AABB24: New Approaches to Disaster Preparedness

The critical importance of preparedness and adaptation in ensuring the effective management of blood resources during crises such as natural disasters and mass casualties cannot be emphasized enough. The Monday session titled “Paradigm Changes in Transfusion Medicine: Disaster Preparedness” gave attendees invaluable insights into the strategies, challenges and practices associated with disaster preparedness from a blood center perspective.

As Audra Taylor, vice president of blood operations at South Texas Blood and Tissue in San Antonio, highlighted in her presentation, disasters come in many forms and are becoming more frequent. From weather-related events to mass shootings and cybersecurity threats, blood centers and hospitals must be ready to respond at a moment’s notice.

“Adequate blood supply is the difference between life and death for victims,” Taylor said. “We all are very familiar with the right product at the right place at the right time. We struggle… trying to meet the demand of our patients. It’s even more so in an emergency when we’re trying to respond.” 

Ensuring an adequate blood supply during emergencies is challenging. Pre-disaster planning, including managing inventories and donor recruitment, is essential. In fact, AABB’s Standards for Blood Banking and Transfusion Services requires all accredited facilities to have an emergency preparedness plan in place and to exercise it regularly. This plan should cover various scenarios, including facility disasters and inventory challenges. Additionally, any deviations from the Code of Federal Regulations must be approved by the Food and Drug Administration in advance.

The response to a disaster occurs in phases. In the first 24 hours, blood centers rely on their existing inventory, emphasizing the importance of maintaining an adequate supply at all times. Group O blood and AB plasma are particularly critical in the initial response. As the situation evolves, all blood types come into play, and full-scale collections and distribution efforts are implemented.

Collaboration is key in disaster preparedness. The AABB Interorganizational Task Force on Domestic Disasters and Acts of Terrorism, the Blood Emergency Readiness Corps (BERC) and state-level partnerships all contribute to a coordinated response.

One innovative approach to disaster preparedness is South Texas Blood and Tissue’s pre-hospital whole blood program. This program, which includes low-titer O whole blood units in circulation daily, allows for rapid response to emergencies. The program’s success relies on a dedicated donor base, effective education and strong partnerships with regional emergency management and trauma centers.

Taylor noted that they are constantly working to improve their plans, identify gaps and develop strategies to address them. The recent Cybersecurity Summit highlighted that they still have much work ahead of them. “If we did need to collect emergency whole blood and prep for the next thing that we don’t know what it will be, we will target a very specific group. And this mirrors the practice in the Department of Defense. We would target our Heroes in Arms donors. Those are the donors that feed our pre-hospital program. Why? They are very loyal donors. They return at a frequency that the other donors do not.”

Despite these preparations, blood centers face ongoing challenges in maintaining adequate inventories of various blood products. Donor recruitment and retention remain significant hurdles, particularly in ensuring a consistent supply of all blood types and components needed for patient care.

As Jose Quesada, MLS(ASCP), SBB, senior director for the manufacturing laboratory, immunohematology reference laboratory and transfusion services at the South Texas Blood & Tissue Center in San Antonio emphasizes, we cannot afford to wait for emergencies to happen before we act. Our success in saving lives depends on our ability to plan, practice and prepare for the unexpected.

Throughout the past 30 years, there has been a paradigm shift in transfusion practices. From the days of relying heavily on crystalloids, we have moved to more sophisticated approaches involving massive transfusion protocols and the strategic placement of blood products in emergency rooms and operating theaters. The introduction of type A plasma as a universal donor option has further expanded this shift.

The evolution continues with the introduction of new products and methods. Cold-stored platelets are now available, and dry plasma is on the horizon. The use of cryoprecipitate, granulocyte collections and stem cell harvesting for various emergency scenarios, including potential radioactive contamination events, are being explored.

Time is of the essence in emergency transfusions and this underscores the importance of addressing “blood deserts”—areas with limited access to blood supplies. In vast states like Texas, the logistics of transporting blood quickly to remote locations presents a significant challenge.

To combat these issues, there’s a growing movement towards pre-hospital blood administration. Emergency medical services and helicopters are increasingly equipped with blood products, allowing for faster response times in critical situations. This shift is supported by various regulatory bodies and professional organizations, which are developing new standards and guidelines for out-of-hospital transfusions.

Additionally, the concept of emergency blood collection, often referred to as “walking blood banks,” becomes crucial when conventional blood supplies are exhausted and immediate transfusion is necessary to save lives.

Quesada said that in south Texas, efforts are underway to develop comprehensive plans for emergency blood collection. These plans are being integrated into existing disaster response protocols and business continuity strategies. The process involves creating detailed algorithms, procedures and training programs to ensure readiness in case of catastrophic events.

Developing an effective emergency blood collection program requires collaboration across multiple departments and stakeholders. It is a complex process that requires thorough planning and coordination.

The ultimate goal is moving from a state of partial readiness to full preparedness. By staying informed about new developments, collaborating across disciplines and maintaining a focus on rapid and effective response, we can significantly improve outcomes in critical situations where every second counts.