients are blunt trauma which means car wrecks balls motorcycles and quite often it's old people riding motorcycles falling from the roof fixing their water cooler whatever and all these people are on these what we call blood thinners Plavix aspirin Coumadin now the thing he's mentioning these newer agents like Eliquis I can't think of the other one which is great for your heart and your brain if you had a stroke but if you get injured they will bleed like crazy so our job is to quickly reverse it with the blood products that's why I like the whole blood because it's got all the clotting in the platelets and we use the txa or tranexamic acid which actually is a very old drug and now it's come back into Vogue and it's very cheap it's like 25 so we use that on our trauma patients and even some ladies that are bleeding from uh having uh deliveries so we give it they give it to them too so we use that but we use these this expensive agent he's talking about in some other reversing agents so we're a lot of more sophisticated than in the past yeah that's just give them more ffp give them more plasma give more platelets so now we are more sophisticated there's actually a device which is an old device from the 1940s that just fell out of favor in the 1990s that started coming back and now the American College of Surgeons require every level one and level two trauma center to have that it's called a rotim rotem or a tag to EG it's just two different types they basically do the same thing so we put an aliquot of blood from the patient in there and in about 10 minutes we have an answer like do I need to give more platelets do I need to get more oh interesting plasma do I need more whole blood or do I give the txa additional dose of txa or is this patient clotting okay or they're lysing their red cells and they're not clotting for because sometimes a trial patient will be hypercoagulable I mean they clot a lot too much or they just don't clot at all so right that's the test that we use and we get the answers like in 10 to 15 minutes after we do that so I'm looking at you and I'm thinking again the last you know 23 four or five years that we've been doing this together and when we're talking about whole blood and we're talking about these different blood products just in what you've seen just by knowing me I know there's been times that you practice before that but the research has gone into this so you're talking about different machines for the lack of a better word drugs and machines drugs and machines that that you are now able to use in the emergency room or when you're doing surgery point of care so how much has that changed and you can even go like what was it like five years ago what was it like 10 20 years ago this is the part that fascinates me just again going through how I was going to carry through to nights program because I was I was really focused on all these different products but then we're looking at these drugs now and going back to whole blood so I feel like everything I studied today goes down the toilet um but over the last let's say 20 years there is a lot more blood products being used as I understand yes and then now going back to whole blood and that's that's globally as well as just here why is that and how did that come to be was it just the answer okay so the fact that you use the word 20 years is very accurate they're about 20 years once we went to Afghanistan once we went to Iraq yes you said that the military started losing these soldiers because a third of them were dying because they were bleeding to death so quickly and they looked at that and said you know these are preventable deaths so that's when they started using the whole blood they actually they didn't start using whole blood first they were using something called a balanced transfusions for every unit of red cells they give a unit of plasma I say what do you use in the field it's not like you have storage facilities well they could bring them they were so quick with the helicopters and stuff they could bring them okay and so they would give a one-to-one ratio we used to say give a two to one ratio if you're happy if you're lucky that's your goal once ones your your gold standard once again August 3rd the despite all the chaos we were 1 to 1.5 so we were under two that day with all those patients but so our goal now had well now has been if you're going to just give Pat red blood cells and plasma you do a one-to-one ratio so we monitor that as we're transfusing in the operating room or in the trauma Bay of the critical care unit but since then what's evolved not everywhere but we have it here at EMC is the whole blood so that's more refinement but then again we have the ages the txa the indexinet other things that we can use the fibrinogen concentrate which we just started using they've been using that in Europe for about five to ten years now and now it's come to the United States so we're using that every place is the ffp or plasma one thing that to amplify what Dr tyrock has said and I agree with everything he said is that the military because we're a military town a lot of the new devices that I have brought in the new hemostatic agents the rapid infuser which is called Belmont Belmont is uh a military device that can Infuse blood or fluid very quickly and in fact when a battlefield is going on I remember at Grand rounds that one yeah was talking about it where they would take these Belmonts and they're they're wrapped in a specific they'll throw them out of a helicopter at 1500 feet dear Lord they'll hit the ground balance the Medics will pick them up plug them in and they work oh geez so with the Belmont you can give like a unit of blood in what two minutes or less yeah oh wow it depends on the ID