DaBears

Thanks for the encouragement. I think I need that right now! Maybe anyone just sharing you "baptism by fire" stories would be really helpful!
The BB supervisor has told me that I can call her pretty much any time, so I know she's there. This was a fluke because she was on vacation when this happened.
Our medical director is very knowledgeable and is willing to help, but she's not "warm and fuzzy" so it's hard to gauge her.
I think a lot of the problem with this situation is that since the supervisor was out and the medical director is more hands off, there was no debriefing, no one to say "hey you did great with this, but next time try this" etc. . .
So all I know is I did what I could to the best of my abilities and skill and fortunately, it all worked out.

Thanks for the encouragement. I think I need that right now! Maybe anyone just sharing you "baptism by fire" stories would be really helpful!
The BB supervisor has told me that I can call her pretty much any time, so I know she's there. This was a fluke because she was on vacation when this happened.
Our medical director is very knowledgeable and is willing to help, but she's not "warm and fuzzy" so it's hard to gauge her.
I think a lot of the problem with this situation is that since the supervisor was out and the medical director is more hands off, there was no debriefing, no one to say "hey you did great with this, but next time try this" etc. . .
So all I know is I did what I could to the best of my abilities and skill and fortunately, it all worked out.

There's not much I can add to what has already been stated ... a learning experience, talk about it so you can be better prepared next time, etc.
 
Except ...
 
1. Your supervisor dropped the ball here.
 
As 'Quality Guy' quoted CLIA (and it should be a 'rule' regardless of who requires it), your supervisor should have a 'call me anytime and if you can't get me, call ____' with the phone numbers perpetually posted at every BB phone. As far as the policy about 'the patient has not been transfused so you do not need to repeat the workup' - yes, it may be a rational thing to do, but unless this exception is written in your policies, you are not free to skip the testing.  That exception should be written in your procedures and you should have been informed of it during your training.  Sounds like you were not trained to deal with 'unusual crisis' cases.  Were you trained in what antibodies are truly 'clinically signficant'?  Were you trained what to do if you have a crisis patient who has 'clinically significant antibodies'?  ... or other issues like IgA Deficiency, Sickle Cell Protocol, etc.? 2. "Remember exanguination is a lot harder to treat than a transfusion reaction." 
 
Keep in mind that it's up to the attending MD to decide if the patient can wait until all the required testing is done or not ... it's not the Blood Bank's responsibility.  All the demands, threatening statements, and loud voices are not going to change that fact.
 
The responsibilities of the BB Tech are:
to inform the requesting MD of any additional risks (e.g. clinically signficant antibody, IgA Deficiency) to convey to the requesting MD the TIMING for filling the order (very important, they will change care plans based on what is said) and not burdening them with the details about 'how'. to do whatever tasks are necessary to get the safest blood out the door in a timely manner in accordance to whatever can be done in the given period of time, e.g. Group O RBCs vs Type Compatible RBCs vs crossmatched RBCs. to focus on those tasks, not worrying about what's happening in the ED or who's screaming on the phone or what MAY happen 'if'. Yes, it's all these things that help techs get through these tougher situations.  You lucked out with this crisis, but as you are feeling, you need more support and more information ... get those things before this happens again.

Ditto to all the above. You did a fine job. A few thoughts:
1. Your BB should have some procedures regarding "what if" situations (uncrossmatched blood, uncrossmatched blood with antibodies, etc). An emegergency release form with several check boxes for different scenatios is helpful; there was a thread a few months ago where someone had added the relative risks of hemolytic reactions under those scenarios. If you don't have those in place, and you've got a decent relationship with your supervisor, you could gently suggest that they could be very helpful to a newbie (as well as everyone else).
2. Practice your emergency issue scenarios. The Boston Mathathon bombing victims did very well because the hospitals treating them had active trauma units and held frequent drills.
3. Someone should always be available to give a helping hand, for both benchwork or advice.
4. Someone exsanguinating bleeds out their antibodies, too. Your patient may have a delayed reaction down the road but at least they'll be alive to do so!
 
