Transfusions occur on a daily basis across a wide range of hospital clinical settings, and in both elective and emergency situations. The urgent provision of blood for life threatening haemorrhages requires a rapid, focused approach as excessive blood loss can jeopardise the survival of patients. Early recognition of major blood loss and immediate effective interventions are vital to avoid hypovolaemic shock and its consequences. One such action is the rapid provision of blood and blood components, for which effective communication between all personnel involved in the provision and transportation of blood is key.
NHS organisations should ensure that:
1. The hospital transfusion committee reviews the local protocols and practices for requesting and obtaining blood in an emergency (including out of hours), ensuring that they include all the actions required by clinical teams, laboratories and support services, e.g. portering and transport staff/drivers and any specific actions pertinent to sites without an on-site transfusion laboratory.
2. Local protocols enable the release of blood and blood components without the initial approval of a haematologist although they should be advised of the situation at the earliest opportunity.
3. Staff (clinical, laboratory and support staff) know where to find the massive blood loss protocol in all relevant clinical and laboratory areas and are familiar with it, supported by training and regular drills.
4. The blood transfusion laboratory staff are informed of patients with a massive haemorrhage at the earliest opportunity.
5. Clinical teams dealing with patients with massive haemorrhage nominate a specific member of the team to co-ordinate communication with the laboratory staff and support services for the duration of the incident.
6. There is a clear and well understood trigger phrase to activate the massive blood loss protocol, for example “I want to trigger the massive blood loss protocol [and state location e.g. delivery suite]” and all subsequent communications between clinical areas and laboratory staff should be preceded by the use of a locally agreed trigger phrase such as “This call relates to the massive blood loss protocol [and location]”.
7. All incidents where there are delays or problems in the provision of blood in an emergency are reported and investigated locally, and reported to the NPSA and the Serious Hazards of Transfusion (SHOT) scheme (www.shotuk.org).
8. Each event triggering the massive blood loss protocol is recorded and reviewed by the hospital transfusion committee to ensure local protocols are applied appropriately and effectively.