Disaster experiences shared?

[khalidm3]

This my presentation from 2006 on our experiences of the London Bombings. Much of this I think is still relevant.

Thanks Colin

[Malcolm Needs ☆]

This my presentation from 2006 on our experiences of the London Bombings. Much of this I think is still relevant.

Thank you for this Colin; it was extremely interesting.

We initially had similar problems to you with the Harrod's bomb in establishing how many victims were involved. Gruesome as it may sound, in that particular case, the numbers were over-estimated because many mannequins (if that is the right spelling - dummies, anyway) were blown apart and were, at first, thought to be humans that were blown apart.

:omg::omg:

[RR1]

Great presentation Colin, many thanks!

[Colin Barber]

Thanks to all who posted positive responses to my Powerpoint presentation.

Colin

[L106]

Interesting post, Colin. Thanks!

Donna

[DPruden]

The powerpoint presentation was really good, thanks for posting that.

I attended a disaster planning seminar where the New Orleans Blood Center CEO spoke about the Hurricane Katrina flood. One of the things I found particularly interesting was their discovery that mobile phones weren't reliable, but texting did not take as much bandwidth, so texting on personal cell phones was their only mode of communication while the phone line were all down.

[L106]

That's interesting. Thanks!

[Mabel Adams]

Thanks Colin, but I wonder if someone could translate it into American English. I don't follow all of the acronyms in the slides. I get the hospital acronyms and can assume the ITU = our ICU but you lost me on the V numbers and the PAS. Likewise HCT, Tabards & PALS. HIC is incident command? What is MIP --major incident protocol?? Bleep system? LAS? Thanks for any help. Sorry if I am being dense.

[Colin Barber]

Thanks Colin, but I wonder if someone could translate it into American English. I don't follow all of the acronyms in the slides. I get the hospital acronyms and can assume the ITU = our ICU but you lost me on the V numbers and the PAS. Likewise HCT, Tabards & PALS. HIC is incident command? What is MIP --major incident protocol?? Bleep system? LAS? Thanks for any help. Sorry if I am being dense.

Mabel,

You are not being dense, TLA's are the bain of our lives - BTW that is 3 letter acronyms.

I will translate:

V numbers were the hospital numbers in the disaster plan pre-prepared case notes, these had been introduced following a serious train crash in the 1970's - and were never updated, they sat in the cupboard waiting to be used. As they were created before we had computerised hospital information systems we found in the middle of the mayhem everyone's IT systems and the centralised hospital system could not recognise these numbers. For pathology and radiography it meant results were not "on-line" and they had to be hand delivered on paper.

PAS = Patient administration system, the hospitals computerised patient's records - often called HIS hospital information systems or EPR electronic patient records.

HCT = Hospital Control Team (sometimes called Gold Control in incident plans)

HIC = Hospital Information Centre

Tabards = a type of apron which labels who each member of the trauma team is - often these are also lead lined as a protection from the mobile x-ray units used in the trauma room

PALS = patient advisory and liason service

MIP = Major incident plan

Bleep system = pagers

LAS = London Ambulance Service

Hope this helps ans sorry I should really of added a glossary.

Colin

[Malcolm Needs ☆]

I think, Mabel, you should also be aware that "Hct" (as opposed to "HCT") is often used as short-hand for haematocrit on this side of the pond (but, very obviously, not in this case)!

[bduff]

I think, Mabel, you should also be aware that "Hct" (as opposed to "HCT") is often used as short-hand for haematocrit on this side of the pond (but, very obviously, not in this case)!

We use that also in the USA...

[Mabel Adams]

Thanks so much. I wanted to share this with our disaster manager but wanted to understand it myself first. I am sure the ppt was created for more local use where everyone would have understood the acronyms. (PS In our hospital a TLA is a Technical Lab Assisstant so we have no shortage of "inside" abbreviations ourselves.)

