This story was originally published by KFF Health News.

Crystal Hiwalker wonders if her heart and lungs would have continued functioning if paramedics had been able to give her a blood transfusion as the blood drained from her body during the stormy 100-mile ride.

Because of the 2019 snowstorm, the drive from her small town of Lame Deer, Montana, to the modern trauma center in Billings took two and a half hours.

Doctors at Billings Clinic resuscitated Hiwalker and stopped the bleeding from her ruptured ectopic pregnancy. They were shocked that she not only survived after her heart stopped beating and she lost nearly all of her blood, but that she also recovered without brain damage.

The Montana State Trauma Care Committee, which works to reduce trauma incidents and improve care, later discovered that the ambulance transporting Hiwalker had passed two hospitals that had blood supplies. What if Hiwalker had access to that blood on her way to Billings, committee members asked.

That realization and question inspired committee members to create the Montana Interfacility Blood Network, which they say is the first program of its kind in the U.S. The network allows emergency responders to collect blood from hospitals and deliver it to patients en route to the advanced care they need.

“We came up with the idea of ​​giving blood — like driving through the drive-thru at a fast-food restaurant — and picking up blood along the way,” said Gordon Riha, a trauma surgeon at the Billings Clinic Trauma Center, where Hiwalker was treated. Riha said timely blood transfusions could prevent death or permanent brain damage.

The network targets patients in rural areas where rates of traumatic injury and death are elevated, says Alyssa Johnson, trauma system manager for the state of Montana.

“We have to get more creative. We don't have a blood bank on every corner, nor do we have a Level 1 trauma center on every corner,” Johnson said.

Network leaders say the program has helped at least three patients since it launched in 2022. They hope it will be used more widely in the future.

Hiwalker is enthusiastic about the program.

“I am so glad that something like this has been started because it could save many lives in my area,” she said.

Hiwalker said she has heard of people bleeding to death in her rural community after car accidents, gunshot wounds and stabbings. Johnson said workplace accidents, cancer, gastrointestinal problems and childbirth can also cause severe bleeding.

Montana's trauma committee began discussing the blood network several months after Hiwalker's near death. First, it created a map of 48 facilities with blood banks. Then it developed guidelines for how hospitals, blood banks, outpatient clinics and labs should communicate, package, transport, document and bill for blood.

The network is used only in emergency situations, meaning there is no time to test the blood group of patients. Therefore, only group O red blood cells are used, which can be safely transfused to most patients.

The receiving hospital – not the one that provided the blood – is responsible for billing the patient's insurance for the cost of the blood. The cost depends on how much blood the patient needs, but typically ranges from several hundred to over a thousand dollars, says Sadie Arnold, who runs the Billings Clinic blood bank.

Arnold said blood must be stored in a laboratory and managed by professionals with appropriate degrees, clinical experience and professional certifications.

Some rural hospitals lack the space for a lab or the money to hire those specialists, Arnold said. Or they don't need blood often enough to justify storing a product that can expire and — especially during the current national blood shortage — be needed elsewhere. The network uses blood that has a shelf life of 42 days or less.

Rural hospitals that store blood may have only small amounts on hand. A rural Montana resident with severe bleeding experienced this firsthand when he went to the nearest hospital, which had only one unit of Type O blood on hand, according to a report from the blood service. But thanks to the new program, paramedics were able to collect more blood from a hospital halfway through an 80-mile drive to the trauma center.

Ideally, patients with severe bleeding in rural areas would be transported by rescue helicopter or with blood transfusion equipment. But as in Hiwalker's case, flying is sometimes impossible in bad weather. This can mean hours-long ambulance rides. Some towns in northeast Montana, for example, are more than 250 miles from the nearest modern trauma center.

“This was really designed as a kind of last-ditch effort,” Johnson said. “If we run out of options, we have to get the patient to a larger center, and we can't fly.”

The blood drop might mean the ambulance stops at the second hospital, Johnson said. In one incident, however, a police officer picked up the blood and gave it to the ambulance at a highway exit, she said.

Ambulances may also carry a paramedic or nurse along the way to administer the blood transfusion, as many ambulance crews in rural areas are made up of emergency medical technicians, who are not certified to do so in Montana.

In other cities and states, including rural areas, doctors have already begun performing blood transfusions in ambulances and helicopters, said Claudia Cohn, chief medical officer of the National Association for the Advancement of Blood and Biotherapies.

She said researchers are also interested in the possibility of using frozen and freeze-dried blood products, which could be helpful in rural areas because they are easier to store and have a longer shelf life.

Johnson said the Montana Interfacility Blood Network is the only program she knows of that specifically targets patients in rural areas and involves ambulances picking up blood from hospitals along their routes. She said the network is also attracting interest in other states with large rural regions, including Oregon.

Hiwalker said a blood transfusion in the ambulance could have prevented her near-death experience and the trauma her husband went through watching her suffer in the ambulance. She's glad her ordeal led to an innovation that helps others.

KFF Health News is a national newsroom that produces in-depth coverage of health issues and is one of the core operating programs of KFF – an independent source of health policy research, polling and journalism. Learn more about KFF.

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