Wondering what everyone's Blood Bank procedures are for when a Trauma rolls in, what is current standard practice. We are a level 2 trauma center.

We currently emergency release two units on every Trauma Priority 1 and 2 that comes in the door. This has proven to be a huge waste of time and resources, (we need a T&S and usually a retype on these folks so that we can perform the XM in Safetrace) but our ER and/or Trauma docs (not sure which ones) insist on this. We have been collecting data to show that only a fraction of these patients receive blood, (usually the trauma 1's or a patient who progressed to and MTP ANYways) to hopefully move to only emergency issuing units on Trauma 1's, or even moving to a "we set up emergent units if you call the BB requesting them" kind of policy.

We would like to have an emergency fridge down in the ED but this will not happen for the foreseeable future, and in the meantime we have set up blood needlessly on 15 patients in the past 10 days alone!

I have also calculated the cost to a patient for a T&S, retype, and 2 electronic XM's. If I was a patient that was called as a trauma 2 and then downgraded to a 3 almost as soon as I got here I would not be happy about paying almost a grand for a bunch of totally unnecessary testing. I would say we are lucky at this point for not coming under fire for this policy from a billing/ethics perspective.

What are some thoughts on how we can resolve this while placating the docs / what are some policies other trauma centers have in place and is there a current standard of practice we can show our docs to help them see? I tried searching Uptodate and wasn't able to find much about this general of a situation. Of course, we provide blood FAST when it is really needed.

We switched to emergency issuing 2 units of plasma, not RBCs on our "full traumas".  That helps a lot.  We also don't do the XM on any emergency issued RBC unit that gets returned.  They usually order a T&S on these patients so that isn't a problem. We are also on SafeTrace.   I have found some articles supporting this.

Association of Prehospital Plasma Transfusion With Survival in Trauma Patients With Hemorrhagic Shock When Transport Times Are Longer Than 20 Minutes A Post Hoc Analysis of the PAMPer and COMBAT Clinical Trials

Anthony E. Pusateri, PhD; Ernest E. Moore, MD; Hunter B. Moore, MD, PhD; Tuan D. Le, MD, DrPH; Francis X. Guyette, MD, MPH; Michael P. Chapman, MD; Angela Sauaia, MD, PhD; Arsen Ghasabyan, MPH; James Chandler; Kevin McVaney, MD; Joshua B. Brown, MD; Brian J. Daley, MD; Richard S. Miller, MD; Brian G. Harbrecht, MD; Jeffrey A. Claridge, MD; Herb A. Phelan, MD, MSCS; William R. Witham, MD; A. Tyler Putnam, MD; Jason L. Sperry, MD, MPH

Plasma as a resuscitation fluid for volume-depleted shock: Potential benefits and risks

Daan P. van den Brink1,2 | Derek J. B. Kleinveld1,2,3 | Pieter H. Sloos2,3 | Kimberly A. Thomas4 | Jakob Stensballe5,6 | Pär I. Johansson6 | Shibani Pati7 | Jason Sperry8 | Philip C. Spinella4 | Nicole P. Juffermans

Transfusion. 2021;61:S301–S312.

 

Edited August 21, 2024Aug 21 by Mabel Adams

And WHEN are we going to get freeze dried plasma?!?!?  

Spray-dried plasma: A post-traumatic blood “bridge” for life-saving resuscitation

Mark A. Popovsky1 | Nathan White

Transfusion. 2021;61:S294–S300.

 

We ended up getting an undercounter Helmer fridge to hold 2 O Neg RBC units. This fridge is locked and hooked up to the Pyxis in the Trauma Bay in the ED.  They must use the Pyxis to open the fridge and access those RBC units which triggers an alert to our Trauma pager up in the blood bank.  This works well and has saved us so much time and resources because we no longer have to pack up units in a cooler and run them down to the ED on all level 1 traumas.  It's well worth the cost of the fridge.