The Norwegian blood preparedness project: A whole blood program including civilian walking blood banks for early treatment of patients with life‐threatening bleeding in municipal health care services, ambulance services, and rural hospitals

Abstract

Background Civilian and military guidelines recommend early balanced transfusion to patients with life‐threatening bleeding to improve survival. To provide the best care to patients with hemorrhagic shock in regions with reduced access to evacuation, blood preparedness must be ensured also on a municipal health care level. The primary aim of the Norwegian Blood Preparedness project is to enable rural hospitals, prehospital ambulance services, and municipal health care services to start early balanced blood transfusions for patients with life‐threatening bleeding regardless of etiology. Study Design and Methods The project is designed based on three principles: (1) Early balanced transfusion should be provided for patients with life‐threatening bleeding, (2) Management of an emergency requires a planned and rehearsed day‐to‐day system for blood preparedness, and (3) A decentralized system is needed to ensure local self‐sufficiency in an emergency. We developed a system for education and training in blood‐based resuscitation with a focus on the municipal health care service. Results In this publication, we describe the implementation of emergency whole blood collections from a preplanned civilian walking blood bank in the municipal health care service. This includes donor selection, whole blood collection, emergency transfusion and quality assessment of practice. Conclusion We conclude that implementation of a Whole Blood based emergency transfusion program is feasible on all health care levels and that a preplanned civilian walking blood bank should be considered in locations were prolonged transport‐times may reduce access to blood transfusion for patients with life threatening bleeding.

Resuscitative practices and the use of low-titer group O whole blood in pediatric trauma

“…At this time, the use of cold-stored whole blood is considered a best practice by the US military, in adult trauma centers in the United States, and internationally. 43,[54][55][56] The benefits and risks of LTOWB compared with component therapy are summarized in Table 1. 45,50,51,53,57,58 Current data support that LTOWB is a safe, efficient, and feasible tool in pediatric trauma resuscitation and may also improve clinical outcomes.…”

“…Hanna et al, 53 in an analysis of more than 8,000 patients in the Trauma Quality Improvement database, reported that LTOWB was independently associated with reduced 24-hour mortality, in-hospital mortality, and major complications in adults with traumatic bleeding. At this time, the use of cold-stored whole blood is considered a best practice by the US military, in adult trauma centers in the United States, and internationally 43,54–56 . The benefits and risks of LTOWB compared with component therapy are summarized in Table 1 45,50,51,53,57,58 …”

Whole blood in civilian transfusion practice: A review of the literature

“…This article reviews the literature on adult and pediatric applications of LTOWB with a focus on North America, as experience in other geographic areas has been published elsewhere. 3,4 It will also examine the use of LTOWB from vein to vein, starting at the blood center, then moving into the field, and finally into the hospital.…”

Total defence and blood preparedness

“…Blodprodukter til bruk ved eventuelle militaere operasjoner i Norge eller ved bruk av norske militaere styrker til operasjoner utenfor Norge må produseres av sivile blodbanker i Norge. Vandrende blodbanker er en nødløsning der tilstrekkelig tilgang på blodprodukter er truet av logistiske årsaker, men vil, som Nissen-Meyer og medforfattere påpeker, gi en svaert volummessig begrenset effekt (3,18,19).…”