Those Troublesome Gubers

Emergo Train ~ Lessons Learned

Avril WentworthTransfusion Laboratory

Westmead Hospital

Emergo Train System

Developed in Linkoping, Sweden, 1980s

Internationally recognised disaster training course

Simulates a mass casualty incident

Patients & staff represented by Gubers

Interactive tool, runs in real time

Evaluates preparedness & management

of major incidents & disasters

Exercise WePrec 2017Scenario:

Bus crash at Sydney Olympic Park, around 0830. The bus driver suffered a heart attack and drove into crowds and concession stands.

2 hospitals, 130 staff, 148 patients

Objectives:

Test surge capacity in response to mass casualty

Ensure timely intervention of patient management options

Test electronic disaster victim registration & tracking system

Transfusion in the Game Responded to Code Brown notification by assessing stock

levels of blood products and staffing resources.

Sourced additional blood stocks from The Blood Service, local Pathology West transfusion laboratories and by releasing crossmatched units.

Transport/delivery times of products taken into account

(Note: only fresh products were involved in this exercise)

Nominated a representative to attend briefings at the Emergency Operation Centre (EOC), to provide and receive information throughout the exercise.

Transfusion in the Game ~2Issues encountered:

> 50% specimens received from ED did not meet acceptable labeling requirements

‘MTP’ written on forms, not verbally activated as per policy

Unable to contact ED by phone to inform them of errors and request recollections

Blood requested by ED was not delivered as the patient was unable to be located

A quick fix:

Pathology deployed a liaison officer to ED to allow communication and monitor specimen collections, thus reducing further errors

“Emergency Department”

Transfusion Outcomes Transfusion/Pathology processes not tested enough

Transfusion was under utilised during this exercise

Areas for improvement identified, to be addressed

Contribute to review of Disaster Plan

“Transfusion” Stock levels at end of Exercise

Exercise OutcomesOverall: Room for improvement

• Internal communication and Command and Control, Review the use of diagnostic services in ED

• Refine role definition and function for pathology and imaging liaison

Pathology: Room for improvement

• Tracking of patients to ensure blood gets to right patient

• Deployment of a pathology liaison to ED on activation

• Alternate process for notification of code

Where to next ? Design & conduct a transfusion focused exercise to more accurately challenge and evaluate the performance of the pathology department during a major incident or disaster.

Apply learning outcomes to New Transfusion Disaster Plan.

Test related areas of pathology, e.g. Haematology and Specimen Reception

Include out-of-hours scenarios, with reduced staffing levels, managers not present

Cover internal & external disasters – catastrophic bleeding/trauma, disruption to transfusion services or evacuation - to where?

Transfusion Exercise ?Communication is Key.

Establish roles for liaison officers between Transfusion and EOC, The Blood Service, medical staff/wards, other areas of pathology – but who?

Nominate deputies for out-of-hours?

Receive accurate &/or relevant information in a timely manner.

Transfusion Exercise ??Anticipating and Supplying Demand.

Requires complex planning due to many unknowns. Immediate reaction was to get in as much blood as possible, as soon as possible!

Scope of disaster ?

Are other local hospitals involved? Who else can we source blood/products from?

Storing the influx of these products before they are required?

Transfusion Exercise ?? Number of critically bleeding patients? Not all victims

will need transfusion.

How will blood for multiple bleeding patients be transported? Who will be transporting blood? Dedicated runner?

To ED or theatres, keeping track of where patients are?

Time frame? Prepare for ongoing transfusion support in days/weeks following event. Staffing levels as incident continues?

Transfusion Exercise ???Type of product? Blood products needed to control massive bleeding and correct coagulopathy (develops in around 40% of seriously injured patients, leads to most deaths within 24 hours after trauma).

Red cells, FFP, cryo, and what about……

Clotting factors need to increase stock levels?

Frozen products how fast will we use up group AB, then group A?

Platelets how are we going to get enough platelets? Storage?

A work in progress !

Thank You “Mortuary”

“Pathology”

References & Acknowledgements

An approach to transfusion and haemorrhage in trauma: current perspectives on restrictive transfusion strategies. Homer Tien, MD, Bartolomeu Nascimento, Jr., MD, Jeannie

Callum, MD, and Sandra Rizoli, MD, PhD

Transfusion support in a community disaster. P.J. Scmidt, W.L. Bayer

Exercise WePrec, Westmead Hospital, Cold debrief report

Scott Pearse, Disaster Manager, NSWHP

Colleagues from Westmead Transfusion