Estimating Blood Transfusion Requirements in Preparation for a Major Earthquake: The Tehran, Iran Study

Abstract

Introduction:Tehran, Iran, with a population of approximately seven million people, is at a very high risk for a devastating earthquake. This study aims to estimate the number of units of blood required at the time of such an earthquake.Methods:To assume the damage of an earthquake in Tehran, the researchers applied the Centre for Earthquake and Environmental Studies of Tehran/Japan International Cooperation Agency (CEST/JICA) fault-activation scenarios, and accordingly estimated the injury-to-death ratio (IDR), hospital admission rate (HAR), and blood transfusion rate (BTR). The data were based on Iran's major earthquakes during last two decades. The following values were considered for the analysis: (1) IDR = 1, 2, and 3; (2) HAR = 0.25 and 0.35; and (3) BTR = 0.05, 0.07, and 0.10. The American Association of Blood Banks' formula was adapted to calculate total required numbers of Type-O red blood cell (RBC) units. Calculations relied on the following assumptions: (1) no change in Tehran's vulnerability from CEST/JICA study time; (2) no functional damage to Tehran Blood Transfusion Post; and (3) standards of blood safety are secure during the disaster responses. Surge capacity was estimated based on the Bam earthquake experience. The maximum, optimum, and minimum blood deficits were calculated accordingly.Results:No deficit was estimated in case of the Mosha fault activation and the optimum scenario of North Tehran fault. The maximum blood deficit was estimated from the activation of the Ray fault, requiring up to 107,293 and 95,127 units for the 0–24 hour and the 24–72 hour periods after the earthquake, respectively. The optimum deficit was estimated up to 46,824 and 16,528 units for 0–24 hour and 24–72 hour period after the earthquake, respectively.Conclusions:In most Tehran earthquake scenarios, a shortage of blood was estimated to surge the capacity of all blood transfusion posts around the country within first three days, as it might ask for a 2–8 times more than what the system had produced following the Bam earthquake.

Assessing Point-of-Care Device Specifications and Needs for Pathogen Detection in Emergencies and Disasters

“…20 Respondents identified HIV 1/2 virus, ABO typing, and Hepatitis B and C viruses as priority targets for a rapid POC device that can address the need for emergent blood donation screening during mass casualty events when traditional transfusion services infrastructure is destroyed.…”

Cascadia Rising: thoughts on a Seattle earthquake disaster exercise

“…Regional blood need estimates were drawn from the published work of groups that have reviewed the injuries that result from major earthquakes and calculated the amount of blood that would be required to support all the surgeries required in the first 24 hours . Such published estimates based on Force 9 earthquake scenarios for Tehran, Iran, and Lima, Peru, cities with approximate populations of 10 million people each, led to similar estimates of 9000 units of RBCs needed to treat the casualties presenting in the first 24 hours . This suggests that Western Washington with half that population might want 4500 units of RBCs in the first 24 hours, 200 units of RBCs/hr.…”

“…7,8 Such published estimates based on Force 9 earthquake scenarios for Tehran, Iran, and Lima, Peru, cities with approximate populations of 10 million people each, led to similar estimates of 9000 units of RBCs needed to treat the casualties presenting in the first 24 hours. [9][10][11] This suggests that Western Washington with half that population might want 4500 units of RBCs in the first 24 hours, 200 units of RBCs/hr. Failure times were calculated as inventory divided by issue rate or the length of time the institution could sustainably issue blood before their inventory ran out if they issued at the maximum rate as determined above.…”

Postdisaster Volatility of Blood Donations in an Unsteady Blood Supply Chain*

“…Furthermore, Tabatabaie et al. () highlighted that demand is highest during the first 24 hours of a disaster. Other concerns relate to the restriction on storage and transportation of blood products.…”

“…For example, Tabatabaie et al. () and Guo et al. () concluded that postearthquake first‐time donors are less likely to donate again in the absence of continuing motivation strategies.…”