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Disaster experiences shared?


Mabel Adams

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I think it could be a great help if we were to share experiences with disasters so we could all learn from each others' successes and failures. I think really big disasters make the journals, but what if we had a sort of database of them as well as smaller events on BBtalk? Whether it is an influx of patients, an internal system failure, weather or other natural issues, a transportation stoppage, an act of violence or some combination of these, it could provide helpful ideas. One obstetric patient in DIC is a disaster if you are 100 miles from the next closest hospital and you only stock 4 units of FFP and 16 units of blood.

If you post an experience it would be good to know circumstances like what country you are in, how many beds your hospital has, how far you are from your blood supplier, whether you have other nearby hospitals, etc. I was even imagining some sort of template for gathering this background information so some SBB student could mine the data for a project on disaster preparedness someday. It is so hard to think of all the possibiities but even having a sustained computer network outage may bring up some unexpected issues that we could learn from.

So, is this just another of my mind's wanderings? Or would it be of use?

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In an earlier part of my life, when I was working in Hospital Blood Banks, I was involved in dealing with the results of three IRA bombs (the Chelsea Barracks bomb, the Hyde Park Corner bomb and the Harrod's bomb) and two train crashes (the Selsdon train crash and the Paddington train crash).

In four of these five major incidents, the communication between the Blood Bank and the rest of the hospital, in particular the Accident and Emergency Department, was pretty appalling. They were far too busy to answer the telephone, and we were working blind as to how many victims to expect. On the other occasion, we had a very senior Haematology doctor who was quite wonderful. He kept out of our way whilst we were working, but acted as a runner between us and A&E. This kept us well in the loop. We were able to get messages to them, and they were able to talk to him and, because he was a doctor, he was able to tell us how many and which victims would require blood quickly, and gave us some idea about how many units they would need.

So, the first thing that I would say is that you need a dedicated runner between the Blood Bank and A&E, and that, if this person is a doctor, who understands the situation of both the victims and those other doctors who are actually dealing with the victims, so much the better.

You do not need too many people in the Blood Bank. In fact, it is best to call more people in than you need, but tell all but the minimum number of people to go to another room, where they can remain on immediate stand-by for when required, but who do not mill around in the Blood Bank, getting in the way of those actually performing the work. That having been said, it is useful to have one person "extra", who can work as the runner for things other than those covered by the person mentioned above, can field telephone calls and can immediately communicate with your blood supplier, so that those performing the cross-matching are not disturbed.

Try to estimate, as early as possible, how much blood and blood components you will need. This is terribly difficult to do, but, in most major incidents, the amount of blood and blood components actually required is far less than might be expected. The most blood used in a single incident within the UK within the last few years was not from a "normal" disaster, but from a single incident, when someone went made with a samuri sword in a church and badly injured 12 people.

For the Paddington train crash, we actually only cross-matched 6 units of blood, of which only two were used, and yet someone (I won't say who, but it wasn't me this time) panicked, and order 40 units of group O, D negative by blues and twos, and we then had a glut for about a month, whilst other hospitals struggled.

Have a practice at regular intervals. Prior to the Selsdon train crash, there had been no practice for years. This resulted in two very strange things that, fortunately, did not result in any real problems - but could have done.

Firstly, the only access to the crash site was down a cul-de-sac. Two different ambulance services attended the crash site. The first service had one person go to the crash site and the other remained with the ambulance. The second service sent both people to the crash site. This meant that when the first service had "swooped and scooped", they could not get their ambulances out of the road, because the other ambulances, with no crew members in the cabs, were blocking the way.

The second was that the Blood Bank were too far down the list of Departments to be told of the incident. In fact, within Pathology, the first person to be telephoned was the Microbiologist. Whilst British Rail sandwiches can be pretty toxic, it is unlikely that there would have been to many cases of acute poisoning coming in from the crash site!

Hope that helps a little bit. If I think of more, I'll get back to you.

:blahblah::blahblah::blahblah::blahblah::blahblah:

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Few years back we had a blast in the town and some casualties were rushed to our hospital. It was last hour of the morning shift when our executive director informed about the disaster.