you have in the arm of the patient okay you can just slam it in there and it warms it up too because you want warm blood right so there that the Belmont has been very effective in being able to do that we now have six of those that we have purchased um we're looking at some of the hemostatic agents the military was using a device called quick clot I used this years ago and they used to when you would pour it on it was a powder and when you poured it on it would hiss suck all the water out of the blood but it would get very hot on a patient I remember telling the nurses don't touch it don't touch it and one nurse went over and put her hand what you know because it was hot right well when all these military surgeons started leaving Afghanistan and Iraq they said we want this in private practice well the FDA said not at that temperature so they reformulated it and it came out as this towel type device called quick clot Dr tyrock and I were talking today about a new product that's coming out that the military is switching to and we're going to switch to it too and it stops bleeding three times faster than quick clot and it will work no matter what drug the patient has on board is it something that you apply topically as well yes okay it's an agent you just lay on the wound interesting sort of makes a matrix over the wound to help stop almost like some service plotting yeah I used three of them today on a patient not the new one yet but the older one so these are just things that because we have to find a way because of the diminished blood supply to find a way to do more with less right and the other thing we haven't touched on was so when I train we'd always check the hemoglobin if a hemoglobin was less than 10 especially an older person we got to give him some blood if the email is eight or nine oh give them genius but you know about that actually so now we go down to hemoglobin to seven to six and it depends on the patient's physiologic status are the blood pressure okay are they making good urine are they meditating we may not transfuse especially the younger ones so we we have a lower thresh or a higher threshold to not give the blood so that's saving the blood for people that really need it so that's one thing we do so you hit on a word that is always interesting me too you know the transfusion you know that always seems like if you're looking at Marcus wilbmd from 10 000 years ago it's like oh he needs a blood transfusion all of a sudden it's like what does that mean but it means several different things there are uh full on transfusions and maybe not though I would love for someone to kind of explain when somebody says a blood transfusion how many different things can that mean and I'm just throwing that out there by the job and I can James do you get this one well I mean anytime blood is going to be used whether it be a single component or multiple components to me that's a singer we've been transfusion there may be multiple components in a transfusion episode okay um I don't know if that's the same my little itsy bitsy head I'm thinking since there's no blood something you just get the whole all the blood goes away and then also you just get new blood it depends on the patient so I guess it might actively bleeding I'll give like I said earlier one-to-one ratio every unit of red cells I give a unit ffp I usually get the ffp first I want right the the endothelium of the blood vessels start clotting with the plasma and then I'm starting the blood to go in and I'm probably throwing in some platelets along the way if I have whole blood almost like give me whole blood is it right on that patient if we have oh well sometimes we run out so we do that if it's a head injured patient and they're on aspirin and I see that they're not clotting I'm going to give those patients platelets because aspirin knocks out platelets oh right if they're on coumadin or Warfarin right I will probably give plasma because that's that's how the Coumadin works it works on the vitamin K dependent factors of a clotting Cascade so but we're checking those things with that device I call the rotam before the rotem we were using inrs PT ptts things like that played the function assays that's just sort of gone out of the on the Wayside now those worked but these just work much faster yeah yeah and rotational the rotem stands for rotational thrombo elastometry as Dr tyrock was indicating it gives you an indicator by means of how these bullets come out if it looks like a 45 caliber bullet okay you don't need anything if it looks like a 223 which is a rifle bullet then you begin to decipher okay what is it that we need what specific could this be replaced with and that's very helpful if it comes up and looks like a polywog it comes up and then it just comes down like this that's called lysing and lysine is destruction so with that then we'll give tranexamic acid reverse that and then see if the patient needs any blood products so or some other assay to be able to help them another thing that umc's got we're very good at is we love clinical studies and I do a lot of things I do a lot of these we're using a a brand new device we just finished it in fact Dr Tarak and I used it very quick very a lot two o'clock in the morning I was in the hospital running these things with traumas for about it we did two of them so about about a year oh wow we were doing this and um I aged about three years in that year but doing that it enables us to get results instead of 10 to 15 minutes you get a result in eight minutes wow okay and anyone that's in surgery will tell you 20 minutes is forever right eight minutes you got the patient draped and you have a result so we want to switch to that right that'll be that's not a military device