Trauma Coolers and the ED

[Jody]

My ED department is requesting coolers for trauma situations. Truly, what they are after is a cooler with O Negs in the ED potentially before the patient has been identified. I have been looking back at previous post about trauma coolers and one scenario is missing. Multiple trauma patients. We are not a huge hospital were traumas are well handled process. Frankly, the patient identification aspect has me worried.

I would appreciate any words of wisdom

[tbostock]

My advice: don't do it. Giving the ED free reign with O negs will not be a good thing, trying to track which unidentified trauma victim received which unit will be a nightmare for you. Having worked in a very busy trauma center, we handled it by bringing two O negs down when they called us that a "bad one" was on the way in. We brought a phlebotomist with us so we could get a sample ASAP. We waited a few minutes to see if the doc wanted the O neg, if not, we took them right back. If they wanted it, we would check the trauma band number on the patient and write it on the unit tag so it was trackable, then if possible watch them hang it to make sure they weren't wasting it.

This takes more effort on your part, and some of your staff may not be comfortable with seeing trauma victims, but the ED appreciated the customer service of us delivering it, and we appreciated that it was done right.

[L106]

I agree with Terri......Don't do it. I think Terri has developed a good "trauma plan" that appears to work for them. If necessary, you could probably might some modifications of that plan that would fit your facility. (We promise Stat delivery of uncrossmatched blood within 10 minutes, and our ECC Dept has never requested any other arrangement.)

Donna

[Jody]

My advice: don't do it. Giving the ED free reign with O negs will not be a good thing, trying to track which unidentified trauma victim received which unit will be a nightmare for you. Having worked in a very busy trauma center, we handled it by bringing two O negs down when they called us that a "bad one" was on the way in. We brought a phlebotomist with us so we could get a sample ASAP. We waited a few minutes to see if the doc wanted the O neg, if not, we took them right back. If they wanted it, we would check the trauma band number on the patient and write it on the unit tag so it was trackable, then if possible watch them hang it to make sure they weren't wasting it.

This takes more effort on your part, and some of your staff may not be comfortable with seeing trauma victims, but the ED appreciated the customer service of us delivering it, and we appreciated that it was done right.

How many tech are scheduled in your blood bank? Our one BB'er is usually too busy to leave the department to hand deliver units to the units.

[Likewine99]

We deliver 2 units of O neg in a cooler and use the emergency release functon of our BB system to assign a trauma number.

Once we get a sample we use that to complete the T&S and XM. The ED returns the paperwork to us with a sheet that links our system assigned trauma number to the pt who received the blood.

[AMcCord]

We are a smaller facility with 1-2 in Blood Bank during AM shift and no 'assigned' blood banker the rest of the time. We used to deliver x# O negs, though assigned to a specific patient/room, and as often as not ended up throwing most of them away:cries::cries:. Some bright individual would always take them out of the cooler and drop them on a counter, gurney, table, chair, etc and that's where we found them. I never trusted them not to grab a unit for another patient, either. When we cut the cord on that practice, we agreed to provide 2 units RCs immediately whenever they wanted to hang units. They must give us the patient's emergency armband number, name, if known, and location when they call. When we deliver, a signout paper document goes with us and someone on the other end is required to sign for the blood. We have agreed with ER that this will be the 'recorder' (the person who is documenting everything - meds, treatment, status, etc.) or any nurse with that patient. We follow our normal checkout procedure as closely as is possible under the circumstances. Minimum is that the tech sees the armband number or someone reads it from the patient's arm to them. On the dayshift I can usually find a tech in another section of the main lab who can run the units, answer the phone, etc. If it's a bad day/bad trauma situation or happens evenings or nights, and we are all busy, then ER is told they must send someone. That someone is sometimes the ER director and sometimes the resource coordinator/house nursing supervisor (or whatever you call that person at your place), if there isn't anyone else free to run. The resource coordinator may also draft a nurse from somewhere else in the house to do the fetching for them. If they come to us, they have to have that emergency armband number, name if known and location - sometimes they have to call back to ER to get it.

This process came about because we had data on wasted blood products and staffing numbers that we presented to the ER manager. We were able to convince them that we were just as busy as they were. We were also able to show them that they were wasting a lot of blood. Do things run smoothly with all traumas? No, but we sit down with the ER manager, and ER staff if needed, and review the things that went haywire with particular trauma cases. It's not pretty, but it does work.

Edited October 22, 2009 by AMcCord

[beths]

We use color coded coolers for our multiple traumas. Each trauma "packet" is identified using a color. That color is assigned to everything having to do with that patient (wrist bands, flow sheet, cooler for uncrossmatched blood). Once we have identified the patient, they are registered accordingly. This process has helped us a lot during multiple trauma when you recieve 3 18 year old girls wearing the same soccer uniform.

[tbostock]

We use color coded coolers for our multiple traumas. Each trauma "packet" is identified using a color. That color is assigned to everything having to do with that patient (wrist bands, flow sheet, cooler for uncrossmatched blood). Once we have identified the patient, they are registered accordingly. This process has helped us a lot during multiple trauma when you recieve 3 18 year old girls wearing the same soccer uniform.

beths: looks like you have a good system. It's necessary to come up with a system that does work for multiple victims. That's why I don't recommend the "John Doe" system...we found out that didn't work the day we had 8 drunk guys in the back of a pickup that were ejected in an accident. And just for fun, none of them spoke English and could not (or would not) give us their real names.

[L106]

Boy, I bet that was a "fun" night in the Emergency Department, wasn't it, Terri? What a nightmare!

Donna

[KKidd]

Upon request we will deliver a trauma cooler. We get as much information as possible on the patient - especially sex and approximate age. This deterrmines whether the blood is O pos or O neg. We do not automatically send a cooler with O negs unless we have to. We follow up when we get the patient info. That being said we are a small hospital and this only happens several times a year: except for this month and it has already happened twice!

Ooops, almost forgot - we did have a patient getting O pos (2 units) when we typed him as A neg. Called the ED at once to stop the transfusion. He had recieved 150 mls of the O pos. I have seen physicians not wait when they could.

:confuse::confuse:

[Mabel Adams]

If all of your emergency blood is O neg (more common at small hospitals) then patient ID is only important to know who got the blood after the fact. If you use O pos for males and O neg for young females, then you have to have a way to separate those that everyone understands (do they make pink coolers?).

One thing I always worry about in the ED is cases of multiple traumas where someone grabs a cooler of blood, assumes it is the uncrossmatched universal donor blood for their patient but it is really some A pos crossmatched for another patient (maybe even a GI bleed that came in hours before). Since the nurses are assuming it is universal donor blood and therefore safe for anyone, they may skip the ID check and not notice that it is for someone else. I see units of blood out hanging around a bit like a loaded gun so maintaining as much control saves wasted units but someday may also save a patient. This is also why I am very leery of using type-specific uncrossmatched blood. At that point every bit of patient ID must be in place just like for crossmatched blood, and all the staff involved has to understand the difference. If they don't, stick with O until the usual process is in place.