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

Abstract

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.

Blood component transfusions in mass casualty events

“…Various estimations of blood transfusion needs in MCEs have been based on numbers of patients brought to hospitals or admitted or in triage categories of injury severity [2]. The AABB Interorganizational Task Force on Domestic Disasters and Acts of Terrorism (AABB ITF) recommended three group O RBC units per patient admitted (UPA) as an initial estimate of RBC needs in a disaster [3,4].…”

How do I get an emergency civilian walking blood bank running?

“…The goal was to implement WB and FDP as far forward as possible in military settings. In our civilian health care services, the collaboration resulted in a contingency plan for our hospital in case of a mass casualty event (MCE) . This includes the use of freshly drawn WB from established or pre‐tested blood group O donors with a low titer of anti‐A and anti‐B (LTOWB).…”

“…In our civilian health care services, the collaboration resulted in a contingency plan for our hospital in case of a mass casualty event (MCE). 10 This includes the use of freshly drawn WB from established or pre-tested blood group O donors with a low titer of anti-A and anti-B (LTOWB). In our civilian helicopter emergency medical service (HEMS) we have progressively introduced advanced storage and deployment of FDP (2013), pRBC (2014), and LTOWB (2015), 11 followed by in-hospital use of cold-stored LTOWB (2017) for patients with massive bleeding.…”

Disaster planning: the role of the transfusion practitioner

“…The TP will be able to ensure that things that are an absolute requirement when it comes to transfusion and safety are not overlooked, for example correct patient identification and other mandatory patient safety issues regarding transfusion and emergency issue of blood. The training should include what to do when there is limited availability of blood stocks (particularly O negative RBC stock), all the logistic and communication channels used in case of a disaster and link with the massive transfusion protocol . The TP can help ensure that any training exercises for disasters include the laboratory in a meaningful way and can assist staff to understand the outcomes of these sessions and address any issues that might arise.…”