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We are revising our mass casualty/ disaster plan. The computer system we use (Sunquest) is not ideal for Emergency Release of products because if you use it, it automatically collects the TS specimen. We are keeping the E-Release/Mass Casualty on downtime. Does anyone use unit tags that are carbon copy? This seems like it would be the next best process in chaos to keep up with who is getting what. We do use carbon copy transfusion records - but in mass casualty situation would rather use just the unit tag. Also, how would your facility handle physician signatures for uncrossmatched blood? Any advice is greatly appreciated!

Does anyone use a provider signature form for transfusions with increased risks that are not for just uncrossmatched blood? I would love any examples anyone might share of forms used to inform the provider (and get their signature) of things like incompatible units being issued (warm autos, DARA interference, no compatible units for antibody to high incidence antigen or a HTLA-like antibody, maybe even a compromised specimen that a provider insists must be used for testing or some such). I'd appreciate any examples, explanations or procedures.

We're reviewing our procedure for the provision of blood products before completion of pretransfusion/compatibility testing. Our medical staff has also asked for an educational tool that can be used house-wide. I'm very curious of the generally accepted practice standards of the BBT community. One major focus is on how everyone handles a situation where an antibody screen is positive (or a patient has a history of clinically significant antibodies/special transfusion requirements) and transfusion is needed prior to the completion of antibody ID and/or acquisition of appropriate products. Does your medical director/on-call pathologist get involved? Does the supervisor/manager/Lead/Senior tech get involved? Are there instructions for the selection of 'best matched' products? Are there special forms to be signed? Is this handled under the same policy/documentation as when a blood product is emergency released due to no type and screen specimen? Is anyone willing to share some information or even their policy/process/procedure documents? Does anyone have any good reference articles about this topic or even an educational tool they used at their institution and would be willing to share? Thanks in advance and happy Holidays!! Literature that was able to be retrieved from PubMed: Goodell PP, Uhl L, Mohammed M, Powers AA. Risk of hemolytic transfusion reactions following emergency-release RBC transfusion. Am J Clin Pathol 2010;134:202-6. Johnson V, Langeberg A, Ahmad M, Sandler SG. Emergency transfusion of incompatible red blood cells [letter]. Arch Pathol Lab Med 2007;131:1514-1515.Mulay SB, Jaben EA, Johnson P, Badjie K, Stubbs JR. Risks and adverse outcomes associated with emergency-release red blood cell transfusion. Transfusion 2013;53:1416-20.Ong MG, Ezidiegwu C, Beadling W, Rosales LG. Re: Emergency transfusion of incompatible red blood cells [letter]. Arch Pathol Lab Med 2008;132:1386.Saverimuttu J, Greenfield T, Rotenko I, Crozier J, Jalaludin B, Harvey M. Implications for urgent transfusion of uncrossmatched blood in the emergency department: The prevalence of clinically significant red cell antibodies within different patient groups. Emerg Med (Fremantle) 2003;15(3);239-43.

I need to predict how much plasma would go to waste if we kept some thawed at all times for traumas. We would probably have to use A's since AB's are in such short supply and we would convert all our non-pediatric plasma to a 5 day outdate. We are a 250 bed hospital in a rural area, level II trauma center and we get around 2 massive transfusions called on traumas per month (not all turn out to be true massives). We transfuse about 90 FFP a month currently to all patients. We do some open heart surgery but they don't use much plasma. We do occasional plasma exchanges via apheresis which might drive up our totals when we have such a patient. I just need a ballpark idea whether we will waste 20%, 50% or 80% of the plasma we keep thawed so I can estimate the financial and supply impact. Thanks for any input on how to make this estimate.

If blood is emergency released but all of it comes back and none is infused, is it necessary to keep the emergency release form signed by the ordering physician? Thanks!