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mollyredone

Roseburg college shooting

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Well, today was a hard day at work.  I was working in blood bank when we had a shooting at a community college where at least 13 people were killed and 20 injured.  We are a level 3 trauma center, but fortunately had a good supply of blood and FFP and were able to weather the storm.  Lots of paperwork to finish up, but I'm thankful everyone kept their cool and we had pretty smooth incident.

 

Mari

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Mine as well. I'm sure Mari and staff did a splendid job. But that's a blood banker's nightmare - and a parent's, student's, relative's, friend's, educator's and everyday American's nightmare as well. Far too many of these of late.

Edited by Dr. Pepper

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Mari, you have been through the fire.  I am certain you and the rest of your staff did us proud.  There are times when you have to shut out everything but what is in front of you and do the job to the best of your abilities.  There is always time later to reflect, and tremble, grieve and cry but the true professional manages to get the job done.  From you post it is obvious your training was well done and your plan well thought out.  It reminds the rest of us why we go through the exercises.

Well done young lady.  You are all a credit to the profession. 

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Thanks everyone!  We have had an incredible outpouring of support.  They are calling one of the injured victims a hero for rushing the gunman and saving people-he was shot 5 times!  After the first three shots, he fell and told the gunman it was his son's birthday and was shot 2 more times.  Roseburg is also the home of one of the Americans who stopped the terrorist on the train in France.  He works at Costco here.  People are amazing!

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Compliments to you and your staff for handling such a tragedy.  Sympathy to the family & friends of those killed and injured.  I agree....far too many of these types of episodes during the last few years.

 

Donna

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Thanks go out to you and your staff -- thank you for being prepared to handle this situation.  So often the lab folks don't even get recognized for our contributions in these tense situations.  There is nothing quite like that old adrenaline rush to help accomplish what needs to be done!  I am sorry that your community had to experience this sad event, and I pray that healing will happen as quickly as possible.  Pat each other on the back for "taking care of business".

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Mari, I am so sorry for the tragedy that your community had to endure. I'm sure you and your staff behaved heroically. I'm sure most of us have practiced disaster drills/emergency preparedness drills many times hoping never to have to use those plans. Might I inquire how well your emergency preparedness plan worked? Do you have any words of wisdom for revising such a plan given your real life experience?

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Well, I would have to say that there is a lot we could learn from this incident.  The first thing I did when it was announced was to pull two segments to label from all the ON and OP PRBCs that we had.  We had 12 ON and 40 OP on hand.  Then we thawed out 4 AB FFP, and started the second batch when they were done.  With the segments we could crossmatch after the units went out and specimens came in.  Unfortunately, our trauma ID system fell way short.  Plus the ED did not specify “I need 2 ON, 2 FFP for this patient, 2 ON for this patient, etc.”  We started out more orderly and then they came up and took our last 4 ON and 4 OP in a box, no names, and as they headed out, I shouted, “Give the OP to the guys!”  We had 3 patients transferred, and a lot of units, including most of the FFP, returned to the lab.  Now we are trying to backtrack and see if we can figure out who got what.  The ER documentation is abysmal.  One doc even noted that a patient received 1 FFP and 1 PPH.  We didn’t give out any PPH.  I had just been to a seminar where a hospital recounted the high school shooting in Marysville, Washington and the fact that they had a blood banker in the ED to keep track of where their trauma packs went.  I definitely think that we will implement that if we have another incident.  I feel that the ER took that box of 8 PRBCs and handed them out like Halloween candy.

Our blood supplier called within 30 minutes to see what we needed and brought down more ON and PPH.  We do have a call back system, so I had three others in blood bank to help when normally it is just me.

I just reread the whole disaster thread and saw that others have had similar problems with trauma IDs and ED just wanting blood.  That’s why I think having a tech in ED would go a long way to keeping track of units.  I also brought up the idea of a lab internal disaster with our medical director and she thinks we ought to start making a plan for that.

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Mari,

I cannot thank you enough for relaying your experience for our edification. We do disaster drills at our hospital but, IMHO, they never go well. I always feel like I've lost track of something. 

It sounds like your hospital is similar in size to ours. Our typical red cell inventory for our 375-bed hospital is 55 O pos and 15 O negs (not counting other groups and types). 

I love the idea of having a tech in the ED area during a disaster. I think it would be super helpful to have a 'gate-keeper' for blood products who really understands the critical nature of proper documentation. It would also help to have someone as a resource in the ED who knows the indications for use, for each blood product. Many of our providers seem to get platelets and plasma mixed up and I can only imagine that in a disaster that gets even more confusing.

Great job handling such a difficult situation. My hat is off to you and my heart goes out to you and your community.

Regards,

Amelia

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Yes, part of our mass casualty procedure includes someone from the blood bank managing the blood in the trauma bay/ED. We send them with a cooler of blood (mostly O pos, a few O neg, unless the situation calls for more O negs for whatever reason) and a cooler of plasma and we have a form where they can put a sticker from the unit and the patient's trauma name. Unfortunately with plasmas they'd have to write the unit number as ours don't come with DIN stickers on the back. We'd handle getting them platelets on an as-needed basis, and it would just work the same way.

 

Luckily so far we've just had a day where 13 traumas came in back to back, and four or five were bleeding. In that situation we triaged blood product issue in the trauma bay like this, but most patients ended up moving to the ICU or OR fairly quickly, so we could issue from the blood bank to those patients quite soon and eliminate a lot of the confusion.

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I'm feeling more urgency to have a basic plan in place for a mass shooting.  Most of these events have occurred in large population centers where they are close to their blood suppliers and have many hospitals to spread the patients among so our odds seem lower but I think we need at least a very basic plan. 

We are 3.5 hours' drive from our blood supplier (state police can do it in 2 hours). We have 4 hospitals within our region, 2 critical access and one 40ish bed that we supply with blood products as a depot for our supplier and our 170ish bed level 2 trauma center.  Although we have MTPs called every week or so, we truly massively transfuse (10-20+ red cells) a patient only every few months so we aren't in practice like a big trauma center.  Does anyone have any wisdom on how to predict the number and severity of hemorrhaging patients we might get based on the initial information from a mass shooting? I know it will be highly variable.  I need to know whether to have the blood center pack 40 red cells or 100 at the first inkling so it may arrive in time.  I can't take all of the blood from our supplier because that city is where we would send stabilized victims that exceed our capacity.  I suspect that the worst injured don't make it to the hospital. 

Mari, how many massively transfused patients did you get and how many rounds did they take?  Did you ship them all out?  Did you get to type-specific on any? How many RBCs and plasma were actually transfused? How fast did you get replacement blood in?  How much blood did you get in? Did you actually feel like you "ran out" of blood?  Did you end up with a huge excess of blood products after the fact? Roughly how many hours elapsed from when the first patient arrived until the last emergency issued unit went out?  If anyone else has info to share on this, I would much appreciate it.

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Like Mabel, I am feeling like we need to be better prepared for these mass shootings in smaller hospital settings. We are a 170 bed hospital at least an hour away from our blood supplier but also the home to a fairly large university. Anyone else have words of wisdom through experience or a policy you would be willing to share?

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