[Colin Barber]

Thanks so much. I wanted to share this with our disaster manager but wanted to understand it myself first. I am sure the ppt was created for more local use where everyone would have understood the acronyms. (PS In our hospital a TLA is a Technical Lab Assisstant so we have no shortage of "inside" abbreviations ourselves.)

Mabel,

Thanks - sorry I did not acknowledge your response earlier.

BTW We call TLA's - MLA's (Medical Laboratory Assistant).

Colin

[Mabel Adams]

We just had a 3 county disaster drill so I am back with more questions. In fact, I have decided that gathering the data I am interested in would make a great SBB project (start with Googe Images of bus crashes and then you can call the hospital Transfusion Services listed in the news article for their experiences). I realized that in many kinds of disasters that include a large influx of patients over a short time, I don't have enough experience to judge how many patients might need blood and how much they might need based on early reports of the disaster. So, if anyone can find write-ups or has personal experience (or know someone that does) with bus wrecks, commuter train crashes (or other transportation crashes), explosions, mass shootings or earthquakes (I don't need tornado info, but others might), I would like to know: the nature of the disaster, how many people were involved as possible casualties, how many of that denominator were brought to hospitals, how many of them were critically injured, how many required transfusion within the first 24 hours and how many needed massive transfusions. I am sure that it is extremely variable but if none of them ends up with massive transfusion because those patients don't survive the delay of getting to the hospital, then that is useful info. When I get a disaster announcement saying there are 60 possible casualties because 2 tour buses hit each other and rolled over the bank I would like a way to guess whether I will need to give blood to 40 of them or 6. Or maybe I just need to know for sure that I can't know with any accuracy. I have to plan 3-6 hours ahead because of our remoteness from our blood supplier so what I really need is a crystal ball.

Edited June 9, 2011 by Mabel Adams
typo

[tbostock]

When I get a disaster announcement saying there are 60 possible casualties because 2 tour buses hit each other and rolled over the bank I would like a way to guess whether I will need to give blood to 40 of them or 6. Or maybe I just need to know for sure that I can't know with any accuracy.

Working for many years in a busy trauma center, there is really no way to know...every one is a new adventure. Just have a really good massive transfusion policy. And also a disaster policy specific to the Blood Bank with the following included:

1. How to get more units of blood quickly

2. How to get more staffing if needed

3. Communication issues (during 9/11 the phones were all tied up and we couldn't get through to our blood supplier...yikes)

4. How you will handle the chaos (assigning one tech to do only testing, one to do only signing out/ordering blood, keeping well meaning spectators out of the Blood Bank, limiting phone call interruptions, having a "runner" if possible to bring blood to the ER/OR)

5. How you would handle an internal disaster (plan for a fire, flood, etc within the Lab...how will you get the blood out quickly if possible)

6. If you collect blood at your hospital: that you will NOT collect any additional blood in response to the disaster. This has been shown not to work; we have to rely on the current supply of blood.

[David]

I would agree that you can't predict future needs based on past. I think these main points are very good. Just be sure everyone knows where the plan is, not just management. Long ago we had an explosion in our city while the BB manager was at the AABB meeting, and the staff had to manage without her. So when you write your plan, share it with all.

Recently our phone system went down for a couple of hours on a Saturday night. Has anyone come up with an alternative communication system? Cell phone in the lab is pretty spotty, so that's not a real good option for us.

[Malcolm Needs ☆]

I would agree that you can't predict future needs based on past. I think these main points are very good. Just be sure everyone knows where the plan is, not just management. Long ago we had an explosion in our city while the BB manager was at the AABB meeting, and the staff had to manage without her. So when you write your plan, share it with all.

Recently our phone system went down for a couple of hours on a Saturday night. Has anyone come up with an alternative communication system? Cell phone in the lab is pretty spotty, so that's not a real good option for us.

Homing pigeons???????

[Deny Morlino]

Recently our phone system went down for a couple of hours on a Saturday night. Has anyone come up with an alternative communication system? Cell phone in the lab is pretty spotty, so that's not a real good option for us.

