Blood Clots and. Black Holes
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1 Blood Clots and. Black Holes
2 Early (Emergency) Activation of Transfusion Services E.A.T.S. Project The Problem History Solution Journey Future
3 To care WNSW LHD The Problem Resources
4
5 because the life of every creature is its blood Lev17: BC
6 Richard Lower Animal to Human Transfusion
7 1818 Human to Human Dr. James Blundell
8 War MTP
9 The Problem Best practice Where? Evidence of early intervention Coagulopathy ATC
10 Inverse Care Law Hart Hart Higher the need for medical care, the less likely the community will have that care
11 E.A.T.S. Project Transfusion Strategy / Delivery System Goal Timely delivery of blood products for patients with life threatening Haemorrhage within remote locations (WNSW LHD). Equip Regional Retrieval Services Remote rapid blood transfer ACC Awareness / Policy / Education
12 Meticulous Attention to Haemorrhage Control
13
14 Equip Regional Retrieval Services Red Cells / MTP
15
16 Emergency Rural Transfusion Transfer ACC identifies critical bleeding patient WNSW LHD = System Locate Closest Activation Hospital with suitable blood products Contact Blood Lab & request products Arrange NSW Police for transport Transfuse Patient with ACC Clinical support
17 Blood Map + Data WNSW LHD
18 ACC s Role Policy & Procedure Awareness Education
19 ACC Policy / Procedure Prehospital or Secondary Cases Traumatic / Medical / Surgical /Obstetric Life Threatening Haemorrhage SBP <90nnHg HR > 120 Other worrying Signs & Symptoms Notify Consultant Immediately Consider following Haemostatic controls Multiple tourniquets, ligation/clamping, Reversal of anticoagulation, balloon Tamponade, TXA. Aim for; Temp >35 C ph > 7.2 BE < 6 Lactate < 4 INR 1.5 EMERGENCY BLOOD TRANSFUSION ACTIVATION PROCEDURE Criteria for Emergency blood products: 1. Severe Mechanism of injury and / or disease with or suspected severe haemorrhage. 2. Demand for blood products outstrips the capabilities of the referring hospital to meet the patient s needs. 3. Predicted time to deliver patient to definitive care is > 120 minutes. 4. Clinical Metrics SBP< 90mmHg HR> 120 & GCS< 13 Two or more criteria yes No Continue to monitor and re evaluate *For WLHD ONLY Emergency Rural Transfusion Transfer ACTIVATE Transfusion Response Retrieval Consultant to decide one or both of the following. *Sydney & WLHD based Retrieval Services only Massive Transfusion Protocol Contact closest Link Hospital with blood products (Blood Bank) Refer to resource map. 1. Make request (aim for 4xP/C & 4xFFP) clear & approx. timeframe of pickup 2. Complete & Send Preformatted Fax 3. Contact Police Coordination Tamworth PH stating location of blood pickup / drop off and time criticality. Regional Response (WLHD) Contact Regional Hospital Blood Bank closest to tasked Retrieval Service; Dubbo Hospital Blood Bank (RFDS) (02) or Switch (02) Fax (02) *Orange Hospital Blood bank (Orange Helo) Path Switch Fax (02) State you are activating the MTP. 2. Complete & Send Preformatted Fax 3. Communicate MTP activation for Retrieval team 4. Arrange transport to Medical team... ORG Duty Paramedic / Police (02) RFDS RFDS Retrieval Doctor Sydney Response Contact Liverpool Hospital Blood Bank; (02) Fax (switchboard ) 1. State that you want to activate the MTP 2. Complete & Send Preformatted Fax 3. Communicate MTP activation for Retrieval team 4. Arrange transport/pickup Phone Numbers Tamworth Police Radio Coordination Centre Supervisor (02) Liverpool Hospital Blood (02) Fax (switchboard ) Dubbo Hospital Blood Bank Hotline or Switchboard Blood bank Fax ) Orange Hospital Blood Bank (Path switchboard Fax ) * Due to the rapid Helo response & Blood Lab processing times, it is unlikely to activate the Orange MTP under current arrangements ACC Consultant to use their clinical discretion with all Orange tasking's. Version 1.1 March 2015
20 Media Strategy
21 Challenges Peers criticism
22 Dealing with challenges Take Risks
23
24
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