but it's a device that the military is incorporating because it's so fast it's just a new generation yeah it's a new the latest mouse trap so when you're talking about clinical trials and you're looking at also any equipment you know lack of a better word machines equipment how did these all come about in the first place and I know we were talking about the wars and and getting everything done um and we haven't and let's just say El Paso when you have a clinical trial what makes you think this is what I want to do like Dr Tyrone this would be a question for you really what would your wish be when it comes to blood transfusions being able to get give people Bloods that you see can happen in the next 20 years so we were talking about 20 years ago okay what you see that is actually realistic can be realistic in your next five to ten to twenty years of everything that Bradford's doing everything that clinical trials are doing everything that my talent's doing what is a trauma surgeon would be like oh this would be awesome so when I was a resident I think like an intern the big thing that we thought was over the horizon was artificial blood yes that really never came into being and it was always talking okay make artificial platelets well there's been some work on that but it hasn't happened what we're seeing it's going to be a while I think there's two things one is this one's probably a little bit more realistic somebody's got internal bleeding well if he got external bleeding put just direct pressure I would put a tourniquet on you and get you the operating room now they're like I think they're doing this in Baltimore in Maryland the shock trauma center you know it's it's Philadelphia where they actually inject something into your belly in some kind of foam and it'll just make cast in your belly and essentially make a tamponade effect on the bleeding site so then you take the patient it's you just you know it's just holding pressure see I can't hold the pressure on your Shadow liver right without going in and doing it so now they just inject it and they'll make a cast all in the abdomen oh wow and you get them to the or and then you in control conditions with all the blood available and then you can take it off and start doing that now we're probably about 10 years away from that right the other thing which I think we're much further off even though it's really pretty cool stuff suspended animation which where you just basically just stop the patient and chill them even at the scene but basically put him in a coma so that they stop bleeding they stop bleeding interesting yeah you drop the temperature yeah the military is looking at that I think we're about probably 20 years plus away from that one but they are doing that in some places yeah it's a very small clinical trials animals first and I think they've even done it a little bit on humans I could see that being beneficial in so many different areas I mean again time I always think of strokes and heart attacks you're looking at get to the hospital get everything you need to have done or you need to have a major liver transplant yeah right a lot of bleeding you may put in a suspended animation and then next time it gives everybody it gives everybody time to do what they need to do because it's protecting the brain protecting the heart right and the interim so that's what we're seeing for me common stuff is we need more and more whole blood yeah we're trying to get that in the pre-hospital setting where the ambulances would have it I know one of the flight companies they actually come with whole blood almost all the helicopter companies now cover they carry red blood cells and ffp so they do that and they have the txa tranexamic acid so they're already injecting that it's been showing the faster you give it the better it works now it's been shown if you wait too long over three hours you shouldn't give it because it can cause clotting and bad outcomes so you got to always watch that so right now we need the blood and vitality has been an incredible resource in what he hasn't said but if you give blood in El Paso right my talent's going to keep the blood here not all blood places do they all ship it out right they keep it in the region so James okay yes so I would love to talk about so let's go back to whole blood is that that's still again old and new it fascinates me the shelf life of whole blood now I know that you were talking about freezing platelets for about a year plasma sorry plasticity at room temperature that's only five days okay and see that that seems like nothing which is why again plead to our audience plead to everybody tuning in um a lot of times we have zero or basically one or two in that City okay and if people need that yeah not just for trauma and also James if you can walk through so people who have never given blood walk through what it is that they they can expect coming through the door so this is a big plea and I I'm I'm for it completely number one the big question was what is the shelf life of whole blood is it the same as platelets is it is it do you put it in the refrigerator and it hangs out for a while is that an expiration date like a you know bottle of milk I don't know whole blood whole blood's good for 21 days okay so we don't because we don't put any type of a preservative on it after processing okay other components so if we take a unit of whole blood and we further process that down and separate the red cells off of the plasma we had a preservative to those red cells depending on what you add it could add uh take this shelf life to 35 days or up to 42 days okay rare blood will be treated if it's ultra rare um we can treat that blood and we can and then we can freeze it what is ultra rare mean what