Civilian walking blood bank emergency preparedness plan

Abstract

Background The current global pandemic has created unprecedented challenges in the blood supply network. Given the recent shortages, there must be a civilian plan for massively bleeding patients when there are no blood products on the shelf. Recognizing that the time to death in bleeding patients is less than 2 h, timely resupply from unaffected locations is not possible. One solution is to transfuse emergency untested whole blood (EUWB), similar to the extensive military experience fine‐tuned over the last 19 years. While this concept is anathema in current civilian transfusion practice, it seems prudent to have a vetted plan in place. Methods and Materials During the early stages of the 2020 global pandemic, a multidisciplinary and international group of clinicians with broad experience in transfusion medicine communicated routinely. The result is a planning document that provides both background information and a high‐level guide on how to emergently deliver EUWB for patients who would otherwise die of hemorrhage. Results and Conclusions Similar plans have been utilized in remote locations, both on the battlefield and in civilian practice. The proposed recommendations are designed to provide high‐level guidance for experienced blood bankers, transfusion experts, clinicians, and health authorities. Like with all emergency preparedness, it is always better to have a well‐thought‐out and trained plan in place, rather than trying to develop a hasty plan in the midst of a disaster. We need to prevent the potential for empty shelves and bleeding patients dying for lack of blood.

Blood product availability in the Washington state trauma system

“…Platelets are rare, expensive, and would spend most of their usable life in transport from blood centers to remote centers with little use for them. In sum, the costs of establishing and maintaining infrastructure and training to handle blood products are substantial-including the types of walking blood bank/whole blood programs that are currently being advocated 10,11 -and unless such products (including whole blood) are available immediately, deployment delays will continue to be associated with excess bleeding deaths.…”

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

“…Examples include maintaining low-titer type-O whole blood inventories in hospitals, 32,33 stocking dried plasma products (both lyophilized and spray dried), 34,35 using cold-stored platelets which may have more hemostatic potential and a longer shelf life, 36,37 employing hemostatic adjuncts (e.g., tranexamic acid, fibrinogen concentrate, or prothrombin complex concentrate in an off-label fashion as these medications are not cleared by the Food and Drug Administration for this indication) to complement blood component resuscitation, 11 and planning for warm fresh whole blood collection and infusion. 31,38 Synthetic blood product options should also be further explored for this purpose. 39 Then, from an inventory management standpoint, implementing regional blood product inventory dashboards would significantly enhance readiness for unexpected surges in demand.…”

The U.S. Armed Services Blood Program support to U.S. Central Command 2014–2021: Transformation of combat trauma resuscitation through blood product innovation and expansion of blood availability far forward

“…[3][4][5][6]33,34 This will dramatically increase the demand for whole blood products both in times of military conflict and in civilian trauma system management. 35 Although the demand for blood products at all Roles of Care has increased, transfusion of the products has decreased. 36 Blood supplies are nonetheless needed for contingency management.…”