Economical provision of blood components for critical patient transport across a large geographic area

Latimer, Andrew J.; Utarnachitt, Richard B.; Tuott, Erin E; Hess, John R.

doi:10.1111/trf.16315

Cited by 6 publications

(5 citation statements)

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“…From November 2012 – February 2014, HMC participated in the Pragmatic Randomized Optimal Plasma and Platelet Ratios (PROPPR) trial 5 . In July 2015, the HMC transfusion service began supplying liquid plasma and red blood cells to both the rotary and fixed‐wing aircraft of AirLift NorthWest, the UW critical care air ambulance service 6,7 . As of June, 2019, whole blood was incorporated into HMC resuscitation protocols.…”

Section: Introductionmentioning

confidence: 99%

Blood component use and injury characteristics of acute trauma patients arriving from the scene of injury or as transfers to a large, mature US Level 1 trauma center serving a large, geographically diverse region

et al. 2021

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Background Advanced trauma care demands the timely availability of hemostatic blood products, posing special challenges for regional systems in geographically diverse areas. We describe acute trauma blood use by transfer status and injury characteristics at a large regional Level 1 trauma center. Study design and methods We reviewed Harborview Medical Center (HMC) Trauma Registry, Transfusion Service, and electronic medical records on acute trauma patients for demographics, injury patterns, blood use, and in‐hospital mortality, 2011–2019. Results Among 47,471 patients (mean age 45.2 ± 23.0 years; 68.3% male; Injury Severity Score 12.6 ± 11.1), 4.7% died and 8547 (18%) received at least one blood component through HMC. Firearms injuries were the most often transfused (690/2596, 26.6%) and the most urgently (39.9% ≥3 units in <1 h; 40.6% ≥5 units in <4 h), and had the highest mortality (case‐fatality, 12.2%) (all p < .001). From‐scene patients were younger than transfers (42.9 ± 21.0 vs. 47.2 ± 24.4), predominated among firearms injuries (68.2% from‐scene vs. 31.8% transfers), were more likely to receive blood (18.5% vs. 17.6%) more urgently (≥3 units first hour, 24.4% vs. 7.7%; ≥5 units first 4 h: 25.6% vs. 8.2%), were more likely to die of hemorrhage (15.5% vs. 4.3%) and from firearms injuries (310/1360, 22.8%) (all p < .001). Discussion Early blood use, firearms injuries, and mortality were all greater among from‐scene patients, and firearms injuries had worse outcomes despite greater and more urgent blood use, but the role of survivor bias for transfer patients must be clarified. Future research must identify strategies for providing local hemostatic transfusion support, particularly for firearms injuries.

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Section: Introductionmentioning

confidence: 99%

Blood component use and injury characteristics of acute trauma patients arriving from the scene of injury or as transfers to a large, mature US Level 1 trauma center serving a large, geographically diverse region

et al. 2021

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“…As such, our interests have always focused on what is immediately available to be pulled out of the cooler, hung, and dependably re-supplied in quantity in the first urgent hours of resuscitation of critical bleeding. 9,10,15 We have been able to deliver LTOWB and components to our pre-hospital care partners continuously without a break in service. We have also been able to meet our inhospital educational and service goals of providing enough WB so that all the surgical residents and critical care fellows and all trauma anesthesiologists have developed experience and comfort with both WB and component resuscitation.…”

Section: Discussionmentioning

confidence: 99%

“…As such, our interests have always focused on what is immediately available to be pulled out of the cooler, hung, and dependably re‐supplied in quantity in the first urgent hours of resuscitation of critical bleeding 9,10,15 . We have been able to deliver LTOWB and components to our pre‐hospital care partners continuously without a break in service.…”

Section: Discussionmentioning

confidence: 99%

“…In December 2018, the Transfusion Committee made the formal decision to initiate a WB program. Given the success of the Harborview Transfusion Service in developing, validating, and supporting a program to deploy units of liquid plasma and red cells to the University of Washington AirLift NorthWest regional air ambulance system, 8,9 the logistical support necessary for expanding such a program to the Seattle Medic-One ground ambulance system was already in place. We were therefore directed to develop a pilot program that incorporated WB into both fixed-facility and pre-hospital acute resuscitation protocols.…”

