Blood and bombs: the demand and use of blood following the London Bombings of 7 July 2005 – a retrospective review

Glasgow, Simon; Allard, Shubha; Doughty, Heidi; Spreadborough, P; Watkins, Elaine

doi:10.1111/j.1365-3148.2012.01173.x

Cited by 32 publications

(27 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The final step in planning demand was to apply a ‘hospital demand factor’ to all required estimates. There was approximately a three‐fold difference between hospital demand and patient requirement following the London bombings with a similar experience reported during MCEs elsewhere (Soffer et al , ; Glasgow et al , ). Despite this, the local shortages of blood components during an incident were realised as a possibility.…”

Section: Demand Planningsupporting

confidence: 63%

“…These are common place in military operations and amongst certain civilian populations, but have not been experienced on the same scale in the UK since the 2005 attacks (Rodoplu et al , ; Aylwin et al , ; Dann et al , ; Nelson et al , ). The lessons identified from that incident have been described previously (Glasgow et al , ). These attacks required a total of 338 U (unit) of RBCs across all treating units, with an average of 14·5 U per casualty receiving a transfusion and 6·1 U per patient triaged at scene as a priority one (P1) casualty (Hodgetts, ; Aylwin et al , ).…”

Section: Demand Planningmentioning

confidence: 96%

See 1 more Smart Citation

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

Glasgow

Allard

Rackham

et al. 2014

Transfusion Medicine

Self Cite

View full text Add to dashboard Cite

The Olympics is one of the largest sporting events in the world. Major events may be complicated by disruption of normal activity and major incidents. Health care and transfusion planners should be prepared for both. Previously, transfusion contingency planning has focused on seasonal blood shortages and pandemic influenzas. This article is the first published account of transfusion contingency planning for a major event. We describe the issues encountered and the lessons identified during transfusion planning for the London 2012 Olympics. Planning was started 18 months in advance and was led by a project team reporting to the Executive. Planning was based on three periods of Gamestime. The requirements were planned with key stakeholders using normal processes enhanced by service developments. Demand planning was based on literature review together with computer modelling. The aim was blood-stock sufficiency complimented by a high readiness donor panel to minimise waste. Plans were widely communicated and table-top exercised. Full transfusion services were maintained during both Games with all demands met. The new service improvements and high readiness donors worked well. Emergency command and control have been upgraded. Red cell concentrate (RCC) stock aged but wastage was not significantly increased. The key to success was: early planning, stakeholder engagement, service developments, integration of transfusion service planning within the wider health care community and conduct within an assurance framework.

show abstract

Section: Demand Planningsupporting

confidence: 63%

Section: Demand Planningmentioning

confidence: 96%

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

Glasgow

Allard

Rackham

et al. 2014

Transfusion Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…21,33 Restocking of the hospitals involved in a response is difficult or impossible during the early phases of the event. At least initially, hospitals must rely on the stocks already present before the event occurs ( Figure 15).…”

Section: Mass Casualty and Event Response Planningsmentioning

confidence: 99%

Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood

Brohi

Eaglestone

2017

Programme Grants Appl Res

View full text Add to dashboard Cite

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.

show abstract

“…Many units have relied on restocking RBCs to manage demand in past MCEs. 39 This, however, has always been on a request-first basis from the TCs themselves. This approach risks delaying the delivery of RBCs, potentially missing the narrow window of opportunity for improving transfusion-related outcomes in these events.…”

Section: Discussionmentioning

confidence: 99%