
January 13, 2025
MENASHA – In what is being described as a groundbreaking initiative to enhance emergency care, Gold Cross Ambulance now offers whole blood products as part of its ambulance services.
Nick Romenesko, executive director of Gold Cross Ambulance, said this innovative step aims to improve patient outcomes during critical situations, particularly for trauma and surgical patients who require rapid transfusions.
‘A game changer’
Romenesko said it’s not often that someone would expect whole blood therapy – also known as a blood transfusion – in an ambulance.
Rightfully so, he said, as until March 2024, first responders were not authorized by the Wisconsin Department of Health Services to offer patients whole blood transfusions, limiting it only to a hospital setting.
The ability to administer whole blood directly in the field, Romenesko said, allows Gold Cross Ambulance to act quickly and improve survival rates and recovery times for patients – describing it as “a game changer.”
“When you have traumatic incidents or situations where there’s a heavy amount of blood loss, there really is no substitution to this type of therapy,” he said.
Not every call requires this therapy, and Romenesko said Gold Cross has protocols for trauma alerts where patients are exhibiting signs of shock or massive external or internal bleeding.
Having whole blood therapy capabilities in the ambulance, he said, allows paramedics to replace lost blood right at the scene or en route to the hospital rather than waiting.
“This is a groundbreaking ability,” he said.
Romenesko said Gold Cross Ambulance has two of the six whole blood transfusion kits in the region, with ThedaCare in Neenah having two and the helicopter in the area having the other two.

“We have a very small amount of whole blood that can be given out because it’s such a vital resource,” he said. “The Community Blood Bank only has so much.”
By equipping the Gold Cross team with whole blood products, Romenesko said they can significantly reduce the time it takes to administer essential blood components, thereby potentially increasing survival rates and improving recovery times for patients in critical condition.
“This is a monumental advancement in our commitment to providing the highest standard of care,” he said. “The ability to administer whole blood directly in the field allows our team to act swiftly, providing a critical bridge to definitive care in hospitals.”
Romenesko said Gold Cross administered its first unit of whole blood therapy last month when it was dispatched to a critical medical emergency in Appleton.
The whole blood therapy ambulance – known as the rapid response vehicle – he said, was actually not the first on the scene but was requested.
When paramedics arrived on the scene, he said they identified that the patient required whole blood therapy and requested Gold Cross’ rapid response vehicle.
A collaboration effort, with a history
Romenesko said the decision to carry whole blood products comes after extensive collaboration with local hospitals, blood banks and trauma specialists.
The Gold Cross EMS team, he said, has undergone specialized training to ensure safe handling and effective transfusion procedures on site.
Romenesko said the initiative is in line with national best practices and recommendations for pre-hospital care.
In Wisconsin, he said Gold Cross – which covers 1,200 square miles of portions of Calumet, Outagamie, Waupaca and Winnebago counties, responding to more than 21,000 calls each year – is the second ambulance service able to provide the therapy, the other one is in Milwaukee County.
“A lot of what we learn, especially with trauma medical care, comes from the military,” he said. “In Iraq and Afghanistan, blood therapy became the No. 1 treatment for hemorrhaging soldiers.”
Whole blood therapy, Romenesko said, has been around much longer than most people think – predominantly starting during World War I.
He said it’s one of those things that went away and came back.
“That’s the funny thing about medicine, sometimes we think too much about how to do things, we think there’s more complicated solutions, but many times, it’s pretty straightforward,” he said.
Romenesko said Gold Cross stocks blood from universal donors, which allows for safe transfusions.
All five of Gold Cross’ operations managers, he said, were excited to become a whole blood therapy carrier.
“One of the managers, Brian Nolde, has a military background, so he had first-hand experience seeing this type of therapy work,” he said. “So, he knew that it was really important for our community to have.”
The Gold Cross Board of Directors – which consists of leaders from both ThedaCare and Ascension – were also supportive backers as they, too, recognized the importance of getting this therapy into Gold Cross ambulances.

Carrying whole blood products, Romenesko said, is Gold Cross’ most recent advancement in its mission to provide the best care possible.
“These days it’s not just showing up and getting them to the hospital – it’s diagnosing, treating and making this person feel better right now,” he said. “It helps mitigate some of the work that needs to be done in the ER as well.”
Becoming more prevalent, at a cost
Though only between 250-300 ambulance providers nationwide currently offer whole blood therapy services, Romenesko said he believes this will become a more common thing among ambulances.
The key, he said, is access to a blood bank and access to a trauma center.
Within urban settings, Romenesko said he predicts people will likely begin to see more ways whole blood will be used.
The therapy, he said, has a lot of moving parts that all have to function for it to remain usable.
This includes storing the blood at a consistent temperature.
To accomplish this, Romenesko said the blood cooler has inserts that will keep it cool for up to 12 hours.
Attached to the cooler is a Wi-Fi unit connected to a thermometer inside the cooler, he said, that sends real-time temperatures every five minutes, providing real-time diagnostics, too.
Within the rapid response vehicle, he said there is also a warming device so the blood can be effectively transfused, without causing the patient to become hypothermic.
Specialized tubing, Romenesko said, is also needed.
Each fully set up unit, he said, costs about $10,000, with each unit of whole blood coming in at about $500.
When you consider Gold Cross has 19 ambulances ready, Romenesko said to do that across 19 ambulances would’ve been a huge investment.
An even larger problem, he said, is how there isn’t enough whole blood in the area to stock every ambulance.
However, now that Gold Cross has a rapid response vehicle with whole blood therapy capabilities, Romenesko said it gives the team a chance to introduce whole blood therapy to the other regional ambulance providers.
“Because it’s in the rapid response vehicle, it’s very mobile,” he said. “We’ve been communicating with all the regional groups. We’ve been doing our best to let them know that this is their resource as well. This is a community resource.”
Learn more at goldcross.org.