Transcription

• Stevon Burrell

  Expanding pre-hospital blood transfusions to save lives, a veteran pathologist on the future of diagnostics, a breakthrough targeting an undruggable leukemia protein, plus insights from CAP member Dr. Julie Cruz. All coming up next. This is the Path News Network Daily Edition, powered by the College of American Pathologists. I'm Stevon Burrell. It's Thursday, December 18th. And here are the latest headlines. Severe bleeding remains the leading cause of preventable death after traumatic injury, with more than half of those deaths occurring before patients reach the hospital. CAP's position statement, Support of Pre-Hospital Blood Transfusion, expands the ability of trained EMS personnel to start blood transfusions in the field. Broader access could save up to 10,000 lives a year, yet only about 2% of ground EMS programs currently carry blood products. CAP President Dr. Jim Zhai says, quote, "Allowing ground and air ambulances to start blood transfusions when needed will save lives." Later in the show, we'll be joined by CAP member Dr. Julie Cruz for a closer look at what this means in those first critical minutes of care. And in a recent peer-to-peer interview published in The Pathologist, Dr. Michael Laposata calls for a more integrated role for pathologists in patient care. Dr. Laposata says diagnostic errors still claim tens of thousands of lives each year and argues pathologists must move beyond reporting results. Quote, because we perform the test, we must also help interpret them. End quote. Researchers at UCLA have identified a way to target a cancer-driven protein long considered undruggable, opening new possibilities for treating aggressive leukemia. The study, published in Haematologica, describes a small molecule that disrupts IGF-2 BP3, a protein that fuels leukemia by stabilizing cancer-promoting RNA. Senior author and CAP member Dr. Dinesh Rao says, quote, what matters most is that we proved we can hit the protein and disrupt its biology. It's a step forward not just for leukemia research, but for the entire field of RNA-binding proteins in cancer. And finally, as we reported in our lead story, when it comes to traumatic injury, the most dangerous moments often happen long before a patient reaches the hospital. For pathologists, emergency physicians, and EMS teams, the question isn't whether blood saves lives. It's how quickly it can reach the patient who needs it and what systems must be in place to support that care. To explore what this looks like in practice, I'm joined by CAP member Dr. Julie Cruz. Dr. Cruz, what inciting incident sparked the need to address this concept of pre-hospital transfusions?

• Dr. Julie Cruz

  So, you know, this was basically brought up based on military experience in Iraq and Afghanistan. Afghanistan. And when those surgeons returned back to the civilian theater, the ability to provide far forward or pre-hospital blood is not there. So their experiences that were very positive and showed how good it was resuscitative strategy created a frustration in the civilian theater because they were not able to deliver that same standard of care. So that was the beginning. And it was really through the leadership of Dr. John Holcomb and others who came back and said, we need to do this for our trauma patients in the civilian theater. This is the right thing to do. And we can take those lessons that were learned far forward and bring them to the civilian theater. So that's really the inciting incident.

• Stevon Burrell

  No. Some states are still placing limits on EMS teams starting transfusions in the field. What are their concerns and how can they be overcome?

• Dr. Julie Cruz

  You know, the biggest thing is it's an issue of access and equity, right? So where you receive your care or where you live shouldn't make a difference in what life-saving measures are available to you. So. As we look at those limitations, you know, some states in the scope of practice have been hesitant to acknowledge that pre-hospital providers, our paramedicine folks, our clinical colleagues. and they operate according to evidence-based protocols with an EMS medical director oversight, and they have the capabilities already in place and the additional knowledge on how to administer other ACLS drugs and therapies. And so the blood transfusion really is just an extension of that. You know, some folks have a concern. They say, well, you know, blood's highly regulated and carefully controlled. And my response to that is, you mean like narcotics? You know, our EMS folks, paramedics are routinely managing those appropriately, tracking them appropriately, and then monitoring patients for adverse events. Blood is really no different. It's simply a matter of education.

• Stevon Burrell

  The physician statement notes that pre-hospital transfusions could save up to 10,000 lives a year. Now, why is that figure so important?

• Dr. Julie Cruz

  So that figure comes from the National Highway Traffic Safety Administration. They have initiated a program called Road to Zero. And this program is intended to reduce traffic fatalities with the ultimate goal being zero fatalities. So it has a broad program that includes everything from manufacturing safer vehicles and engineering roads differently and some of those kinds of mechanical processes. But also then includes pre-hospital blood. And from their system, they have a system called FARS, it's Fatality Analysis Reporting System. From that system, they were able to extract data that over 10,000... pediatric and adult patients were alive at the scene when EMS arrived, but then died before they reached the hospital for that opportunity for definitive care.

• Stevon Burrell

  And according to the CAP, EMS providers can safely initiate transfusions before a patient reaches the hospital. So how does the statement describe that capability?

• Dr. Julie Cruz

  our EMS colleagues are operating under evidence-based protocols and with physician oversight and really are akin to providers that are in the hospital. So I think it's really important. I think sometimes, especially within our own, with our own membership or our transfusion service pathologists, they don't realize how analogous that care is. We think about the outside of the hospital as an uncontrolled environment, and certainly it is. But kind of recognizing that these people can be hanging upside down through a windshield, intubating a patient with the blanket over the top of them while fire is using the jaws of life to extract the patient. They can definitely handle blood.

• Stevon Burrell

  That's all we have for today. You can find us on Apple Podcasts, Amazon Music, or Spotify. Subscribe on your favorite platform. Look for more news like this in our weekly newsletters published every Tuesday and Thursday. We're back tomorrow at 5 a.m. Eastern with more CAP News. For The Daily Edition, I'm Stevon Burrell. Have a great day.