does that mean um RH knows for instance okay the rarest blood type there is in the world there's very Maybe so if you find those folks then um then they'll freeze those units and they go into a rare donor repository to where it's stored and most most facilities around the world will reach into those repositories and pull those units if they need them okay because we gotta there's not very many of them right um but what a donor can expect when they come into a wedding can be greeted with a with a with a smile and a coconut cookie or a soda that's right and then we're gonna and we're gonna take you and we're gonna put you through a bit of a screening to make sure that your travel didn't put you at risk for malaria or other things um and then we're going to talk about a little bit about your uh your health history um and then we're gonna do a little mini physical we're going to stick your finger with uh with a little the little prick that we were talking about and make sure you got enough blood to be able to make a blood donation take blood pressure and make sure that you're otherwise healthy if you pass all of that then we're going to take you out put you in a nice comfy bed we got an outstanding staff that's going to create start that really nice experience because has to be good because you want them to come back you are gonna we are going to stick a rather large needle into your arm don't say that it's it's the reality it's it's hard you know I actually I'd rather be really it is definitely hard to ignore that that is part of the process and um and then everything will go well and then when you get done we're going to tell you how much we appreciate that donation the fact that you're saving somebody's life uh with that generosity and then we're going to really into the canteen feed you as many snacks as we can put inside you and then we're going to ask you to see if you're if you loved it enough to want to come back and do it again nice so when you said earlier you said if there's enough blood in you and I guess I'm thinking okay dehydration is that is that what you're looking at too is it like if someone knows I'm gonna go to the blood blank Bank sorry Blood Services to my talents on Thursday and it's Monday so I'm just going to drink a ton of water is there something that if someone knows they're gonna go that they should do to help the blood be better if that is if that's even a thing well being hydrated is always helpful right you know increasing your the volume that you have salty snacks are always good um to help and then eating a good meal will help you tolerate the um the loss of blood while you're while you're bleeding um there's in their diets things that are high in iron always are helpful to make sure that you're not iron deficient when you come in because again you're losing blood whether you're stuck with needle in a controlled bleed or you cut yourself you're losing blood either way we do want you to stop during the process right exactly at some point all bleeding stops one way or the other that's right well you just brought another question in my head too uh when you give blood it usually how long does it take the body to replace what you get donating a pints usually um what's normal correct you can't you can't come back and donate again if you if you donate a pint of blood for 56 days that'll allow your body to replenish what was lost in other things ferritin and iron and those kind of things that are have other dependencies on how fast they rebound diet is some of that as well if you donate plasma you can replace your Plasma in 48 hours oh goodness okay it covers a lot faster oh you said we always need platelets and play this yeah platelet play it's hard as well because it's a it's a yellow components it's it's it's platelets that are suspended in a lot of plasma basically yeah because the screen does that okay and because we target those donations we actually have in today's technology we can put you onto a machine that will pull whole blood from you spin it in the machine and do it and separate it uh plasma from from Red cells and give you back the red cells if we're looking for platelets or plasma or we'll take the plasmin and or give you back the plasma we'll keep the red cells that's what's nice about today's technology we can Target uh collections that better suits the needs of patients okay and before and you said too when you're looking at the blood type that's coming in uh the willingness of the patient Etc that's when you decide what what process it's going to be with going to be whole blood where you're going to do platelets whether you're going to do plasma Etc all that's decided when someone comes in that is correct we'll ask and then if they if their blood type is desirable for a platelet collection for instance and they've got some extra time then we'll put them on uh on a machine to collect platelets that's a that's a little bit longer of a time commitment platelets can take anywhere from an hour and a half but Dr tyrock needs some that's right he really needs those platelets and I think I think that's what's kind of important to remember when you have donors that we have some donors that donate the maximum time a number of times per year 24 times per year and play the donation that's a lot and if you have uh donors like myself I'm a platelet donor it's a two and a half to three hour procedure for me to do that it's only a year's time I may spend 40 or 50 hours connected to a machine how many movies you can watch on your phone that's exactly I mean there's so many things you can do now or you're just sitting there it's fabulous but you know what makes it all work for me is that is some that's a quite a that's a long time if you just kind of think