Bleeding Patient Receives Essential Blood Products and TXA from Air Care

West Michigan Air Care began carrying two units of thawed uncrossmatched fresh frozen plasma (FFP) on January 19, 2016 in addition to our regular two units of uncrossmatched packed red blood cells (PRBC). A few weeks later, James Diebold was the first to benefit from this addition.

While building an addition on a home on February 6th, 2016, James (J.D.) Diebold, was walking across an area of 2x10 joists when he stepped on a piece of plywood that wasn’t nailed down. The plywood flipped and J.D., still holding his heavy toolbox, fell ribs-first onto a joist knocking the wind out of him, then fell through to the crawl space below. Knocked briefly unconscious, J.D. nevertheless was able to climb out of the construction area and into a pickup truck and was driven 10 miles to South Haven Health System’s Emergency Department. He was dizzy and lost consciousness twice on the way. 

A 4-foot fall onto a joist may not seem like a severe mechanism of injury, but a CT scan showed J.D.’s spleen was fractured beyond repair (Grade V) and he was bleeding extensively into his abdomen. His systolic blood pressure fell to 60 and his heart rate dropped precipitously. Arrangements were quickly made for his transfer to a trauma center. 


Tranexamic Acid (TXA) significantly improves outcomes for trauma patients suffering hypovolemic and/or hemorrhagic shock. TXA is classified as an anti-fibrinolytic drug that stops the breakdown of clots and can prevent further bleeding in trauma.

Packed red blood cells (PRBC) – the red, oxygen-carrying component of blood. 

Fresh frozen plasma (FFP) – the “white” part of the blood that contains coagulation factors necessary for clotting, which helps control further bleeding in hemorrhagic shock. 

When Air Care arrived, the staff was giving intravenous resuscitation fluids and retrieving packed red blood cells (PRBC). The Air Care medical crew helped start the first unit of PRBC from the hospital’s blood bank and gave a Transexamic Acid (TXA) infusion over 10 minutes. The medical crew continued to give blood products in a 1:1 ratio, administering one unit of fresh frozen plasma (FFP) for every unit of PRBC from the blood products they carried onboard. (See TXA, PRBC, and FFP sidebar.)

During the 16-minute air transport, J.D.’s blood pressure continued to trend downward, requiring more blood. By the time the helicopter landed in Kalamazoo, he’d received a total of two units of PRBC and two units of FFP. Upon arrival at Bronson Methodist Hospital Trauma and Emergency Department, Air Care handed over their last unit of PRBC to the trauma team, and J.D. continued to receive blood products as he was prepped for surgery. The rest is a blur for J.D. He went to surgery and his ruptured spleen was removed by Dr. Sheldon Maltz, MD. The surgery went well and J.D. began to heal. 

After dealing with a few complications, J.D. is still having some rib pain but is now at home and getting back into his routine. 

Regarding his experience, J. D. says:  “Little did I know that the frozen plasma onboard was indeed saving my life long enough to make it to trauma surgery where my life could be saved again … you are in the business of saving lives. I give God the glory for the science as well. I pray that you continue to receive all you require to continue your compassionate mission.”

David’s Air Medical Team:

  • DeWayne Miller, Flight Nurse
  • Dawn Johnston, Flight Nurse
  • Brian Vanderberg, Pilot
  • Terry Tratt, Communications Specialist

By Dawn Johnston, BSN, CFRN, EMT-P
Flight Nurse
West Michigan Air Care

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