The law of unintended consequences persists in various aspects of workers' compensation. There are various instances in which regulation or legislation with a specific purpose drives behavior in a manner that is unexpected and even surprising. Intertwined in every workers' compensation case are complex questions of medicine and care delivery.
An intriguing question of medical care delivery is being pushed to the fore by a group of veteran doctors whose experience in the area of trauma is significant. They are advocating for policy change directed at medical reimbursement and they say that simple changes could have a significant impact on saving lives.
The Centers for Disease Control and NIOSH report significant numbers of workplace injuries are related to trauma and many of those are serious traumas. Trauma is a major issue for workplace safety and these veteran physicians are convinced that a relatively minor change could work to the advantage of those workers and all trauma victims such as motor vehicle accident victims.
NBC News reports that this movement started in Somalia in 1993. Facing an influx of trauma victims, a physician improvised a "walking blood bank." Essentially, the caregivers working on trauma victims each donated a pint of their own blood and then returned to the tasks of patient care. The thought process was simple, to deliver whole blood replacement rapidly in the care process.
Physicians note that the key to trauma survival is in arriving at the hospital alive. The critical moments, according to them, occur in the hands of rescue personnel who are responsible for extracting, stabilizing, and transporting patients to care facilities. They note that in 99% of instances, those rescue teams are not equipped with blood to begin an immediate transfusion. So most communities have yet to embrace this.
But, there is improvement. They note
"In 2016, the number (of locations with blood in rescue vehicles) was zero. Now, it includes 152 emergency medical service agencies in 23 states."
That is significant progress but pales in comparison with the corresponding statistic that these locations account for about 1% of the U.S. Most of us face the significant probability that a rescue unit responding to a workplace accident will arrive without access to blood. Any transfusion will necessarily await arrival at a hospital in those instances, and that will require significant time. Time that might very well save the live and improve the recovery of the trauma victim.
The physicians are critical of the alternative. They explain that it is common for transfusions to be administered with saline. They opine that this is not a valid substitute for blood and that it may do more harm than good. It is blamed for various complications and challenges in the recovery process.
They are also critical of the minimal access to "whole blood" in various trauma hospitals. The NBC article notes that there has been a historical practice of separating the blood we donate into various components. A single pint of donated blood can become various blood products and impact the lives of a number of patients. That is a positive multiplier effect that benefits many in need. Nonetheless, the physicians assert that trauma victims would benefit instead from access to the whole blood, which is difficult to obtain in many communities.
Innovative programs are putting whole blood back in the treatment options in some communities. These physicians believe that their initial and perhaps superficial successes have saved the lives of thousands of patients. They claim that their emphasis on whole blood access is literally returning patients from death's door. The article notes that some of the communities that have made this seemingly simple shift are in Florida, and a success story of a young girl here is highlighted.
The "unintended consequence?" As is so often true, it is accounting rather than medicine. The article notes that most insurance companies will not reimburse for the use of blood in rescue vehicles. The ambulance cannot count on getting paid for administering blood during the rescue so they do not do so. The operators of these services, government or private, are working within budgets, maintaining vehicles, staffing efforts, and managing priorities.
There is a cost. The blood costs money. Refrigeration on the vehicles costs money. The blood is literally a lifesaver, and so there has to be some method of keeping the inventory moving so it does not expire unused in some vehicle. But, these are all issues that have been thought through and overcome in various communities. There are some places where trauma is more survivable than others. Would you choose to have the benefits in your own community, for the workers injured in your business?
In a world where trauma surrounds us, there are opportunities for this simple innovation to improve patient survivability and recovery. The inhibition to better care is partially logistical, but the economic impediments exacerbate resistance to change. A simple step, in accounting, would perhaps enhance everyone's chances of surviving a motor vehicle accident or other workplace trauma.
If a patient needs this blood, the cost will occur regardless. In today's primary paradigm, that occurs at the hospital after suffering and physical tissue deterioration. In the paramedic-blood paradigm, the same blood would be administered, the same cost incurred, but the timing would change. While logistics would cause some increased storage costs, the incremental expense of this change seems minimal. The potential benefit in patient care seems marked.