Luckily we had a good number of staff available on the duty, one receptionist on reeving the phone call, 4 techs and me for coordination. Medical Supervisor also stayed with us. 4-6 porters were to carry the products. We thawed 8 units of FFP from each group and kept in ref. Each tech prepared 8 units suspension from the bags and rechecked the blood groups from segment, One tech had A+, other B+, and two of them O+, the tech maintained his suspension till the end. I kept for me issuing products without specimen.

As soon as we received a written request with sample we processed ABO and Rh Cell typing by slide and forwarded to the techs having ready suspensions for that group. He performed IS and issued the PRBC, Receptionist and me helped in paper work, and FFP requests to release already thawed plasma. We had two calls for O Neg without specimen; we issued 4 packs each and meanwhile requested the sample, on receipt of sample we shifted to group specific.

We issued 10-12 patients by IS, 2 patients O Neg and later some cold victims by complete cross match. Most of the patients were given 8-16 units red cells and same number of FFP (figure may not accurate, as it is long ago). All cross match were compatible on completion and no discrepancy in ABO and Rh.( At that time we had not ABS, we were on major cross match only.)

Luckily we had no shortage; our PRBC stock was 900-1000 FFP +5000 and RDP 200-250.

We declared emergency collected a lot of blood. Donations were opened for 72 hours round the clock and we recovered with in these 72 hours, +1000 red blood cells.

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We've found that the trouble with people wishing to donate immediately after a major incident is that we end up with an awful lot of blood straight afterwards (which, of course, often expires before we can use it all) and then a shortage for a while after this, as we cannot bleed the donors too often. We now take the names and addresses of most of the prospective donors, and then ask them to give at a later date (but, we keep in touch with them to try to foster their good will, so that they won't feel rejected when we don't actually take their blood straight after the event).

I believe I am correct in saying (but I am happy to be rebutted if I am wrong) that one of the co-ordinators in New York actually lost her job after 9/11 because she allowed too much blood to be donated at the time, masses of blood went out of date and had to be discarded, and, as with us in the early days, there was a shortage of blood afterwards.

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We are a 125 bed hospital 1 hour away from our supplier. Last month we had a nice snow/ice storm. That evening one of our physicians ordered 8 FFP on a AB pos patient. We normally stock 8 AB plasma but had transfused some that evening. The courier service would not deliver in the bad weather(not that I blame them). We would not send one of our people out in extremwe weather either.

Now, our protocol is to go ahead and get our inventory up to max levels when inclement weather is expected. We haven't had to worry about it yet.

:boogie::boogie::clap::bye::bye:

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Hi Malcolm! Agree with u. Actually we were forced to do that, the details I can not write here.

At the occasion my opinion was same and I opposed this much draw but in the end I proved to be wrong, a few units were expired most of the red cells were consumed.

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Malcom, you're right about the glut of blood after 9/11. Donor centers all across the US, not just NYC, were flooded with well-intended donors whose blood never had a chance of reaching the patients who needed it immediately and ended up outdating.

One thing to consider is internal disasters as well as external. Many years ago we had a laundry fire in the hospital and the basement, including the lab, was evacuated. We weren't let back in for 3 hours, and it occurred to us that if someone needed blood in a hurry they were out of luck. So we have a policy in place to grab a few coolers of group O blood on the way out the door, or, if there's no time, to call for a STAT shipment from our blood center (just a few miles away). We have an envelope of downtime transfusion forms and emergency releases next to the door and we'll set up shop somewhere else in the hospital. There is also a contingency plan if we we can't return to the lab in a timely manner. I know AABB Standards say you need an internal disaster plan as well as external, I'm not sure about CAP off the top of my head.

These policies are reviewed with yearly competency evals since we have never had to actually do them yet.

Edited by Dr. Pepper
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...One thing to consider is internal disasters as well as external. Many years ago we had a laundry fire in the hospital and the basement, including the lab, was evacuated. We weren't let back in for 3 hours, and it occurred to us that if someone needed blood in a hurry they were out of luck.....

Excellent point and I have to confess that I hadn't given that a thought!:o:o:o And, no, the CAP checklist for Blood Bank does not require an emergency plan - yet.

