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Measures to Preserve the Blood Supply during a Severe Emergency

BEST. Measures to Preserve the Blood Supply during a Severe Emergency. John R. Hess, MD, MPH, FACP, FAAAS Professor of Pathology and Medicine Associate Medical Director, Blood Bank Medical Director, Stem Cell Lab U. of Maryland School of Medicine, Baltimore

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Measures to Preserve the Blood Supply during a Severe Emergency

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  1. BEST Measures to Preserve the Blood Supply during a Severe Emergency John R. Hess, MD, MPH, FACP, FAAAS Professor of Pathology and Medicine Associate Medical Director, Blood Bank Medical Director, Stem Cell Lab U. of Maryland School of Medicine, Baltimore Chair, Conventional Components Committee Biomedical Excellence for Safer Transfusion Collaborative WHO Expert Panel, Blood Transfusion Medicine

  2. The destruction of the World Trade Center towers in 2001 was the largest disaster in the US in a century.

  3. Texas City, TX - 16-17 April 1947 Two shiploads of ammonium nitrate exploded

  4. Texas City, TX - 16-17 April 1947 - Chemical explosion 576 killed, 178 injured Disaster led to the founding of the AABB

  5. Seward, Alaska, 1964 - Earthquake and Tsunami

  6. Mt . Saint Helens, 1980 62 dead

  7. San Francisco, CA 17 Oct 1989 - Earthquake, Mag 7.1

  8. Northridge, CA 17 Jan 1994 - Earthquake, Mag 6.7

  9. Hurricane Andrew - 24 Aug 1992 15 direct deaths, 25 indirect in Dade County Quarter of a million homeless

  10. Civil Disasters in Britain 1975-2000 • Airplane crash on a motorway • Oil platform fire • Three-train surface accident • Two-train underground accident • Underground station fire • Terrorist bombing • Crowd stampede at soccer stadium

  11. Troubles in Northern Ireland • A quarter of a century of terrorism and communal strife in Northern Ireland killed 3,100 and injured 36,500 out of a population of 2 million. • Twice in 25 years the local blood center released an additional 200 units when bombings lead to more than 100 casualties (blood used to replace stocks). • Blood used to treat casualties was 3-6% of total blood use.

  12. Terrorism in Israel • 1148 incidents between September 2000 and September 2002. • 5354 casualties • 6934 units of blood used. • Israel has 6 million population • Israel collects 280,000 units of blood yearly. • from Dr. Eilat Shinar, MDA Israel

  13. U.S. Embassies Tanzania and Kenya - 1998 • 4100 injured • 223 killed • Local hospitals handled all the casualties • U.S. sent 200 U of RBC 2 days later

  14. Madrid Train Bombings -2004 • 1800 injured • 191 killed • All casualties handled in local hospitals • No blood data available

  15. London, 7 July 2005 • 56 people died • 700 injured • 5 teaching hospitals received patients • Total day-1 blood use • 338 U of RBC • 103 U plasma • 31 U platelets • 235 U cryo

  16. Disaster Planning • “The two primary lessons learned from the Sept. 11 disaster include the need to control collections in excess of medical need and the need to ensure that facilities maintain adequate inventories to prepare for disasters at all times in all locations.” • Don Doddrige, Chair, AABB Intraorganizational Task Force on Domestic Disasters and Acts of Terrorism

  17. Disaster Planning • “there are no currently identified scenarios in which the need for blood and/or blood components would be beyond the capabilities of the blood community to provide. It is the consensus of the task force that the single greatest risk of natural disasters and acts of terrorism is not lack of supply, but disruption of the blood system” • Don Doddrige, Chair, AABB Intraorganizational Task Force on Domestic Disasters and Acts of Terrorism

  18. Civil Disruption - US • Terrorist attacks – 11 September 2001 • Loss of electricity to 8 states and 45 million people – 14 August 2003 • Hurricane Heta – Jan 2005 • Hurricane Katrina – 28 August 2005 • Northeastern Snowstorms – Feb 2010 • Midwestern flooding – Spring 2011

  19. Massive Civil Disruption – US1918 Influenza Epidemic • 30% of the population was sick at one time • Schools closed • 600,000 dead in 10 weeks • There were not enough hospital beds • There were not enough healthy people to take care of the sick • Dead were buried in mass graves

  20. Transfusion 2007 June Methods: Project 1918 morbidity and mortality on the current US healthcare system Results: 30% of workers sick and unable to work. Schools are closed. There are multiple patients for every hospital bed.

  21. Early warning • New pandemic influenza will probably originate in SE Asia were more people live in proximity to domestic fowl and pigs. • In the past medical teams in Hong Kong and Bangkok gave us early warning. • With modern air travel international spread may occur early. • If we have early warning there will be time to review plans, obtain extra supplies, and put preventive measures in action.

  22. Early response • Many government warnings • Stockpile canned food and bottled water • Avoid crowds • Prepare for school closings • Blood system consequences • Decreased donation • Stressed workers

  23. Worsening crisis • Increased demands for health care • US has 2.6 hospital beds / 1000 population • Many patients will need respiratory care • Probably reduced demand for blood • Fewer elective surgeries • Less cancer chemotherapy • Increasing stress on workers • Some sick • Some caring for loved ones • Some afraid

  24. At height of pandemic • > 40% of workers not available • Lack of basic consumable supplies like test tubes and gloves • Lack of routine maintenance or repair services for equipment and info systems • Lack of short-lived reagent red cells • Lack of protocols and supervisors for how to function without critical reagents and support systems.

  25. Stresses on workers • Increased work load and work hours • Lack of critical coworkers and supervisors • Lack of critical supplies (gloves, tubes, reagent cells, platelets, …) • Conflicting demands (finding food and gas) • Instructions to increase intrapersonal distance in crowded work areas. • Threats of violence

  26. Potential ways to maintain transfusion service function • Triage – do not massively transfuse • Do not outdate blood products normally • AS-1 RBC were once licensed for 7 weeks • Platelets were once licensed for 7 day storage • Keep RBC as long as not hemolysed • Keep platelets as long as they “swirl” • Do not discard warmed red cells • Reduce routine testing • Do not retest for alloantibodies every 3 days

  27. Recovery • Donor side of blood system (relatively easy) • Motivated donors • Availability of supplies • Transfusion service side (more difficult) • Losses of critical medical directors and technologists • Difficulty restoring the reference red cell system • Computer systems that do not reflect the new situation

  28. Recovery • Regulatory guidance • Many small systems will fail for a variety of reasons • One looses a critical supervisor or worker • One looses a computer system • One runs out of gloves • One runs out gel columns • Limited experience with making decisions • Limited knowledge • No history of permission

  29. Thank you jhess@umm.edu

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