Going for gold: blood planning for the London 2012 Olympic Games

Glasgow, Simon; Allard, Shubha; Rackham, Richard; Doughty, Heidi

doi:10.1111/tme.12116

Cited by 14 publications

(17 citation statements)

References 46 publications

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“…New DCR paradigms requiring transfusion of more blood products per casualty will also increase the strain on these limited resources. 34 There are important implications, therefore, for major incident preparedness, as well as for planning for expected events such as the London Olympics. We studied the utilisation of blood stocks during mass casualty events through a systematic review of the literature and a detailed examination of blood utilisation during the London bombings and Norway attacks.…”

Section: Mass Casualty and Event Response Planningsmentioning

confidence: 99%

“…We were able to feed this information into the planning process for the 2012 London Olympics. 34 We then created a model of casualty flow and blood utilisation by hospitals during a mass casualty event. 35 We populated this with the data collected from the literature, our specific investigations and the results of interviews with hospital staff and specialists.…”

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confidence: 99%

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Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood

Brohi

Eaglestone

2017

Programme Grants Appl Res

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Introduction Dysfunction of the coagulation system, termed trauma-induced coagulopathy (TIC), is a major problem in patients who bleed after injury. Trauma haemorrhage is considered one of the leading preventable causes of death worldwide. Deaths occur early and, despite the presence of trauma teams and large transfusions of blood products, outcomes remain poor. Methods We conducted a multimodal programme of work to develop our understanding of coagulopathy and its optimal management. We studied the epidemiology, management and health economics of trauma haemorrhage, including the provision of care during mass casualty events. We combined systematic reviews of the literature with a national study of trauma haemorrhage, its transfusion management and associated health-care costs. We further examined several point-of-care coagulation tools for their ability to diagnose coagulopathy and assess the response to blood component therapy. We progressively implemented our findings into practice and assessed the outcomes of trauma patients presenting to our major trauma centre. To examine different approaches to the provision of blood to casualties in a mass casualty event, we constructed a discrete event model based on data from the 2005 London bombings. Key results Our systematic reviews found little strong evidence for the existing diagnostic tools or the practice of delivery of blood components in trauma haemorrhage. Our national study recruited 442 patients in 22 hospitals and found that the 1-year mortality rate for massive haemorrhage approached 50%. Half of these deaths occurred in the first 24 hours after injury and half of these occurred in the first 4 hours. We identified this early time window as a period when the provision of blood component therapy was often below the recommended thresholds and blood component therapy was delivered inconsistently. Studying early TIC we determined that loss of fibrinogen and excessive fibrinolysis were key derangements. We were able to determine that rotational thromboelastometry could identify early coagulopathy within 5 minutes, a large improvement on laboratory tests. We were further able to show how existing damage control resuscitation regimens with high-dose plasma do not maintain haemostatic competency during haemorrhage. In total, the estimated cost of treating a major haemorrhage patient was £20,600 and the estimated cost of treating a massive haemorrhage patient was £24,000. Nationally, the estimated cost of trauma haemorrhage is £85M annually. In mass casualty situations, early results show that the only mutable factor that affects the provision of care to a large degree, in the initial phase of the response, is the level of blood stocks held in the receiving hospital. Conclusions This multimodal programme of work has led to new understandings of the epidemiology of trauma haemorrhage and its underlying mechanisms and clinical course. We have defined diagnostic tools and trigger thresholds for identification and management and increased our understanding of how blood component and other therapeutics affect coagulopathy and when they are likely to be most effective. This diagnostic work has been taken forward at an international level to produce new personalised guidelines for the management of trauma haemorrhage. The findings have had important therapeutic implications, which have led to important changes in practice that have been incorporated into new national and international guidelines. Funding The National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Mass Casualty and Event Response Planningsmentioning

confidence: 99%

mentioning

confidence: 99%

Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood

Brohi

Eaglestone

2017

Programme Grants Appl Res

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“…It is better to start transfusion treatment early followed by safe and rapid MTP de-escalation if not required. The process becomes even more valuable in the context of multiple casualties where blood component use may need to be prioritised [26]. Some investigators have developed predictive models for massive transfusion to aid clinical decision making [9,10,27,28].…”

Section: Discussionmentioning

confidence: 99%

Emergency red cells first: Rapid response or speed bump? The evolution of a massive transfusion protocol for trauma in a single UK centre

Boutefnouchet

Gregg

Tidman

et al. 2015

Injury

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“…Approximately 85% of the nation's transfusion needs are provided by the English Blood Service, NHS Blood and Transplant (NHSBT). NHSBT undertook a review of its MCE transfusion response plans in preparation for the 2012 London Olympic Games and is currently reviewing the implications of the Paris MCE.…”

Section: Transfusion Service Delivery For Mces In the United Kingdommentioning

confidence: 99%

Mass casualty events: blood transfusion emergency preparedness across the continuum of care

2016

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Transfusion support is a key enabler to the response to mass casualty events (MCEs). Transfusion demand and capability planning should be an integrated part of the medical planning process for emergency system preparedness. Historical reviews have recently supported demand planning for MCEs and mass gatherings; however, computer modeling offers greater insights for resource management. The challenge remains balancing demand and supply especially the demand for universal components such as group O red blood cells. The current prehospital and hospital capability has benefited from investment in the management of massive hemorrhage. The management of massive hemorrhage should address both hemorrhage control and hemostatic support. Labile blood components cannot be stockpiled and a large surge in demand is a challenge for transfusion providers. The use of blood components may need to be triaged and demand managed. Two contrasting models of transfusion planning for MCEs are described. Both illustrate an integrated approach to preparedness where blood transfusion services work closely with health care providers and the donor community. Preparedness includes appropriate stock management and resupply from other centers. However, the introduction of alternative transfusion products, transfusion triage, and the greater use of an emergency donor panel to provide whole blood may permit greater resilience.

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Going for gold: blood planning for the London 2012 Olympic Games

Cited by 14 publications

References 46 publications

Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood

Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood

Emergency red cells first: Rapid response or speed bump? The evolution of a massive transfusion protocol for trauma in a single UK centre

Mass casualty events: blood transfusion emergency preparedness across the continuum of care

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