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Emergency

9/27/2010

Emergency Situations

The duty of a MO/BB in


Management of an
Emergency Situation

Natural disasters
x
x
x
x
x

x RTA, Derailments

Pandemias

Dr. Gamini Karunadipathy / NBTS

There is an increased

blood request
blood donors
the capacity of blood bank is restricted

This may effect the quality of work

Dr. Gamini Karunadipathy / NBTS

To determine the capacity and


functions of blood bank

Blood Bank should work on

Calculation of the quantity of necessary blood and


blood components
Setting up donor organisations
Coordination with other blood banks
Logistical support

Dr. Gamini Karunadipathy

Dr. Gamini Karunadipathy / NBTS

Emergency Management Plans

Dr. Gamini Karunadipathy / NBTS

Regulations about administrative measures and


organisation should be done prior to the
disaster
The regulations will determine the course of
action
ti iin emergencies
i
Leaders
Working plans
Emergency Management Plans

Records must be kept through correct and practical


methods
y The minimum requirements of a record keeping
system should be determined
y Blood bank staff should be trained on these issues
y

Administrative Measures

In an Emergency

Earthquakes
Floods
Fires
Landslides
Volcano eruptions

Mobilisation and wars


Terrorist attacks
Mass Casualties

Dr. Gamini Karunadipathy


Consultant Transfusion Physician
NBTS

Emergencies

y
y
y

An inventory of blood banks must be taken


What type of emergencies
The probable magnitude of the problem
Wh the
What
h personnel,l equipment,
i
training
i i and
d
capacity of the regional blood banks to deal
with the problem are

Dr. Gamini Karunadipathy / NBTS

Emergency

9/27/2010

Structure of blood banks in


emergencies

Human Resources Management


y
y
y
y

Determine duties of personnel during


emergencies
Personnel must be trained for these duties and
exercises
Duty plans for personnel to work in other
regions during an emergency
Job descriptions for the new coming blood bank
personnel

Dr. Gamini Karunadipathy / NBTS

y
y
y
y
y
y

Dr. Gamini Karunadipathy / NBTS

Blood bank must make its calculations


appropriate for the type of disasters it is likely
to face
Blood and blood components needed in
previous disasters may be a criterion
Dr. Gamini Karunadipathy / NBTS

y
y
y
y

Dr. Gamini Karunadipathy

The stocked red cells ratios for A, B, O and Rh


blood groups in normal times reflect the blood
group distribution of the country
O blood group can function as a general donor,

10

Donor Creation and Donation

In an emergency, the initial aim is to meet the


loss of blood volume following injuries
Formation of crystalloid and colloid solution
stocks is important

Dr. Gamini Karunadipathy / NBTS

O blood could be stocked at double the calculated


ratio

Transfusion alternatives
y

Blood collection, processing and storage


During disasters, blood collection, processing and
main storage should be carried out at locations
outside the disaster area

Blood Stocks
Stocks to be held at blood banks

Working areas of personnel


Means of communication with the coordinator and
NBC or other blood banks
Stocks should be documented
SOPs should be developed for donor acceptance,
acceptance pre
pretransfusion tests and registering/labeling work
Disaster exercises must be conducted
All pre-planning must be approved by the authorities
concerned
Optimum staff numbers, qualifications and shifts must be
determined
Dr. Gamini Karunadipathy / NBTS

Preparatory Work for Emergencies


y

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To meet hospitals need for blood and blood


components in a rapid, adequate & effective way
To prevent unnecessary panic among the
population
To prevent unnecessary collection of blood
To prevent a drop in the number of voluntary
donors after the incident

Dr. Gamini Karunadipathy / NBTS

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Emergency

9/27/2010

Blood Donation

Problems in Blood Donation

Blood is collected predominantly at the


hospital
y A sufficient donation area and adequate
number of beds should be provided
p
y Measures should be taken to process the
received blood
y Personnel back up should be provided
from other hospitals and/or the same
hospital.

Dr. Gamini Karunadipathy / NBTS

y
y
y
y

Dr. Gamini Karunadipathy / NBTS

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Cold chain

Red Cells Temp not exceed 10C


Platelet concen. - maintain its temperature at 20-24C
y
y

Refrigerated vehicles used in emergencies for


carrying
i bl
blood
d must be
b preplanned
l
d
Drivers should also be trained about blood
products storage and transportation

Dr. Gamini Karunadipathy / NBTS

x Electricity, water, fuel, transportation, communications


x Equipment and material shortcomings

Should have an adequate number of trained personnel


Cooperation must be made with volunteer
organisations for providing logistical support

Dr. Gamini Karunadipathy / NBTS

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Transfusion guide in emergencies

Personnel training for emergencies

y
y

Dr. Gamini Karunadipathy / NBTS

Transfusion Guides should be prepared on


Use of transfusion alternatives in situations of
emergency
Modifications for the selection of blood groups in
situations necessitating emergency transfusion
Compatibility tests in emergency transfusion

SOPs supporting the emergency plans must


be developed
Based on these SOPs, a task organization
must be made among the personnel
Emergency exercises must be conducted

