Post on 15-Dec-2015
Practical aspects of emergency response in blood establishmentsBPAC, August 2011, Gaithersburg
Louis M. Katz MDMississippi Valley Regional Blood Center
Davenport, IA
Blood use following US disasters: Historical perspective
• US civilian disasters 105-131 unitso Skywalk collapse in KC hotelo Airliner Sioux City Iowao Oklahoma City Govt. Center bombingo Columbine High School
• 9/11/2001o 258 units 1st day (1000 collections/d NYBC)
Hess and Thomas. Transfusion. 2003)
Sept. 11, 2001:
Courtesy of the New York Blood Center
ABC/BCA Spoke and Hub system: 2011
Many useful resources for planning templates• AABB plans
www.aabb.org/programs/disasterresponse/Pages/default.aspxwww.aabb.org/programs/disasterresponse/Pages/taskforcepibs.aspx
• CHEST: triage of limited resources in disaster:Definitive care for the critically ill during a disaster: a framework for optimizing critical care surge capacity: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL.
Rubinson L et al. Chest. 2008. 133(5 Suppl):18S-31S.
Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007.
Devereaux AV et al Chest. 2008 May;133(5 Suppl): 51S-66S.
If you’ve seen one pandemic, you’ve seen one pandemic
Kamp et al. Transfusion. 2010
Response in (extended) blood emergencies: a question of balance
• Supply: enough qualified donors (and enough supplies, personnel, equipment etc.) to accommodate “needs”
• Demand: effective control of blood use to accommodate supply
NoYes
94.3%
5.7%
Did you have a pandemic flu plan in 2009?
ABC centers N=35
revised their plans25.7% have already
432
60
50
40
30
20
10
0
1-5 with 5 fully prepared
Per
cent
Percent within all data.
How well prepared for pandemic flu are you?
Yes25.7%
No25.7%
NA, don't exercise plans48.6%
Do you include hospitals if you excercise the plan?
Don't knowSome doMost doFew doNone
30
25
20
15
10
5
0
Per
cent
Percent within all data.
Do your hospitals have blood triage plans?
RBCs: supply side• Increase collections by established groups and
general appeals• Increase O positive (and negative) inventory• Use of frozen blood reserve if available• Autologous• Adjust donor eligibility: a large, immediate source
of already committed donors • Reduced interdonation interval• Travel (malaria-deferred donors)• TSE deferrals • Hemoglobin• 2-RBC qualifications
RBC: demand side• Peri- and post-operative salvage
• Autologous predeposit
• ESAs for appropriate chronic anemias
• Limit O negatives to fertile females• Enforce conservative transfusion triggers• Postpone elective surgery• "Triage" elective blood-intensive care• Ration based on the expected survival of
candidates for transfusion
The Supply Side: global red cell use rates: 2008-09
Venezu
elaBraz
il
South Afri
ca
Singa
pore
Saudi-A
rabia
Poland
Hong Kong
New Ze
aland
Canad
a CBS
Canad
a Hem
a-Queb
ec
Irelan
dSp
ain
Netherl
ands ²
⁾
Croati
a
France
UK NHSBT ¹
⁾
Portuga
l
Australi
a
Hungary Ita
ly
Norway
Japan
Finlan
dUSA
Swed
en
Austria
Belgium Fl
anders
German
y0
10
20
30
40
50
60
RBCs per 1,000 Population
Devine D et al: International Forum: Inventory Management. Vox Sang. 2009
13121110987654321
14
12
10
8
6
4
Hospital number
Grams
TRICC
Median=8.5
Hemoglobin triggers in non-bleeding recipients by hospital
MVRBC 2009-11
MVRBC hospital service contract: you can lead a horse to water…
• Hospital will develop…written plan for the distribution of blood and blood product during a shortage…. Such …plan must include, but is not limited to, management of blood and blood product distribution.
• Hospital will also provide updates to the …plan to blood center as updates are completed.
• Blood center will assist in the development of this plan upon request by hospital.
Summary and conclusions• There is no history of local disaster that has stressed our
ability to provide adequate blood and components
– Protecting transportation and communication is key
• The blood community, in response to the 2009 influenza A pandemic, generally produced response plans for a widespread and prolonged event (and feels confident)
• Those plans have not been adequately exercised
• The blood community welcomes “prospective” regulatory flexibility for donor/donation qualification
• Management of the demand side at hospitals via planning and triage must be formally implemented