Jump to content

Disaster experiences shared?


Mabel Adams

Recommended Posts

  • 1 month later...

Does anyone from Oklahoma have any updates with the recent tornados?  It may be still early... but since we have had our 1st ever hospital wide tornado drill it might be nice to hear. :blink:    I did see the past post on Joplin, which I made lots of updates shortly after that happened, but didnt know if anyone else had experience (partically with the power outage/building destruction)

Link to comment
Share on other sites

  • 3 months later...
  • 1 year later...

How are the rest of you planning for an Ebola patient?  I think their blood bank needs would mostly be from going into DIC.  Is that what you all think too?

 

CDC says to do testing on Ebola positive specimens under a hood.  I don't think the gel workstation will fit in the hood. The chemistry and coag analyzers definitely won't fit. :)  Maybe very careful universal precautions would be safe enough? I would be interested in blood bank testing protocols used at Emory, NIH or Nebraska if anyone on here has contacts there.

 

We are much more likely to get a case of Ebola hysteria than of Ebola, but I'm still curious.

Link to comment
Share on other sites

We've been instructed to issue type O's (Rh depends on patient gender).  Our institutional Ebola task force decided opening the tubes to get plasma and cells to test and crossmatch created too much risk for the staff.  Other lab testing will continue because both Hem and Chem have automated track lines that do not require human handling or opening tubes.

Link to comment
Share on other sites

How are the rest of you planning for an Ebola patient?  I think their blood bank needs would mostly be from going into DIC.  Is that what you all think too?

 

CDC says to do testing on Ebola positive specimens under a hood.  I don't think the gel workstation will fit in the hood. The chemistry and coag analyzers definitely won't fit. :)  Maybe very careful universal precautions would be safe enough? I would be interested in blood bank testing protocols used at Emory, NIH or Nebraska if anyone on here has contacts there.

 

We are much more likely to get a case of Ebola hysteria than of Ebola, but I'm still curious.

 Ebola hysteria is right!  For us (in NY), the DOH has said emergency release O negs and though they didnt specify I would assume AB plasma should they need it.  I did hear of some hospitals investigating the use of gel workstations under a hood.  However, we wouldn't have the room for something like that here.  I would definitly love to hear from someone at Emory or even in Dallas as to what they did (if they are allowed to comment on it).

Link to comment
Share on other sites

We are doing emergency release O neg RBCs and AB plasma.  Our blood bank isn't in the same building as the main lab and we don't have a hood, so that would be a lot cumbersome.  We talked about doing slide testing for the ABO type if there were the need (multiple patients, etc.).  I listened to the webinar from Emory and they did not do any blood bank testing, they had a very limited test menu that was done in a dedicated point of care lab that was adjacent to the isolation unit. 

 

I totally agree with the hysteria comment, I'm really annoyed with the US media and all of the fear mongering!

Link to comment
Share on other sites

For the blood bank, we're also going to issue group O rbc and AB FFP.

We are fortunate to have a BSL3 lab in our Micro dept.  We see a lot of TB and virology.  We have purchased iStats and a Piccolo - point of care instruments - for stat chemistries, H/H and blood gases done under the hood in the BSL3.  We have Tyvek suits and PAPR hoods.  Signature Elite for PT/PTT in the hood.  No testing done outside of the hood.  Very limited lab menu, testing time coordinated with the lab - not on-demand.

 

Convalescent plasma is another issue.  We will do A and B slide testing in the hood only.  Rh(D) slide testing only for an OB patient.  No centrifugation of any blood specimen.  My director and I are going back/forth on even that.  1 unit of incompatible convalescent plasma is less risky to the patient than testing is for us.  That amount of plasma is in a bag of pheresis platelets that are given out of type all the time. But it's not my license on the line.  Convalescent plasma is not an FDA approved product, investigational compassionate use.

Link to comment
Share on other sites

How do we argue that it is okay to give these patients less quality of care than normal patients (universal blood rather than crossmatched)?  Won't they fall under the ADA where we can't discriminate due to their illness?  I guess if they had never been transfused before the risk of antibodies would be negligible.  I would not be eager to have my lab do the testing but we would need to do the right thing.

 

How much do these patients need in the way of blood products, does anyone know? It seems like it would be only the worst cases at their sickest.

