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