Walkie-talkies similar to what our maintainence staff carries are our backup if phone service has been interrupted. We used this method successfully over a period of 2 days a few years back when a phone system upgrade occurred. It was heaven without the phones ringing all of the time, but alas was not to last.

[John C. Staley]

There are days I have cursed the day Alexander Graham Bell's parents met!!! :chainsaw:

We also used the hand radios when the phones were out. They were also used by the command center when a full disaster was being handled to contact the major players such as the transfusion center.

[Malcolm Needs ☆]

I wasn't (exactly) joking when I said homing pigeons. These were actually used at our Birmingham Blood Centre within living memory.

[SMW]

.....I realized that in many kinds of disasters that include a large influx of patients over a short time, I don't have enough experience to judge how many patients might need blood and how much they might need based on early reports of the disaster. So, if anyone can find write-ups or has personal experience (or know someone that does) with bus wrecks, commuter train crashes (or other transportation crashes), explosions, mass shootings or earthquakes (I don't need tornado info, but others might), I would like to know: the nature of the disaster, how many people were involved as possible casualties, how many of that denominator were brought to hospitals, how many of them were critically injured, how many required transfusion within the first 24 hours and how many needed massive transfusions..... .

You may want to review the articles below when developing your plans. Some info from these articles:

• Of the entire direct-admission group, 8% received red cells, 5% received plasma, 3% received platelets and 0.1% received cryoprecipitate.
  
• Use rates for blood products were thus slightly less than a unit of red cells and plasma per casualty, half a unit of platelets and one hundredth of a unit of cryoprecipitate for each admission.
  
• Initial massive transfusion, defined as receiving more than ten units of red cells in the first 24 h of care, occurred in 90 patients, 1.7% of all admissions.
  

Blood use in war and disaster: lessons from the past century

J.R. Hess and M.J.G. Thomas: Transfusion;Volume 43, Issue 11, November 2003, Pages: 1622–1633,

Blood transfusion rates in the care of acute trauma.

Como JJ, Dutton RP, Scalea TM, Edelman BB, Hess JR: Transfusion 2004 Jun;44(6):809-13.

Transfusion medicine in trauma patients

Murthi SB, Dutton RP, Edelman BB, Scalea TM and Hess JR

Expert Review of Hematology, October 2008, Vol. 1, No. 1, Pages 99-109

[Malcolm Needs ☆]

I'm not for one minute saying this information is wrong SMW (in fact, I proud to say that I know Col. Mike Thomas quite well, and count him amongst my friends, but I most certainly would NOT argue with him!), but it does, nevertheless, depend upon the nature of the disaster.

We had a bloke go mad with a samuri sword in a church in Croydon, and this situation, although there were few victims in terms of disasters, used the highest number of red cell units in the UK for many years.

On the other hand, we had the King's Cross Underground Railway Disaster, involving many victims who sufferred burns, where few red cell units were used, but massive amounts of FFP, albumin and skin were used.

I repeat, though, it depends upon the disaster.

[clmergen]

After the shooting at Virginia Tech, there was an article in, I think, Lab Med that talked about how the tiny hospital in the area handled the disaster. It was full of good information about how they had to adapt suddenly. Unfortunately I have moved since then and no longer have the magazine.

[clmergen]

Here is a link to the story.

http://tissuepathology.typepad.com/weblog/files/pathology_today_jul07.pdf

[ashliobrien]

I work in the Blood Bank at St. John's in Joplin, MO that was hit by an F5 tornado on May 22nd. Since then there have been many changes, one of them is that I am now the coordinator of Blood Bank. The disaster was more than anyone could ever prepare for. Every reaction by the employees including the ones in lab at St. Johns was remarkable. Nothing can prepare you for what happened there. Starting over from scratch is also turning out to be a hardship as we are not able to retrieve ANYTHING from the hospital including validations, equipment, or paperwork. Thankfully we were mostly paperless! It's amazing what you don't realize you have until you don't have it anymore.