Dr. Gamini Karunadipathy

Blood banks should be able to work in


emergencies or to help another blood bank in
emergencies
Logistical support to blood banks
Infrastructure requirements

Training
y

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Logistical Support Materials

Transporting Blood Components


y

Unnecessary blood donation calls


Problems encountered in concerning the blood
donors (general level of satisfaction etc.)
An increase of stocks as a result of unnecessary
blood donation
Not being able to use hand stocks and
discarding blood as a result
Problems encountered in conveying the
accepted blood for processing

17

Traceability of transfusions
Even in times of emergency, continuation
feedback and hemovigilance efforts is important

Dr. Gamini Karunadipathy / NBTS

18

Emergency

9/27/2010

Issues in Emergency Transfusion


y
y
y

Patient Identification

What is the process to identify patients?


How are blood products requested?
What patients need emergency transfusions?

What is the process to identify patients?


Unidentified patients
Patients identified with more than one set of
identifying information

Blood Sam
Samples
les shall be identified with
ith ssufficient
fficient
information for unique identification of the
patient
Emergency number
Policy for when to change to real name
Policy for when to request a new specimen after the
name is changed

Dr. Gamini Karunadipathy / NBTS

How are blood products requested?


y

Dr. Gamini Karunadipathy / NBTS

19

Telephone request

Emergency Blood Issues


y

Written follow-up order requested


y

x Communication is the key

How long does it take?


x To get a specimen to the blood bank
x Issue type specific blood
x Perform complete pretransfusion testing

Dr. Gamini Karunadipathy / NBTS

22

When ABO & Rh is Unknown

Uncrossmatched Group O Blood

The container tag or label shall indicate that


compatibility testing was not complete
The records shall contain a signed statement from the
requesting physician that the clinical situation is
sufficiently urgent
x Dont let the form slow the process

Dr. Gamini Karunadipathy / NBTS

Dr. Gamini Karunadipathy / NBTS

21

Emergency Blood Issues .

Dr. Gamini Karunadipathy

Whats the rush?


Is the emergency real?

Emergency release form


When blood is issued

20

y
y

O Pos / O Neg
y

23

When ABO group is not known shall issue


Group O Red Blood Cells
Cannot rely on previous records
In an emergency what kind of O Red Cells
The overuse of O Neg Red Cells for males and
women over 50 years can cause O Neg
shortage

Dr. Gamini Karunadipathy / NBTS

24

Emergency

9/27/2010

When ABO & Rh is Unknown.


y

Use O Pos from the beginning for


Males
Older (>50 years) females

Switching Rh Neg Patients to Rh


Pos Blood
y

When to Use O Negs


Females in their child bearing age group
Children (both male and female)
First few units to all patients

Dr. Gamini Karunadipathy / NBTS

Dr. Gamini Karunadipathy / NBTS

25

26

ABO Specific Uncrossmatched


Blood

Use the nature of the emergency and the


inventory levels to determine the ability to
supply Rh Neg. blood

The nature of the emergency


Blood loss is immediate and rapid
Units are for possible use / Units are to hold
The current inventory
x Critical levels
x Adequate levels
x The expected number of units needed

Switching Rh Neg Patients to Rh


Pos Blood .
y

Consider Factors in decision making

y
y
y

If 2 units
i are requested,
d use Rh Neg
N
If >10 units are requested, use Rh Pos
If Rh Pos blood has already been transfused
If the patient has received Rh Pos units historically
determined Ab prior to issue of Rh Pos blood

ABO typing - Forward & Reverse


Rh - immediate spin
Check Previous record
Immediately switch the patient to type specific
uncrossmatched

If the patient has anti-D, should receive Rh Neg


Dr. Gamini Karunadipathy / NBTS

Dr. Gamini Karunadipathy / NBTS

27

No Specimen Received

Compatibility Testing

Should only occur in most seriously


injured patients
y Can designate the patient Unknown
Trauma Patient
y Process specimen as soon as received

Compatibility testing shall be completed


using a patient sample collected as early
as possible
y Implement
p
a system
y
to reduce the risk of
mistransfusion

Dr. Gamini Karunadipathy / NBTS

Dr. Gamini Karunadipathy

28

29

Dr. Gamini Karunadipathy / NBTS

30

Emergency

9/27/2010

Massive Transfusion

Massive Transfusion .

Replacement of Total Blood Volume within 24


hrs
Performance of necessary lab tests

Consider Administration of

Notify Consultant Transfusion Physician of


massive transfusion situation
y Assess patient needs for
y

PT, APTT and FBC (Platelet ct)

Plasma
Platelets
Cryoprecipitate

FFP
Platelet Conc.
Cryoprecipitate
y

Adults -10 units in 24 hours can stop


crossmatching
Dr. Gamini Karunadipathy / NBTS

y Questions

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Dr. Gamini Karunadipathy / NBTS

32

???

Thank You

Dr. Gamini Karunadipathy / NBTS

Dr. Gamini Karunadipathy

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Dr. Gamini Karunadipathy / NBTS

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