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:boo::bored:On 6/7/08, my 225 bed hospital was flooded. The lab was in the basement. The water spread from floor to ceiling and into the first floor(14 feet of water)! Information Services, Food Services, Elevator Services, Pharmacy, Electrical Services were also in the basement. The patients and personnel were all evacuated within 3 hours with the help of the National Guard. No one was injured. Needless to say the hospital was closed for 5 months. We lost EVERYTHING in the basement. It was later declared a 500 hundred year flood. The hospital is next to a very small creek.

The lab had an off-site blood drawing station where we resumed out patient services 2 days later. We sent the specimens to a reference lab. Within 2 weeks they moved in a mobile Emergency Room for which we purchased new lab equipment and provided basic services for these patients. We stocked 4 units of O Negative blood in a blood refrigerator in a house across the street where the Helicopter personnel lived.

Management personnel were housed in an airport hangar. Within a few weeks, we had new computers and began trying to think of everything we needed to replace. It was a huge task. I wished I had had a document listing all of our equipment, etc. I was greatful that our procedures and our personal hard drives were able to be restored on the computers.

It was a devasting experience, but due to a lot of hard work, 4000 construction workers, and FEMA we moved back in to a temporary lab in 5 months. The hospital was reopened. It was a great relief to the community since we are the only hospital within miles. 6 more months later, we moved into a new lab (on the first floor!!).

Lessons learned: I don't think you can fully prepare for such a disaster and our hospital and lab Disaster Manuals didn't work! We didn't have land line phones for days and computers for weeks. We even ran out of toilet paper in 2 days in the off-site location! We now have new disaster plans, but I have lost confidence. In hind sight, communication with personel was difficult. We set up a lab group email so we could at least communicate with them at home if they had computers. I now keep their phone numbers at home. Everyone remained employed in some capacity.

Positive aspects included that people from all departments learned to work together and there was good comradarie.

I hope that none of you ever have to experience anything like this.

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I have to share our experience for those of you who need a laugh:) We are a 500+ bed hospital. On this particular day-shift, there were 3 Techs and the Supervisor (me). A specimen was sent to us via the tube system. Poof, a white powder was discharged when the tube carrier was opened. One call yielded a visit by the completely suited Hazmat Team. They placed each of us in tele-tubbie outfits and led us to the outside showers for decontamination. Thankfully, we are in Florida! The Blood Bank was totally in lock-down for 2.5 hrs, while we (squeaky clean in hospital gowns and no make-up)were placed in isolation with no phone or TV. Security stood outside our room, and we could not even communicate with our upper Management. Identification: Foot Powder. We were released with a bag of sopping wet clothes and shoes in our hospital gowns. That day, the hospital recognized the role that the Blood bank plays, and the Blood Bank staff bonded as never before!

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Hi,

I have worked in 2 hospitals which experienced computer failures lasting 15 days. It was such a mess, because unfortunately not all systems or processes had a paper equivalent. Vendors promised there systems "never" go down for extended periods. I know this seems like such a simple concept but when it is overlooked it becomes a major mess. The blood banks themselves lost large sums of money and paid out dearly in overtime and then trying to build a better system.

Also, in our recent inspection cycle, the inspectors never asked about downtime or extended downtime procedures. I was shocked. I am of the opinion that when inspectors don't look at certain processes that it gives the staff a false sense of security.

Has anyone else experiences extended downtime with respect to computer systems?

I am anxious to hear responses.

Thanks,

Kimba

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Mary** and Kimba, those are awful stories the rest of us never want to experience first-hand. Mary**, very good point that if the magnitude of your disaster is great enough it doesn't matter how well you have planned, you are overwhelmed. I'm on our pandemic flu committee. While we're looking at scenarios where 2/3 of the state is sick, 10% are dead, with bodies stored on skating rinks, I'm thinking, "Plan all you want, if this happens we're scr**ed."

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At a hospital that I worked there was an electrical outage do to a lightning strike of a transformer across the street from the hospital. Only emergency lighting was working in the lab located in the basement of the hospital and therefore the hallways outside the lab were completely dark as this incident occured on 3rd shift. Location was northern suberb of Philadelphia. We came to find that our Helmer blood bank refrigerators where not hooked up to emergency power. As time wore on we became concerned that all of our inventory would expire as a result of being out of temp. Myself and a co-worker went to other parts of the hospital, which was also on emergency lighting, to try to round up ice for transport boxes stacked in the blood bank from previous deliveries. We ended up in the hospital kitchen with flashlights in hand retreiving ice from freezers and ice machines. The Helmers, as we came to find, are designed to hold their temps with doors remaining closed for 2 hours without power. Not bad. The conclusion was that we watched the Helmer temps closely and luckily the power was returned in about an hour and a half. The boxes that we had collected ice in would only have been able to hold about a third of our inventory, O Pos and O Neg PC's. I did not see any immediate changes in the desaster policy after this incident. Life resumed as normal, but there were some very tense moments. As far as the thought of anyone needing blood during this time we just maintained a state of readiness and were prepared to do all necessary work to produce compatible units; flashlights in hand.