about it but when you on the back end of that if you transfuse it to the young person the young mother that goes on to have a family you're preserving generations of life and for me it kind of the time just kind of didn't doesn't really matter how much time I spend look at you you should have this guy following you all day every day talking to people say hey give someone he's very positive and it makes you want to you know it absolutely makes you want to give um we're kind of at that that 10 12 minute Mark before the the show starts to wrap up so what I want to do is really concentrate on and I know you've got a lot in your hip pocket so keep that in there but Bradford I would love for you to talk about what you wanted to say before you got here today just the things that you wanted to make sure that we got across I just want to make sure that the purpose of you coming here today is that we we want to give people to give blood uh whole blood if possible because that's what you need and the shelf life is longer than I expected I didn't think it was would you say 21 yeah that's that's a great point and I appreciate it when we were at the height of the pandemic and everything was well we shut the country down for several weeks when those things happened we had to come up with other means to be able to help ourselves so one of the things that I did was I initiated a drop from Seven as a standard number for a hemoglobin number to consider transfusing I dropped it to six our length of stay has gone way up it hadn't everything was the same so with that we knew we were on to something and because blood with that time wasn't available we initiated I wrote a anemia power plan and we use that all the time now in conjunction if a patient gets blood fine we'll get it to the point that they stop bleeding and then we'll initiate the power plan many times they don't need a transfusion but they're still anemic we will initiate the power plan and that builds their own blood up internally naturally so for people who don't naturally understand the terminology when you're talking about hemoglobin and you're talking about I know earlier you said from ten to nine to nine to eight so we were at seven now you're going to six what do you mean by that what do you mean by the hemoglobin count being dropping and you think oh we should do transfusion or not what's happening physiologically in your body when the hemoglobin count goes down that's a great question and generally it's not just one product that's leaving the body on on average unless you have some type of Destruction that's occurring that's more of a Hematology Oncology concern but generally when your hemoglobin begins to go down your plasma goes down your platelets might begin to reduce a little bit too and that becomes a concern because now the the body is taking on an overall aspect of anemia so what we want to do if the patient is healthy and they have lost a lot of blood there's things that we can do to initiate your body that kick itself into high gear and sometimes when we don't have blood or we don't have the right type or we don't have enough we can do this and we use this again as is mentioned every day and when we dropped it from seven to six I wrote my number down we saved a thousand fifty Seven units of blood oh my goodness and that worked out to everybody's benefit now that we're using the power plan I had the um we had a conference call today with phytalent and we're down in the first quarter ten percent on our red cell utilization all of these things are good because we're still not back to normal and the thing that we have to appreciate too and not that I want to berate anything that's being said here but anytime you take something from Jim and give it to John right that's a transplant right and so blood is the only organ because it's a liquid organ that can be transfused by a nurse or initiated by a nurse so and why is that because of the acceptance of the body receiving the blood no it's because of the acceptance of the the protocol and why blood is so part of the culture and like I was saying you want to initiate it I'll just do this very briefly at the end of World War II the American Red Cross was the major donor um and everyone donated to the American Red Cross um when World War II ended the American Red Cross went around to several blood banks around the country that were independent and said join us shut down and join us and they said no we're not going to do that they then United themselves and formed AABB which was the American Association of blood banks now it's the American Association of blood and biologics so another point that Dr tyrok mentioned which I find is fascinating myself because one of the reasons that got me into this was the blood substitute research and we've used blood substitute said UMC seven times now see to me when I hear blood substitutes I'm thinking artificial blood this is a completely different thing okay this will explain the difference yeah when you think of artificial blood you're thinking of that there's multiple individuals in the industry they're looking for the Magic Bullet some of them are actually made by plural floral carbons what in the heck is that it's okay this might take too long to explain but in in World War II when we built the atomic bomb they had to find a way to keep it cool okay they put water in there and the core was so hot that the water just literally busted apart it didn't even come out of steam so they said we got to find other products what they did was they found if they put silicone into this the silicone would melt that would keep the core cool but because of the heat of the of the core of the atomic bomb it totally changed the chemical makeup of the silicone it wouldn't