Blood product availability in the Washington state trauma system

Abstract

Background Early transfusion can prolong life in injured patients awaiting definitive hemorrhage control. We conducted a community resources assessment of blood product availability at hospitals within the Washington State (WA) Regional Trauma System, with the expectation that a minority of Level IV and V centers would have blood products routinely available for use in resuscitation. Methods We designed a questionnaire soliciting information on routinely available unit quantities of red blood cells (RBC), plasma, platelets, cryoprecipitate, and/or whole blood and submitted this questionnaire electronically to the 82 WA designated trauma centers (Levels I–V). Non‐responders were contacted directly by telephone. The study was conducted in September and October 2021. US 2020 census data were used to correlate results with local population densities. Results First‐round contact netted responses from 57 (70%) centers; the remaining centers provided information via telephone, for a 100% final response. Packed RBC were available in 79 of the 82 centers (96%; range 6–220 units); plasma, 62 centers (76%, range 1–100 units); platelets, 40 centers (49%, range 1–8 units); cryoprecipitate, 45 centers (55%, range 1–20 units). Whole blood was only available at the Level I center. Three Level V centers, located in 2 of the 8 WA state trauma regions, reported no routine blood availability. The two trauma regions affected represent 12% of the state's population and more than a third of its geographic area. Conclusions Within the WA regional trauma system, blood products are wide, if unevenly, available. Large urban/rural disparities in availability exist that should be explored.

Developing a National Trauma Research Action Plan: Results from the trauma systems and informatics panel Delphi survey

“…[25][26][27][28] Previous research has used this approach to evaluate individual state and regional trauma systems. [29][30][31][32][33][34] These observations further align with the work of the Trauma Systems Committee of the American College of Surgeons Committee on Trauma to assess trauma center designation based on population need to ensure timely access to care. 6 As highlighted by the panel, more research is needed to understand the best balance of these priorities (e.g., access, equity, patient volume to care quality relationship) in modern trauma system design.…”

“…Furthermore, many questions considered geospatial analysis as an important strategy to evaluate access to care and to assess trauma center distribution in the civilian setting, which aligns with the desire to ensure equitable access to care while concentrating patients with the most severe injuries in regional Level I or II trauma centers 25–28 . Previous research has used this approach to evaluate individual state and regional trauma systems 29–34 . These observations further align with the work of the Trauma Systems Committee of the American College of Surgeons Committee on Trauma to assess trauma center designation based on population need to ensure timely access to care 6 .…”

“…22 However, the Trauma Systems Panel also raised as an important issue the need for research around the logistical challenges of operationalizing prehospital transfusion programs using robust implementation science approaches. [34][35][36][37] Given that hemorrhage is the leading mechanism of death from potentially survivable injury, it is not surprising that several high-priority research questions also related to innovative strategies to enhance diagnostics and provide earlier identification of compensated/occult shock using point of care devices. The importance of developing strategies to support severe and critically injured patients in austere environments (e.g., prolonged field care scenarios, shipboard incidents, multiple In combat trauma, do small surgical teams (5 or less personnel with 1 surgeon) at the casualty collection points (within 2 km of the injury) decrease mortality versus TCCC and transport to a more robust surgical team (10 or more person team) or a field hospital?…”

How we built a hospital‐based community whole blood program

“…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.…”

“…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.…”