Practical aspects of emergency response in blood establishments BPAC, August 2011, Gaithersburg...
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![Page 1: Practical aspects of emergency response in blood establishments BPAC, August 2011, Gaithersburg Louis M. Katz MD Mississippi Valley Regional Blood Center.](https://reader030.fdocuments.us/reader030/viewer/2022032701/56649c9e5503460f9495d9cb/html5/thumbnails/1.jpg)
Practical aspects of emergency response in blood establishmentsBPAC, August 2011, Gaithersburg
Louis M. Katz MDMississippi Valley Regional Blood Center
Davenport, IA
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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)
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Sept. 11, 2001:
Courtesy of the New York Blood Center
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ABC/BCA Spoke and Hub system: 2011
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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.
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If you’ve seen one pandemic, you’ve seen one pandemic
Kamp et al. Transfusion. 2010
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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
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NoYes
94.3%
5.7%
Did you have a pandemic flu plan in 2009?
ABC centers N=35
revised their plans25.7% have already
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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?
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Yes25.7%
No25.7%
NA, don't exercise plans48.6%
Do you include hospitals if you excercise the plan?
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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?
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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
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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
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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
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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
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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.
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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