My facility's current SOP is to transfuse O red cells and A FFP in trauma situations until we have all the testing completed (including the second ABO typing) and enough compatible products are available to switch. We've not had any problems with following this process in the past (our trauma surgeons are amazing!) and we've always had enough O red cells and A FFP. However, last month we had a horrific trauma case come through that just decimated our inventory (hundreds of units in <24 hours) and the patient was AB Neg. Between this one patient and an emergency bleeding TTP patient we used almost all the A and AB plasma in the surrounding areas.
What do you do in these situations when you can't provide type specific products? Giving a patient incompatible red cells is a huge red flag, even though I have heard of other hospitals having a protocol in extreme emergency situations. After 100-200 units does it really matter as long as the transfused combo of FFP and red cells are ABO compatible? I'm not particularly worried about running out of O red cells units (our blood supplier has a very healthy stock), but at what point do you flip plasma to whatever type you have available? And when do you flip back?