I have recently taken over as bb manager in our hospital. Yesterday I went to a meeting concerning an area wide disaster drill coming later this week. In the event of a true mass casualty should we utilize O pos prbcs or O neg prbcs for everyone. My thought was go with O pos for males and O neg for females. Someone else thought perhaps O neg for everyone. My concern with this is simple math, we don't keep enough O negs to handle a true mass casualty. So I am wondering if anyone has a bb policy for mass casualties? We have a trauma policy that states all men and women >/=55 get O pos and women of childbearing age get O neg. Thoughts???

We have a trauma policy that states all men and women >/=55 get O pos and women of childbearing age get O neg. Thoughts???

Without a shadow of a doubt, I think that this is the correct policy.

Agreed with Malcolm (as usual)

Agreed; go with your trauma policy.

Mine is same as Malcolm except we use the female cutoff as 50 yrs. O Pos for all but females <50.

Actually David, the UK is going over to 50, just as soon as the new Guidelines are published.

Actually David, the UK is going over to 50, just as soon as the new Guidelines are published.

Thanks Malcolm! I love being 'one up' on our hub

Any chance in a mass casualty situation that it would be hard to get an accurate report of patient gender? Our unidentified patient naming protocol includes gender in the name (Yankee, Male or Bravo, Female etc.) which I think would help. Still, I think you have to go with the usual trauma policy or you will have no O neg for the O neg 15 yo female that comes in.

Our mass casualty policy has more to do with getting additional blood products started "in the pipeline" toward us based on early reports. If we wait till we know what patients we are truly getting we will be too late to be prepared for the later ones. Of course, I suspect that the most injured patients in a mass casualty may not make it to the hospital to need blood so our image of multiple massive transfusions may not be accurate--depending on the disaster and other variables (including whether your disaster plan includes triage of cases unexpected to survive to palliative care).

Agreed; go with your own trauma policy.

I agree with Mabel that the Mass Casualty Policy should deal more with obtaining enough units for the influx of patients. Most times, the County EMS system will have an estimate of number of casualties; that way you can order an additional units to cover that number of victums. Your blood supplier may be able to help with how many units or maybe they are set up to send a standard order for the number of victums.

Mabel,

I thought of this too. My thought was that in the event of a true mass casualty the victims would quickly be reduced to their birthday suits. Thus eliminating the guessing part of what sex is the victim. Our disaster plan does include calling blood suppliers to determine how much blood they can send at that time. I feel sure their policy will include importing units from other areas as needed.

Thanks everyone for the thoughts!

I agree with the rest of the group. And depending on your location and size of your hospital you probably wouldn't get "every" mass casuality patient. I believe your county EMS staff have their own sort of triage system so that not all massive bleeders go to one place.

I think the confusion over gender would be less about recognizing the appropriate "parts" as about poor communication in the confusion of a disaster.

I think the confusion over gender would be less about recognizing the appropriate "parts" as about poor communication in the confusion of a disaster.

I think you are very correct about that!

We have a statewide disaster plan for blood banks (developed by us blood bankers). In addition, the Red Cross has a mass casualty protocol depending on the number of victims anticipated.

In our last mass casualty drill, we added gender to the patient identification piece of our disaster plan. So, it is good that you are involved in the drill, because the limited number of O negative units was a surprise to many of the physicians involved in our drill!

I agree with the 0 pos for females > 50. Any thoughts on plasma and/ or platelet requirements? Most hospitals are adapting high ratio RBC/FFP/Plt into their massive transfusion protocols, so you might consider walking through that requirement for at least some of the patients who would meet the massive transfusion criteria.

I spoke recently to the transfusion service for a fairly busy level 2 trauma center. They are keeping group A thawed plasma on hand for massive transfusions rather than precious AB. They figure that 85% of the trauma patients will be O or A anyway and a couple of units of ABO incompatible plasma isn't any worse than a couple of units of out of group plt pheresis. (Also, the anti-B in an A unit would be safer than the anti-A,B and anti-B in an O unit--not that they were thinking of using O.) After a couple of plasma units are in, they hope to have a current ABO/Rh on the pt. This is not a part of the country with a large African-American or Asian population where more group B or AB patients would be likely. It has been working fine for them. This is something I have wondered about doing but wasn't sure we should go out on that limb.

same with us. We do not use precious AB for our trauma stock. We keep A(5), B(3), O(3) plasma thawed for our trauma. We are level I trauma center.

I agree with the 0 pos for females > 50. Any thoughts on plasma and/ or platelet requirements? Most hospitals are adapting high ratio RBC/FFP/Plt into their massive transfusion protocols, so you might consider walking through that requirement for at least some of the patients who would meet the massive transfusion criteria.

We have recently gone to stocking 6 AB liquid plasma. The only indication for use of this product is massive txn, but it buys us time in the event of a massive. Our protocol calls for a 1:1 ratio of rbcs/plasma with a platelet for each "cycle" of rbcs/plasma.

gender is definately part of our trauma alert practice. However every great once in a while this info does not get passed on to bb. If this info is not passed to us, we go with the safest option O neg.

same with us. We do not use precious AB for our trauma stock. We keep A(5), B(3), O(3) plasma thawed for our trauma. We are level I trauma center.

If you got in a massive transfusion that was AB would you give your A or B plasma or have them wait till you thawed some AB. Do you never need to issue plasma before you can type the patient? If so, what type do you use then?

In a true massive casualty situation depletion of O Neg PC supply may be reached and so you would have to give O Pos and/or ABO-compatible products if you were able to eventually get types. The policies presented here seem to address more the start of this situation.

Good point. We often don't think beyond the beginning of a disaster when making plans, but some of them go on for days with changing needs over time. The only time we would need to continue giving universal donor blood would be if we had no power to run our centrifuges to do blood types (yikes!). Then there would be lots of other problems as well.