Worst I had it was years ago with a ruptured AAA who had anti-K. The anti-K antiserum used an indirect AHG test in those days, so there was a time constraint. My coworker and I kept ahead for about 25 units, then ran out of screened, crossmatched blood. The OR called and said if we don't get 10 units RIGHT NOW the patient will die. So we grabbed 10 units, stuck a segment from each onto the counter with a bag sticker, tossed them in a pile on the dumbwaiter and sent it up a floor to the OR. And did this again. We eventually caught up, and the patient did indeed die, but not from a reaction or lack of blood.

All of us Blood Bankers (and you are now one of us) have had to deal with scenarios that helped us develop both our knowledge and technical abilities in Immunohematology.  If you stay primarily in the BB you will develop the knowledge and with that the confidence to handle the stresses of those providing direct patient care.  Most docs don't care about the nuances of Blood Banking, they care about getting the components they need and they usually need them NOW!  Eventually you will experience most of the scenarios described by the very experienced folks who have responded to your post.  As intimated above - in dire situations getting the patient ABO compatible rbcs is the most crucial consideration - exsanguination cannot be cured, almost everything else can be dealt with after the fact.  NEVER let the docs compel you to break policy (eg reducing incubation times or sending the plasma frozen to them to "melt") - your facility should have a policy to deal with outlying situations - become familiar with it.  In my experience most crises do not occur on the day shift.  Best of luck!
 
Decades ago I was the night guy in a tertiary care university hospital.  My Medical Director told me many times he liked me working nights 'cuz I wasn't afraid to say "no".  That is the type of confidence you will develop if you stay in the field.
 
I have found that common sense really helps when the going gets rough. 

Thanks for all of the responses and advice! I have a list of things I am going to discuss with my supervisor when she returns.
I appreciate all the words of wisdom and pointers. I'll keep ya posted and definitely going to browse this forum A LOT!

Thanks for the encouragement. I think I need that right now! Maybe anyone just sharing you "baptism by fire" stories would be really helpful!
The BB supervisor has told me that I can call her pretty much any time, so I know she's there. This was a fluke because she was on vacation when this happened.
Our medical director is very knowledgeable and is willing to help, but she's not "warm and fuzzy" so it's hard to gauge her.
I think a lot of the problem with this situation is that since the supervisor was out and the medical director is more hands off, there was no debriefing, no one to say "hey you did great with this, but next time try this" etc. . .
So all I know is I did what I could to the best of my abilities and skill and fortunately, it all worked out.

Thanks for the encouragement. I think I need that right now! Maybe anyone just sharing you "baptism by fire" stories would be really helpful!
The BB supervisor has told me that I can call her pretty much any time, so I know she's there. This was a fluke because she was on vacation when this happened.
Our medical director is very knowledgeable and is willing to help, but she's not "warm and fuzzy" so it's hard to gauge her.
I think a lot of the problem with this situation is that since the supervisor was out and the medical director is more hands off, there was no debriefing, no one to say "hey you did great with this, but next time try this" etc. . .
So all I know is I did what I could to the best of my abilities and skill and fortunately, it all worked out.

Thanks for the encouragement. I think I need that right now! Maybe anyone just sharing you "baptism by fire" stories would be really helpful!
The BB supervisor has told me that I can call her pretty much any time, so I know she's there. This was a fluke because she was on vacation when this happened.
Our medical director is very knowledgeable and is willing to help, but she's not "warm and fuzzy" so it's hard to gauge her.
I think a lot of the problem with this situation is that since the supervisor was out and the medical director is more hands off, there was no debriefing, no one to say "hey you did great with this, but next time try this" etc. . .
So all I know is I did what I could to the best of my abilities and skill and fortunately, it all worked out.

Thanks for the encouragement. I think I need that right now! Maybe anyone just sharing you "baptism by fire" stories would be really helpful!
The BB supervisor has told me that I can call her pretty much any time, so I know she's there. This was a fluke because she was on vacation when this happened.
Our medical director is very knowledgeable and is willing to help, but she's not "warm and fuzzy" so it's hard to gauge her.
I think a lot of the problem with this situation is that since the supervisor was out and the medical director is more hands off, there was no debriefing, no one to say "hey you did great with this, but next time try this" etc. . .
So all I know is I did what I could to the best of my abilities and skill and fortunately, it all worked out.