Link to comment
Share on other sites

How do we argue that it is okay to give these patients less quality of care than normal patients (universal blood rather than crossmatched)?  Won't they fall under the ADA where we can't discriminate due to their illness?  I guess if they had never been transfused before the risk of antibodies would be negligible.  I would not be eager to have my lab do the testing but we would need to do the right thing.

 

How much do these patients need in the way of blood products, does anyone know? It seems like it would be only the worst cases at their sickest.

 

How do we run a service if staff get infected. Prevention of staff infection is essential to maintain the service - especially if there is a massive outbreak...

Link to comment
Share on other sites

Has anyone seen the volume of convalescent plasma they are infusing each time? I was wondering why the ABO incompatibility prevented its use as we often give ABO incompatible platelets & even keep A plasma for emergencies now.

Our facility has now decided to do point of care testing for the rest of the lab orders & to give group O Pos or O neg red cells. One of the special care facilities they are establishing is close to our hospital so we think an identified patient would be transferred there. Hopefully, the ER would screen the patient before the original samples are sent to the lab & tested routinely.

Link to comment
Share on other sites

Good point, Auntie-D.  Knowing that everyone else is using universal donor establishes that as standard of care so that helps.

 

Yes, the window between identifying a patient as "at risk" and getting the Ebola test results back--especially if your transportation time to your state lab or CDC would be long--will be the period of risky specimen testing. And I think the patient won't be shipped to an Ebola facility until they either test positive or are otherwise considered to be highly likely to have it.  Fortunately, from what I know, the patients are unlikely to need blood products during the early stages--unless a patient waits to come in until DIC has set in.

 

I wondered too about the convalescent plasma question.  I would sure risk a plasma unit's worth of anti-B to get some antibodies to the virus!

Link to comment
Share on other sites

How much do these patients need in the way of blood products, does anyone know? It seems like it would be only the worst cases at their sickest.

My impression from the Emory webinar was maintaining fluid balance and electrolyte levels in their patients was their biggest concern.

Link to comment
Share on other sites

We are going to do point of care testing at bedside. Nothing leaves the room. If the patient needs blood products, he/she will get type O red cells and AB plasma.

 

There was a Hot Topics session on Ebola at AABB with a representative from both Emory and Nebraska Med Center on the panel. Did anyone attend?

 

I'll see if I can find out anything about what was done at Nebraska Med Center for lab testing. We have links with them.

Link to comment
Share on other sites

OK...more info. I didn't go to AABB this year, but do have access to the slides from the Hot Topics presentation. The Nebraska Med Center panelist was the transfusion medicine medical director. Here's what they are doing in Omaha according to that presentation:

 

Specimens from Ebola patients are highly infectious for weeks, especially if aerosolized (not talking droplets, not talking about patient - just specimens).

Unknown Ebola patient (symptoms, diagnosed after admission):

-use personal protective gear, especially splash guards or face covering, all skin covered

-automated testing...waste runs directly into household bleach solution (1:10 - 1:100) and those sinks not used for handwashing

-broken tubes...have a decontamination plan, use it

-after Ebola confirmed:

.....ID, secure and decontaminate/destroy specimens

.....ID staff who processed tests

.....inspect instruments to determine decontamination needs

 

Known Ebola patient

-routine lab work using point of care within the biocontainment unit...they have a stat lab set up in the unit

-routine care does not include blood bank testing

-other testing...specimens decontaminated externally and transported securely to BSL3 lab (which most of us don't have)

-non-aerosolizing procedures such as slide agglutination can be safely performed in a hood

-all patient specimens must be secured and discarded appropriately (likely shipped to the CDC by a courier service that handles that sort of specimen - thousands of dollars)

-transfusions

.....RBCs - O neg, K neg, uncrossmatched

.....Plasma - AB or type compatible

.....use of convalescent plasma - would consider incompatible transfusion, would perform anti-A/anti-B titers on donor

.....Platelets - AB or type compatible

.....once blood products are issued, no returns

.....standard infusion protocol - filters, monitoring, etc. except slow initial infusion rate of red cells because they are uncrossmatced

 

Emory seems to be doing pretty much the same things. WHO recommendations for transfusion are ABO slide type, but no crossmatch.

 

I forgot to mention that Plan A for a suspected case is for us is to call Omaha and have them come and get the patient - straight to the biocontainment unit from there with minimal contact for us.

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
  • Recently Browsing   0 members

    • No registered users viewing this page.
×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.