The effectiveness of a simple ‘Code Red’ transfusion request policy initiated by pre-hospital physicians

Weaver, AE; Thompson, Julian; Lockey, DJ

doi:10.1186/1757-7241-20-s1-o1

Cited by 5 publications

(6 citation statements)

References 1 publication

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“…Each crew was comprised of a doctor and a paramedic. A single adult pre-hospital major haemorrhage ('Code Red') 20 scenario with a non-compressible abdominal and pelvic haemorrhage was used with the same mechanism of injury, clinical ndings and physiological transfusion triggers across all three arms (Figure 1). All crews completed the same scenario three times with the different transfusion strategies.…”

Section: Background Page 4/20mentioning

confidence: 99%

Transfusion Strategies in the Pre-Hospital Setting: Evaluating the Logistical Benefits of Pre-Hospital Whole Blood Transfusion, and a National Survey of Pre-Hospital Blood Transfusion

Tucker

Green

Brohi

et al. 2021

Preprint

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BackgroundPre-hospital blood component transfusion poses logistical challenges. Current patterns of pre-hospital blood use across the UK are not known. A potential benefit of providing a single combined component of whole blood is reduced need for multiple steps of administering separate components and more efficient use of time and resources by medical staff. .Objectivesto undertake a detailed time-analysis of the steps of pre-hospital combined component transfusion against separate blood component transfusion, and to determine current UK pre-hospital transfusion practice and users’ optimal pre-hospital transfusion strategyMethodsA three-arm cross-over major haemorrhage simulation study compared: flow-time (time from decision-to-transfuse [DTT] to complete transfusion); touch-time (direct team ’hands on’ contact time with transfusion process); and number of steps, people and equipment required for transfusion of 2 units of RCP [arm-A], 2 RBC + 2 TP [arm-B] or RBC + 2 Lyoplas [arm-C]). A national survey of current and optimal pre-hospital transfusion strategies was sent to 22 UK Air Ambulance Services (AAS) and 27 Major Trauma Centres (MTC) in December 2019. ResultsThe simulation demonstrated that arm-A had a shorter flow-time (median 6min 31sec vs. 12min 20 sec, vs 16min 29 sec) and touch-time (median 2min 31 seconds vs. 5min 21sec vs. 15min 3sec) than arm-B and arm-C respectively, and required fewer steps, equipment and checks. 18 MTCs and 18 AAS responded to the national survey (response rates of 67 and 82%). 10 transfused RBC/plasma (5 TP/5 Lyoplas), 4 RBC only, 2 Lyoplas only, 1 RBC/Lyoplas/Fibrinogen, and 1 ’red cell and plasma’ (only available at one hospital site). 89% replied that a combined component transfusion would be desirable, as it would reduce patient mortality (83%) and tasks on scene (75%). ConclusionThe time-analysis established the benefits for combined pre-hospital component transfusion in trauma patients. The national survey demonstrates the variation in current pre-hospital transfusion practice and reiterates that combined component transfusion pre-hospital may have logistical advantages over separate components.

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Section: Background Page 4/20mentioning

confidence: 99%

Transfusion Strategies in the Pre-Hospital Setting: Evaluating the Logistical Benefits of Pre-Hospital Whole Blood Transfusion, and a National Survey of Pre-Hospital Blood Transfusion

Tucker

Green

Brohi

et al. 2021

Preprint

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“…This opportunity has developed primarily through our further understanding of the role blood and, more specifically, coagulation therapy, plays in DCR . Driving the focus on optimal transfusion support in DCR is the increasing use of major hemorrhage protocols (MHPs) to ensure early delivery of red blood cells (RBCs) and hemostatic components . In addition, there has been a wider acceptance of the restricted use of prehospital non–blood‐based fluids, in favor of waiting until MHPs can be provided within hospitals .…”

Section: Transfusion Service Delivery For Mces In the United Kingdommentioning

confidence: 99%

Mass casualty events: blood transfusion emergency preparedness across the continuum of care

2016

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Transfusion support is a key enabler to the response to mass casualty events (MCEs). Transfusion demand and capability planning should be an integrated part of the medical planning process for emergency system preparedness. Historical reviews have recently supported demand planning for MCEs and mass gatherings; however, computer modeling offers greater insights for resource management. The challenge remains balancing demand and supply especially the demand for universal components such as group O red blood cells. The current prehospital and hospital capability has benefited from investment in the management of massive hemorrhage. The management of massive hemorrhage should address both hemorrhage control and hemostatic support. Labile blood components cannot be stockpiled and a large surge in demand is a challenge for transfusion providers. The use of blood components may need to be triaged and demand managed. Two contrasting models of transfusion planning for MCEs are described. Both illustrate an integrated approach to preparedness where blood transfusion services work closely with health care providers and the donor community. Preparedness includes appropriate stock management and resupply from other centers. However, the introduction of alternative transfusion products, transfusion triage, and the greater use of an emergency donor panel to provide whole blood may permit greater resilience.

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“…The policy is activated by the hospital trauma team leader and, in an attempt to have blood and blood products available on arrival at the emergency department, the policy can be activated from scene by the attending prehospital doctor. The policy is activated on the basis of suspected or confirmed active hemorrhage and a recorded systolic blood pressure of <90 mmHg; failure to respond to a crystalloid fluid bolus (usually administered by the ambulance service) is also taken into consideration . These simple activation criteria have been monitored to establish whether they correctly identify patients with bleeding and a transfusion requirement.…”

Section: Early Access To Blood and Blood Productsmentioning

confidence: 99%

“…These simple activation criteria have been monitored to establish whether they correctly identify patients with bleeding and a transfusion requirement. Initial data demonstrated that in the first 30 months of operation approximately 3.6% of trauma missions generated a “code red” request. Analysis of available data on 92 “code red” patients received in our hospital demonstrated that the patients had a high mortality rate (31.5%) and were severely injured (Median Injury Severity Score 27).…”

Section: Early Access To Blood and Blood Productsmentioning

confidence: 99%

Practical translation of hemorrhage control techniques to the civilian trauma scene

Lockey¹,

Weaver²,

Davies³

2013

Transfusion

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This article examines how established and innovative techniques in hemorrhage control can be practically applied in a civilian physician-based prehospital trauma service. A "care bundle" of measures to control hemorrhage on scene are described. Interventions discussed include the implementation of a system to achieve simple endpoints such as shorter scene times, appropriate triage, careful patient handling, use of effective splints and measures to control external hemorrhage. More complex interventions include prehospital activation of massive hemorrhage protocols and administration of on-scene tranexamic acid, prothrombin complex concentrate, and red blood cells. Radical resuscitation interventions, such as prehospital thoracotomy for cardiac tamponade, and the potential future role of other interventions are also considered.

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The effectiveness of a simple ‘Code Red’ transfusion request policy initiated by pre-hospital physicians

Cited by 5 publications

References 1 publication

Transfusion Strategies in the Pre-Hospital Setting: Evaluating the Logistical Benefits of Pre-Hospital Whole Blood Transfusion, and a National Survey of Pre-Hospital Blood Transfusion

Transfusion Strategies in the Pre-Hospital Setting: Evaluating the Logistical Benefits of Pre-Hospital Whole Blood Transfusion, and a National Survey of Pre-Hospital Blood Transfusion

Mass casualty events: blood transfusion emergency preparedness across the continuum of care

Practical translation of hemorrhage control techniques to the civilian trauma scene

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