Section: The Decision To Provide Wbmentioning

confidence: 99%

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How we built a hospital‐based community whole blood program

et al. 2022

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Background: Whole blood (WB) is an attractive product for prehospital treatment of hemorrhagic shock and for initial in-hospital resuscitation of patients likely to require massive transfusion. Neither our regional blood provider nor our hospital blood bank had recent experience collecting or using WB, so we developed a stepwise process to gather experience with WB in clinical practice. Methods: When our Transfusion Committee suggested a WB program, we worked with our regional blood provider to collect cold-stored, leukoreduced, low-titer anti-A, and anti-B group O RhD positive WB (low-titer group O WB [LTOWB]) and worked with our city Fire Department to integrate it into prehospital care. This work required planning, development of protocols, writing software for blood bank and electronic medical records, changes in paramedic scope of practice, public information, training of clinicians, and close clinical follow-up.Results: Between June 2019 and December 2021, we received 2269 units of LTOWB and transfused 2220 units; 24 (1%) were wasted, two were withdrawn, and 23 were in stock at the end of that time. Most (89%) were transfused to trauma patients. Usage has grown from 48 to 120 units/month, covers all 5 Fire Districts in the county, and represents about 1 /4 of all hospital trauma blood product use. Conclusions: Developing a WB program is complex but can be started slowly, including both pre-hospital and hospital elements, and expanded as resources and training progress. The investments of time, effort, and funding involved can potentially improve care, save blood bank and nursing effort, and reduce patient charges.

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“…The Transfusion Service at Harborview Medical Center supplies about 8000 units of packed red blood cells (RBCs), 4000 units of plasma, 1400 units of apheresis platelets, and 300 pools of cryoprecipitate to hospital patients each year. The transfusion service also supplied 1850 units/year of RBCs and liquid plasma to the University of Washington's air medical service, AirLift Northwest, of which about 250 products a year are transfused and all but 3% of the remainder returned to inventory and used in the hospital 3 …”

Section: Methodsmentioning

confidence: 99%

Providing whole blood for an urban paramedical ambulance system

et al. 2021

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Introduction Hemorrhage is the second leading cause of death among urban trauma patients, and the provision of prehospital blood‐based resuscitation can be lifesaving. We developed an efficient system to support blood‐based resuscitation by an urban advanced life support ambulance system. Methods We worked with our state health department for permission for fire department paramedics to initiate blood transfusion and built protocols for field whole blood resuscitation. Our regional trauma center transfusion service provided 2 units of O positive, low‐titer, leukoreduced whole blood in an internally monitored and sealed ice box weighing 10 pounds to the fire department paramedic supervisor. When notified, the supervisor transported the blood to the sites of anticipated need. Total blood use and wastage were recorded. Results Following two public hearings, we obtained state‐wide approval for the initiation of emergency uncrossmatched blood transfusion by paramedics. Over a 1‐year period beginning August 27, 2019, 160 units of whole blood were made available for use, and 51 units were transfused to 39 patients, 30 of whom were trauma patients. Other recipients include patients in shock from massive gastrointestinal, peripartum, or other suspected bleeding. Unused units were returned to the providing transfusion service after 1 week and used for hospital patient care without loss. The estimated cost of providing blood per mission was $0.28 and per patient transfused was $1138. Conclusions With appropriate attention to detail, it is possible to provide whole blood to an urban paramedical ambulance system with efficient blood component usage, minimal blood wastage, and low cost.

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Economical provision of blood components for critical patient transport across a large geographic area

Cited by 6 publications

References 6 publications

Blood component use and injury characteristics of acute trauma patients arriving from the scene of injury or as transfers to a large, mature US Level 1 trauma center serving a large, geographically diverse region

Blood component use and injury characteristics of acute trauma patients arriving from the scene of injury or as transfers to a large, mature US Level 1 trauma center serving a large, geographically diverse region

How we built a hospital‐based community whole blood program

Providing whole blood for an urban paramedical ambulance system

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