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In the first extended power outage (monster thunder storm and nighttime) I experienced as a young tech, there was almost no emergency lighting in the lab, almost no emergency power for equipment, no windows in the hallways for even a glimmer of outside light and no flashlights. It was like being in a cave with the vampire bats! The lab had been built before automation and apparently no one had ever thought about the lab's needs changing over time. We responded to the issues at that time, but if it happened again today, I don't think we've kept up with changes. It's easy to forget all that stuff once it's over.

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Our major incident testing nearly led to a disaster!

A&E were testing the major incident simulating a gas attack.

They requested pods from the NBS (as was).

Luckily the NBS sent some pods under close supervision as a "keenie" wanted to take the pods and open them by each "victim", thus potentially rendering them unfit for purpose. Said keenie was not impressed by the NBS being so picky about their precious commodity!

We have Business Continuity plans, IT failure plans, emergency plans for red cell and platelet shortages but what we do not have is a plan which is resourced sufficiently to do the job. Built in redundancy is not a popular concept!

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We have a hospital wide disaster plan for both external and internal disasters, and we have mock drills throughout the year to make sure the plan works accordingly. Part of the drill is a call in list for the lab, where one person initiates it, by calling 4 or 5 people, then they in turn, call the next person on the list after their name, and so on, and the last person to get called reports back with how many people in their column on the list are available to come in to work.

Also, we keep a list of phone numbers of area hospital blood banks, and we call them to assess their inventory in case we need to borrow units from other facilities. Sometimes we'll do that even in a non-disaster situation where we're trying to keep control of our own inventory to not outdate units if necessary; if we see that we have some soon-to-expire products that don't seem to be getting used, we'll call around to see if anyone else would have need for them and transfer them to that facility.

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Make a really good disaster plan, try to include internal as well as external disasters, and make sure you include:

1. staffing issues

2. blood supply issues

3. IT issues

4. where to relocate if the Blood Bank is "closed"

5. communication issues (during 9/11 phone lines were useless, we couldn't get through to our blood supplier)

Then, test it. We did a disaster drill a few years ago where we simulated an internal disaster in the Lab where the entire Lab needed to be evacuated. We made a "disaster box" of supplies we would need and what equipment to take. Our Helmer refrigerator was on wheels, so the blood came with us. We were able to evacuate the Lab in less than 5 minutes, and have the blood and a Blood Bank testing station set up in the ER within 15 minutes. Took a lot of planning, but we learned a lot.

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I said I'd come back if I thought of anything else.

This may sound a bit obvious, but it wasn't that obvious in some cases with which I have dealt!

For the external major incidents, make sure that the Blood Bank is stood down when the rest of the hospital is stood down! I rememebr that, in one incident, we were still on red alert for four hours after everyone else had "gone home"!!!!!!!!!!!!

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Another point: during a crisis, someone (usually the supervisor) needs to limit interruptions by what I call the "Uh-oh squad". Staff constantly coming in to the Blood Bank, or constantly calling to see "how it is going". During an intense situation, it is critical to limit distractions for your staff or errors will occur. Be tough and have zero tolerance for well intentioned people that get in the way.

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Another point: during a crisis, someone (usually the supervisor) needs to limit interruptions by what I call the "Uh-oh squad". Staff constantly coming in to the Blood Bank, or constantly calling to see "how it is going". During an intense situation, it is critical to limit distractions for your staff or errors will occur. Be tough and have zero tolerance for well intentioned people that get in the way.

Terri has an excellent point here, making the designation of restricted access areas well-known during "disaster-preparedness" training of staff is a very good idea...(especially in our swampy climate and a power-outage occurs....the blood bank keeps AC)

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