AABB24: Ensuring Blood Availability for Mass Casualty Events

There is, unfortunately, no shortage of mass casualty events. To address the needs during such times, the blood community is developing more protocols to ensure blood is always available.

“Our community blood centers do a great job supporting one another during these times,” said Nelson Hellwig, MBA, CEO/administrator of the Alliance for Community Transfusion Services and the Blood Emergency Readiness Corps, “but they can only support to the extent that they have units available.”

Recognizing this growing need, a group of blood centers, spearheaded by John Armitage, MD, of Our Blood Institute, came together in 2021 to create a groundbreaking initiative: the Blood Emergency Readiness Corps (BERC). As the backbone of efforts to ensure blood unit availability for mass casualty events, BERC has blood centers across the United States banding together and reserving a modest amount of blood units to be readily available in case of emergencies that put stress on a particular region. If no disasters strike, the units return to the blood centers that collected them, in order to be used for general patient needs.

At its core, BERC is a collaborative effort of blood centers committed to being prepared for disasters. The program has set clear criteria for activation, including casualty events impacting at least five individuals and the activation of the AABB Interorganizational Task Force on Domestic Disasters and Acts of Terrorism.

What started with seven blood centers has now grown to include 37 community blood centers across the country. This expansion has significantly increased the strength and reach of the blood reserve, enabling more effective responses to various emergencies.

The program operates on a rotating schedule, with blood centers divided into groups of three. Each center is on call once every third week, at which time they set aside 10 O-positive and four O-negative units. BERC’s structure is designed for simplicity and efficiency. Blood centers have the flexibility to manage their reserved units as they see fit, whether by tagging them in their inventory or storing them separately. This ensures that the program can be easily integrated into existing operations.

Beyond its primary purpose of emergency preparedness, BERC has proven to be a powerful tool for community engagement. Blood centers have successfully used the program for marketing and recruitment, particularly with first responders and local hospital partners. It has also helped blood centers position themselves as crucial emergency readiness partners in their communities, allowing them to raise awareness of the critical role of blood donation in disaster preparedness.

Hellwig said that BERC demonstrates the power of collaboration and foresight in the blood banking community.

Amanda Hess, MBA, Vice President of Donor Relations at ImpactLife in Davenport, Iowa, shared her facility’s journey with BERC. “Joining BERC was a natural fit for us,” she said. “With 50 years of experience as a blood exporter, we were already familiar with the concept of prioritizing local hospitals while helping others when possible. The idea of a coordinated emergency response network resonated strongly with our mission and values.”

ImpactLife launched its BERC partnership in January 2022, a time when preparedness was at the forefront of everyone’s minds due to the ongoing pandemic. Communities embraced this initiative wholeheartedly, and ImpactLife saw great success in engaging with local media and partners through virtual press conferences and comprehensive media packages.

Hess said that one of the key benefits of joining BERC has been the ability to deepen ImpactLife’s relationships with emergency preparedness and response partners. They have engaged with a wide range of partners, from hospital laboratory contacts and trauma experts to ambulatory services and emergency management agencies. They’ve leveraged existing partnerships, such as “Boots versus Badges” blood drives with local police and fire departments, to further promote our mission.

“Our biggest challenge in this industry is reaching people and telling them about who we are and what we do,” Hess remarked. “We are not ambulance chasers. We are the ambulance and that is the story we have to tell. So I’m very excited when things like this come along because it allows us to tell that story in a different way.”

Throughout the year, ImpactLife uses its “on-call” weeks as opportunities to remind people that the best response is preparedness. It is the blood already on the shelves, donated by routine donors, that saves lives immediately in times of crisis.

Belinda A. Flores, MA, Senior Director of Product Management & Customer Relations at South Texas Blood and Tissue (STBT) in San Antonio, began her talk with a case study of sorts when she shared a video detailing the experience of 10-year-old Mayah Zamora, who was severely wounded in the May 2022 massacre at Robb Elementary School in Uvalde, Texas, in which a gunman killed 19 of her schoolmates and two teachers. Another 17 people were injured, some severely; many required blood transfusions.

With multiple gunshot wounds, Mayah underwent more than 20 surgeries during her 66-day hospital stay. Despite her injuries and trauma, this resilient girl has become an advocate for blood donation, using her experience to inspire others to give. She also participates in donor recruitment events. The video showcased Mayah’s recovery and the gratitude her family feels towards blood donors and STBT.

Flores explained that when the shooting happened, 11 donor centers were on call, and they sent 33 units to STBT—three per donor center. STBT has a helipad and so local emergency services were able to get blood to Uvalde via helicopter in just over an hour. She remarked that this was illustrative of how blood centers are here to help when there is a mass casualty event, and seeing the teams work together really shows the commitment that they have to their communities.

STBT also plays a crucial role in national disaster response through the BERC system. Flores discussed the BERC work activations, detailing the process of backfilling blood supplies between centers to ensure efficient distribution during emergencies. She provided examples of how blood centers collaborate to overcome logistical challenges. For example, STBT is on rotation with Hawaii, a state in which it can be difficult to get blood quickly to the mainland. In situations like this, STBT will send its reserve, which it recently did for Hurricane Milton’s stricken areas, and also send Hawaii’s reserve. Hawaii then backfills to STBT what was sent on its behalf.

Flores’s presentation concluded by noting the appreciation from EMS agencies for the proactive approach of blood centers in ensuring product availability during emergencies. This underscores the critical role of community blood centers in supporting emergency services and saving lives.