Transfusion support during mass casualty events

Doughty, Heidi; Green, Laura

doi:10.1016/j.bja.2021.07.027

Cited by 4 publications

(6 citation statements)

References 23 publications

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“…Such an approach is consistent with the AABB Disaster Handbook and should be instituted as a basic requirement for regional MCI and disaster preparedness. 13,14,16,40 Together, all of these measures represent a comprehensive all-hazards disaster management approach that should minimize potentially preventable death from an MCI.…”

Section: Resultsmentioning

confidence: 99%

“…4,7,12,13 Many trauma centers and other high-acuity hospitals have developed massive transfusion protocols (MTPs) to aid clinical teams in transfusing balanced blood product ratios in keeping with DCR principles. 14 Such MTPs have been readily applied during MCIs, but local inventories in even high-volume trauma centers can become depleted. Furthermore, MCI victims are generally spread out across multiple hospitals, some of which may have very limited blood supplies.…”

Section: Introductionmentioning

confidence: 99%

“…Finally, the current regional resupply "stock-and-flow" plan is intended to unfold over days to weeks rather than the minutes to hours needed for life-saving resuscitation for patients with massive hemorrhage. 14 These multiple sources of strain on transfusion services could lead to potentially preventable death during an MCI. 15,19 Although historically, the supply in U.S. hospitals and blood centers has typically been sufficient to cover the immediate demand following a terrorist attack, 20 careful analysis of the current blood inventory practices in major U.S. cities to enable the application of DCR principles during an MCI has not been performed, the adequacy of plasma and platelet inventories in these historic events remains uncertain, and the number of potentially preventable deaths from hemorrhage is unknown.…”

Section: Introductionmentioning

confidence: 99%

“…And for many hospitals and blood suppliers across the country, increasingly lean inventories to limit wastage 15–17 and difficulties meeting daily blood product demands with current donor recruitment strategies 18 make a posture of persistent readiness for such events untenable. Finally, the current regional resupply “stock‐and‐flow” plan is intended to unfold over days to weeks rather than the minutes to hours needed for life‐saving resuscitation for patients with massive hemorrhage 14 …”

Section: Introductionmentioning

confidence: 99%

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U.S. cities will not meet blood product resuscitation standards during major mass casualty incidents: Results of a THOR‐AABB working party prospective analysis

et al. 2022

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Background Mass casualty incidents (MCIs) create an immediate surge in blood product demand. We hypothesize local inventories in major U.S. cities would not meet this demand. Study Design and Methods A simulated blast in a large crowd estimated casualty numbers. Ideal resuscitation was defined as equal amounts of red blood cells (RBCs), plasma, platelets, and cryoprecipitate. Inventory was prospectively collected from six major U.S. cities at six time points between January and July 2019. City‐wide blood inventories were classified as READY (>1 U/injured survivor), DEFICIENT (<10 U/severely injured survivor), or RISK (between READY and DEFICIENT), before and after resupply from local distribution centers (DC), and features of DEFICIENT cities were identified. Results The simulated blast resulted in 2218 injured survivors including 95 with severe injuries. Balanced resuscitation would require between 950 and 2218 units each RBC, plasma, platelets and cryoprecipitate. Inventories in 88 hospitals/health systems and 10 DCs were assessed. Of 36 city‐wide surveys, RISK inventories included RBCs (n = 16; 44%), plasma (n = 24; 67%), platelets (n = 6; 17%), and cryoprecipitate (n = 22; 61%) while DEFICIENT inventories included platelets (n = 30; 83%) and cryoprecipitate (n = 12; 33%). Resupply shifted most RBC and plasma inventories to READY, but some platelet and cryoprecipitate inventories remained at RISK (n = 24; 67% and n = 12; 33%, respectively) or even DEFICIENT (n = 11; 31% and n = 6; 17%, respectively). Cities with DEFICIENT inventories were smaller (p <.001) with fewer blood products per trauma bed (p <.001). Discussion In this simulated blast event, blood product demand exceeded local supply in some major U.S. cities. Options for closing this gap should be explored to optimize resuscitation during MCIs.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

U.S. cities will not meet blood product resuscitation standards during major mass casualty incidents: Results of a THOR‐AABB working party prospective analysis

et al. 2022

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“…This is more challenging when special requirements are needed (e.g., RhD negative RBC for women of childbearing potential or unknown patients), or during major incidents when demand for blood may exceed supply. In such circumstance, the delivery of blood components may require a modified approach, necessitating advanced planning and knowledge of the transfusion service [20].…”

Section: Introductionmentioning

confidence: 99%

International Forum on the Management of Major Haemorrhage: Summary

Green¹,

Stanworth²,

McQuilten³

et al. 2022

Vox Sanguinis

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Optimizing Mass Casualty Triage: Using Discrete Event Simulation to Minimize Time to Resuscitation

Igra,

Schmulevich,

Geng

et al. 2023

Journal of the American College of Surgeons

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Background: Urban areas in the US are increasingly focused on mass casualty incident (MCI) response. We simulated pre-hospital triage scenarios and hypothesized that using hospital-based blood product inventories for on-scene triage decisions would minimize time to treatment. Study Design: Discrete event simulations modeled MCI casualty injuries and patient flow after a simulated blast event in Boston, MA. Casualties were divided into moderate (ISS 9-15) and severe (ISS>15) based on injury patterns. Blood product inventories were collected from all hospitals (n=6). The primary endpoint was the proportion of casualties managed with 1:1:1 balanced resuscitation in a target timeframe (moderate, 3.5U RBC in 6 hours; severe, 10U RBC in 1 hour). Three triage scenarios were compared including unimpeded casualty movement to proximate hospitals (Nearest), equal distribution among hospitals (Equal), and blood product inventory-based triage (Supply-Guided). Results: Simulated MCIs generated a mean +/- SD of 302 +/- 7 casualties including 57 +/- 2 moderate and 15 +/- 2 severe casualties. Nearest triage resulted in significantly fewer overall casualties treated in the target time (55% vs Equal 86% vs Supply-Guided 91%, p<0.001). These differences were principally due to fewer moderate casualties treated whereas there was no difference among strategies for severe casualties. Conclusions: In this simulation study comparing different triage strategies including one based upon actual blood product inventories, nearest hospital triage was inferior to equal distribution or a supply-guided strategy. Disaster response leaders in US urban areas should consider modeling different MCI scenarios and casualty numbers to determine optimal triage strategies for their area given hospital numbers and blood product availability.

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Transfusion support during mass casualty events

Cited by 4 publications

References 23 publications

U.S. cities will not meet blood product resuscitation standards during major mass casualty incidents: Results of a THOR‐AABB working party prospective analysis

U.S. cities will not meet blood product resuscitation standards during major mass casualty incidents: Results of a THOR‐AABB working party prospective analysis

International Forum on the Management of Major Haemorrhage: Summary

Optimizing Mass Casualty Triage: Using Discrete Event Simulation to Minimize Time to Resuscitation

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