Managing the surge in demand for blood following mass casualty events

Glasgow, Simon; Vasilakis, Christos; Perkins, Zane; Brundage, Susan I.; Tai, Nigel; Brohi, Karim

doi:10.1097/ta.0000000000001101

Cited by 10 publications

(10 citation statements)

References 38 publications

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“…34 We then created a model of casualty flow and blood utilisation by hospitals during a mass casualty event. 35 We populated this with the data collected from the literature, our specific investigations and the results of interviews with hospital staff and specialists. Once the model was constructed (Figure 16), we could modify parameters to investigate the benefits of alternative methods of utilising and preserving blood resources during such events.…”

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confidence: 99%

Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood

Brohi

Eaglestone

2017

Programme Grants Appl Res

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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.

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Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood

Brohi

Eaglestone

2017

Programme Grants Appl Res

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“…They have also discussed emergency donor calling and alternatives for transfusion. Simon Glasgow et al have shown the importance of an automated system to redistribute the blood stocks for trauma centres [16]. In that publication, they have described a computerized simulation model in a trauma center in the United Kingdom that has shown the efficacy of prioritizing.…”

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confidence: 99%

Managing Transfusion Service in Disasters

Senavirathna

2021

SL J. Med.

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Disasters, which may be natural or manmade, can happen unexpectedly, with an urgent increase in demand for health services including blood service. Many casualties undergo transfusions and massive blood transfusion is a common scenario in a disaster. In multiple trauma, requiring massive blood transfusion, each haematological parameter has its target to achieve with correct blood component transfusion. Hence, it is undebatable that the necessity of blood components shoots in a such situation.Publications share the contribution of blood service in disasters, explaining the importance of preparedness. Blood collection, processing, transportation, and distribution should be properly planned. Therefore, experience from past incidences is critical in developing a such protocol. Every aspect of blood transfusion including patient identification, compatibility testing and administration is challenging in a disaster situation. Coordination with other centres is also a crucial point. Well-established IT systems enhance blood inventory management and redistribution in an emergency.The disaster management plan, which must include a multidisciplinary approach, should be established in every transfusion service, and regular training programmes, drills, audits, and revising help to improve disaster management.

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“…Finally, the administration of blood, unlike crystalloid, is limited by its availability, which is tested during MCEs as many patients require the use of massive transfusion protocol. Based on prior MCEs, the highest demand for blood is during the initial 4 hrs when the most gravely injured patients are brought to the hospital, using two-thirds of the total blood transfused 36–38…”

Section: Discussionmentioning

confidence: 99%

“…A study using a computerized simulation model of a UK major trauma center found that even small volume MCEs could overwhelm trauma centers’ blood supplies and restocking would be necessary. The authors also suggest a central supplier for blood as a solution for the massive demand for blood during MCE 37,38…”

Section: Discussionmentioning

confidence: 99%

<p>Mass Casualty Shootings and Emergency Preparedness: A Multidisciplinary Approach for an Unpredictable Event</p>

Melmer¹,

Carlin²,

Castater³

et al. 2019

JMDH

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Mass casualty events (MCE) are an infrequent occurrence to most daily healthcare systems however these incidents are the causation for new hospital preparedness and the development of coordinated emergency services. The broad support and operational plans outside the hospital include emergency medical services, local law enforcement, government agencies, and city officials. Modern-day hospital disaster preparedness goals include scheduled training for healthcare personnel to ensure effective and accurate triage for a highvolume of injured patients. This MDT collaboration strengthens the emergency response to optimize the delivery of life-saving care during MCEs. This review identifies the clinical importance of the interdisciplinary team interactions and the lessons learned from past MCE experiences, strengthening healthcare system readiness for such critical incidents.

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Managing the surge in demand for blood following mass casualty events

Abstract: Therapeutic/care management study, level IV.

Cited by 10 publications

References 38 publications

Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood

Traumatic coagulopathy and massive transfusion: improving outcomes and saving blood

Managing Transfusion Service in Disasters

<p>Mass Casualty Shootings and Emergency Preparedness: A Multidisciplinary Approach for an Unpredictable Event</p>

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