Transfusion emergency preparedness for mass casualty events

Abstract

Transfusion emergency preparedness is increasingly being recognized as an important element in the healthcare response to mass casualty events (MCE). Planning should be designed to support an integrated response between the blood services and hospitals. The lessons identified from the Manchester Arena bombing in 2017 and recent incidents in London have led to new guidance. Demand planning has been informed by the global experience of civilian MCEs and the changing trends in trauma care. Past evidence suggests that only a modest number of hospitalized patients following MCEs require transfusion. The mean blood use per patient admitted is consistently calculated at 2–3 red cell units. Most blood is used within the first 6 h. However, a small number of critically injured with multi‐trauma may require massive transfusion and ongoing support. Many blood services have reported meeting the initial overall demand for blood from stock. However, universal components may be in short supply. The demand can be managed by pre‐agreed substitutions. Early transfusion triage enables the best use of hospital laboratory and blood service support. Careful communication with donor communities is essential to manage a controlled replenishment of stocks. Future challenges for the transfusion community include the trend towards lower red cell stock holdings and the changing trends in weapon use and tactics. A standardized approach to transfusion data collection is required to support future planning. The transfusion community is encouraged to plan for MCEs, contribute to ‘after action reviews’ and work together for safe and sustainable transfusion support.

Transfusion support in mass casualty events: lessons for hospital and pathology preparedness from the Bourke Street Mall incident

“…The Bourke Street Mall MCE highlighted the challenges involved in supplying blood components during such events. The recommendations are similar to those published in a previous review on transfusion preparedness for MCEs and recognise the requirement for an integrated approach that includes a central role for pathology laboratories. Incorporating the lessons learnt from this incident will allow for more organised responses and streamlined communications between all departments and institutions.…”

“…Extra staff may be required and there may be difficulty of access to workplaces if the incident results in road closures. Working during the incident can be physically and emotionally tiring, and replacement staff will be required after the event . Therefore, it is recommended that all staff, irrespective of experience, should be familiar with their local critical incident management plan, and that consideration be given to how staffing levels are managed during and after a critical incident.…”

“…Mass casualty events (MCEs) are defined as events or other circumstances “where the normal major incident response of one or several health organisations must be augmented by extraordinary measures to maintain an efficient, suitable and sustainable response” . Haemorrhage is a leading cause of mortality in MCEs, accounting for almost 50% of deaths in the first 24 hours, and transfusion emergency preparedness is increasingly recognised as a critical element of an integrated approach to MCEs, with timely availability and appropriate delivery of blood components being an essential part of management.…”

Critical developments of 2018: A review of the literature from selected topics in transfusion. A committee report from the AABB's Clinical Transfusion Medicine Committee

“…Most blood products were needed within the first 12 to 24 hours (medians: RBCs, 67%; plasma, 75%; platelets, 84%) . Several areas for improvement during mass casualty events include specimen and patient identification, expediting ABO/Rh typing, allocation of group O RBCs, and communication. The need for improved communication was frequently noted between blood suppliers and hospitals, between blood suppliers and regional emergency management systems (to expedite sending blood components to hospitals receiving patients), and between blood suppliers and the public and media, with regard to the need (or not) for blood donations .…”

Emergency preparedness, resilience and response guidance for UK hospital transfusion teams

“…The main aims were meeting a potential surge in demand for blood components and to optimise Hospital Transfusion Laboratory support following a Mass Casualty Event (MCE). In 2017, there were several major incidents in the UK, which together with global events, have highlighted the need to revisit national transfusion emergency preparedness . The group was reconvened in late 2017.…”