The accuracy of external blood loss estimation by ambulance and hospital personnel

Abstract

Objective: To determine if emergency personnel, either ambulance or hospital based, can estimate the volume of external blood loss accurately enough to be of potential clinical use in guiding fluid resuscitation. Methods: A total of 61 ambulance and 35 hospital personnel viewed nine scenarios consisting of volumes of blood (100 mL, 400 mL and 700 mL) spilt onto three surfaces — carpet, vinyl and a clothed manikin. They were asked to estimate the blood loss in each case. Results: Estimates of volumes of blood loss on all surfaces were generally inaccurate. Both ambulance and hospital groups were comparable in this regard. Hospital personnel had higher mean estimates than those of ambulance personnel. Of particular clinical relevance were the findings that blood loss on carpet was underestimated and small volumes on a clothed manikin were overestimated. Conclusion: External blood loss estimation by ambulance and hospital personnel is generally too inaccurate to be of clinical use.

Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group

“…However, the diagnosis of hemorrhage is of primary concern and the importance of the accurate estimation of blood loss is paramount to allowing the appropriate intervention by warning of impending hemorrhagic shock. Estimates of blood loss by paramedics [64], surgeons [65] and obstetricians and midwives [66] are often inaccurate and vary widely. Studies following vaginal [67] and abdominal delivery [68] show visual estimation of blood loss to be of limited clinical use.…”

Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions

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Ambulance Transfer in Case of Postpartum Hemorrhage after Birth in Primary Midwifery Care in The Netherlands: A Prospective Cohort Study

“…The most common method for this is visual estimation. This method is subjective and leads to underestimation of actual blood loss . Therefore, we applied more objective parameters such as RTS and packed cells.…”