get hard and a doctor from the University of Alabama at Birmingham was sitting in his office one day and he had a five gallon bucket of this stuff and a rat came over landed in it started swimming around realized he couldn't get out and just sank to the bottom and started breathing what and he said oh I'm on to something here so they then wanted to figure out how they could give this as an artificial blood I see well what it did was it carried oxygen exceptionally well but it didn't pick up the dioxide so in essence you would die of your own gases there's another one that we've used and that I have done research on that is made of cow's blood I've heard about this a little bit yeah yes and so that's called hemopure as far as a brand name is concerned I know we don't want to endorse a product and I'm not doing that but that's what it's called and it oxygenates better than blood in that blood has what's called a 2 3 DPG curve and when you refrigerate it the curve shifts to the left because the blood substitute doesn't have a 2 3G 2p diphosphoglycerin it just pretty much goes straight across the bottom so it oxygenates immediately right and that's again the big goals I know we're getting out of three minutes a big goal about blood is getting oxygen to every single point in our body that we need I mean that's why we need the blood on that note yes Dr tyrock did you want to add something I guess say two things yes because he made me think of that as he was talking about the transplant thing with the nurses so that made me remember in the 1960s when they started doing kidney transplants all these people that received a kidney they would transfuse them because blood immunocompromises the patient and that's why they were doing that as Transit because they did not have all the immunosuppressive agents we have now so blood transfusion is an immunosuppressant to the patient their high risk of infections pneumonia Etc so we don't want to just give blood to everybody unless we need to right but what I want to say my closing thing is for my part is the blood shortage is real right okay it was sort of a problem before covet it's definitely a problem now because there's not as many blood drives as there were giving back better now not as many people want to donate not as many donors in the past it's not so good in El Pas playing today but other parts of the country you can read they are stopping elective surgeries in some places because there's not enough not enough blood I just this week I was reading in San Antonio they had one day supply last week of blood for that City that big region of San Antonio that gets covered they're typically three to five days they were down to one day and so they were begging donors just like we're talking tonight right that's what they were doing in San Antonio right that's my thing I want to get a question no it's a real perfect it's a real shortage yeah there is a real short and James you get to close with that idea you know again you we gotta know serve them a beer when it's all set I'm not sure maybe you can put somebody out there but again this is where that plea comes in I mean there's ever a time to do something good for your fellow human being um this would be it I mean people talk about organ donations they talk about you know taking giving people money on the street corner but this is your plea if there's something else you want to say and then we'll wrap it up well I think to look at to kind of understand where it's going because if you listen to the radio or to ads National ads that are out there you're hearing you're probably hearing more about critical blood shortages uh more often than what we used to prior to covet as Dr Carl said there was some there were some challenges with with the blood supply then if you go back even 10 years and and beyond that there's been a steady decline over the last 10 years there's been almost a 38 decline in Blood Donor engagement that's not just that's not by Talent that's Blood Centers across the country yeah and so if that Trend continues there's clearly a little bit bigger Health crisis that's looming I don't want to be gloom and doom about about all these kind of things kovitz certainly has accelerated that right and from a donor from a donor-based perspective we're looking for the same thing that every Civic Club out there is looking for adequacy for today and sustainability for tomorrow so we are needing to engage those uh 17 18 19 year old donors 20 to 45 year old donors that we lose from 20 to 45 and then they start donating again at 60 when they retire they have a little bit of time but in between there is where it's very difficult to get donors to engage and that's that's my job that's my role that's my passion is to go out and get those folks to take make blood donation a part of their life commit to doing it and then and then take that passion forward and advocate for blood donation and that's hopefully what will come out of today and those young people who don't telephone call there's by Talent org that they can always go to check out what you guys are doing you can always sign up to go and or just show up which is kind of nice but if you have not been able to see this entire program you can go back and see it on PBS El Paso you will find the El Paso position just go to watch also the El Paso County Medical Society has this program on there YouTube you can always find this and I say that because sometimes people catch or tune in halfway through and they're like oh I missed the first half so that's always nice to do so by Talent thank you so much for being here James Bradford and Dr tyrock thanks for joining us and give some blood you've been watching the El Paso physician I'm Catherine Berg foreign [Music]