Blood bank protocols for large‐scale civilian casualty events: experience from terrorist bombing in Israel

Abstract

Terrorist attacks in crowded places cause multiple casualties that are evacuated by quick succession to nearby hospitals. The study goals were to analyse the issues of patient misidentification and excessive blood request and to develop recommendations for the management of such episodes. A retrospective analysis of nine explosion attacks was performed. In nine consecutive events, 450 casualties were reported by the National Ambulance Service, 82 of whom (18%) died on the explosion site and 368 were admitted to nearby trauma centres. Red blood cell units were typed and cross-matched for 70 patients. Seventy-three per cent of the blood supplied over the first 24 h was administered during the first 2 h. The cross-matched/transfused ratio was 2.52 +/- 1.42, reflecting the overestimation of blood requirement in mass casualty episodes. In the mass casualty setup, blood bank personnel should be alert to a potential mistransfusion or a blood collection error. Unidentified patients are subjected to errors due to only one-digit difference in their temporary identification number. Application of the system using an additional sequential four-digit number printed in bold and large size font for patients at admission reduced the possibility of misidentification. Modern technologies, including error-reduction design wristbands, barcode-based system or radiofrequency identification tags may also increase reliability of patient identification in the mass casualty setup.

A comprehensive review of blood product use in civilian mass casualty events

“…Twenty eight (10.7%) described quantitative blood consumption in single or multiple MCEs, and seven (2.7%) focused on blood use and supply as a primary objective. 9,11,12,14,18,24Y46 The 28 articles combined with collaborative accounts 19,47Y61 provided a total of 34 reports of individual MCEs with documented RBC consumption. Three reports were excluded from the data analysis: one had reported blood use in excess of the 72-hour defined period, the other two were summaries of events, from which the MOI could not be ascertained or whether they individually met our designated criteria for an MCE.…”

Mechatronic system for performing blood pre-transfusion tests

“…This generates a need for logistic efficiency to keep balance the blood supplies in certain countries or regions. In addition, processing, transportation and storage of blood is complex resulting in regions with a greater risk of lack of blood [30,31].…”

Managing the surge in demand for blood following mass casualty events

“…31,32 The result is two thirds of an event's total RBC requirement on the first day is consumed within the first 4 hours. 14,33,34 Both time and supply elements must be overcome together if MCE RBC provision is to be managed effectively.…”

“…[7][8][9][10][11] The surge in RBC demand from casualties requiring MT has the potential to decimate an individual hospital's blood bank inventory, severely compromising a unit's ability to treat bleeding casualties effectively. [12][13][14] Strategies for best managing this evolving demand are crucial to reduce the inhospital preventable mortality following these events.…”

“…15,16 This has led to the term MCE becoming increasingly synonymous with terrorism and a renewed interest in MCE transfusion planning. 6,14,[17][18][19][20] Modeling methodologies have been applied previously in the context of MCEs, predominantly within the remit of prehospital care. [21][22][23][24][25][26][27][28] Examples of in-hospital event modeling have indicated the perceived capacity of hospitals to manage MCEs to be overly optimistic, one specifically identified blood product volume as a limiting factor in the event response.…”