Paucity of Blood Products Transfused Following the I-35W Bridge Disaster.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4026-4026
Author(s):  
Jed Baron Gorlin ◽  
Sertac Kip ◽  
Dawn Hansen ◽  
Jonathan Pohland
Keyword(s):  
Hurricane Katrina ◽  
Trauma Center ◽  
Local Community ◽  
Blood Donation ◽  
Community Response ◽  
Lessons Learned ◽  
Blood Products ◽  
Blood Center ◽  
Phone Calls ◽  
Level 1

Abstract Following 9/11 and Hurricane Katrina there has been a concerted effort to prepare and organize for disasters. Blood transfusion, a key element of disaster response, has been previously documented to be an important factor in decreasing fatalities from disaster-related injuries, provided there is an organized system of transfusion. Reviews of blood usage following other domestic disasters have generally revealed only modest use of transfusable products that generally do not overwhelm local supplies of blood. We conducted a survey to enumerate the amount of blood and blood products used in Minnesota following the I- 35W bridge collapse that took place on 8/1/07. The bridge is for a major interstate highway that crosses the Mississippi river collapsed under the weight of evening commute traffic. The bridge normally carries 140,000 vehicular trips daily. About 100 individuals presented to local hospitals the evening or day following the incident and 9 individuals died at the scene or by the time of arrival at the trauma center. All critically injured were brought to Minnesota’s largest level 1 trauma hospital that fortuitously was adjacent (less than 1/2 mile) to the disaster site. Within 1/2 hour of the event, the local community blood center sent additional blood to all customer hospitals likely to receive patients, prior to any estimates of the number of injured patients expected at that hospital. However, no blood products were transfused for bridge accident victims at the other surrounding hospitals. Of 25 patients presenting by ambulance to the level 1 trauma center, only 5 received blood following the event. Only 2/5 received emergency group O units, and since both were male, they each received 2 group O Rh(D) + before being switched to type specific units. In total, 14 units of red cells were transfused the evening of the disaster to four of those patients. 30 additional units were required for the 5 patients requiring transfusion over the ensuing week-10 days following hospitalization. One apheresis platelet, 2 jumbo cryoprecipitate units (derived from 600 ml plasmapheresis donations) and 4 FFP were also administered to these same 5 patients the evening of 8/1. The FFP included 2 units of thawed AB plasma that are maintained in the transfusion service for immediate release to emergency patients at all times. Media response uniformly encouraged blood donation and community response was overwhelming resulting in one local community blood center receiving over 11,000 phone calls in the two days following the disaster. The usual collection of ∼400 units/day was doubled to almost 800 units and on the second day after the disaster (8/3/07) the blood center issued press releases noting that the immediate needs had been met. Lessons learned include the importance of disaster drills to prepare staff for such events. In addition, the best disaster preparation is to have adequate supplies at all times, since components from donations that follow the event may not be available for several days.

Maintaining trauma center operational readiness during a pandemic

2021 ◽  
Vol 16 (1) ◽  
pp. 25-34
Author(s):  
Alexander C. Cavalea, MD ◽  
Robin McGoey, MSGC, MD ◽  
Rebecca W. Schroll, MD, FACS ◽  
Patrick R. McGrew, MD ◽  
Jonathan E. Schoen, MD, MPH ◽  
...  
Keyword(s):  
New Orleans ◽  
Trauma Center ◽  
Medical Center ◽  
Lessons Learned ◽  
Trauma Centers ◽  
Surge Capacity ◽  
High Resource ◽  
Slow Moving ◽  
Level 1 ◽  
Level 1 Trauma Center

The coronavirus disease 2019 (COVID-19) pandemic is a slow-moving global disaster with unique challenges for maintaining trauma center operations. University Medical Center New Orleans is the only level 1 trauma center in New Orleans, LA, which became an early hotspot for COVID-19. Intensive care unit surge capacity, addressing components including space, staff, stuff, and structure, is important in maintaining trauma center operability during a high resource-strain event like a pandemic. We report management of the trauma center’s surge capacity to maintain trauma center operations while assisting in the care of critically ill COVID-19 patients. Lessons learned and recommendations are provided to assist trauma centers in planning for the influx of COVID-19 patients at their centers.

Analysis of Disaster Response Plans and the Aftermath of Hurricane Katrina: Lessons Learned From a Level I Trauma Center

2008 ◽  
Vol 65 (5) ◽  
pp. 1126-1132 ◽  
Author(s):  
Sidney B. Brevard ◽  
Sharon L. Weintraub ◽  
James B. Aiken ◽  
Edward B. Halton ◽  
Juan C. Duchesne ◽  
...  
Keyword(s):  
Hurricane Katrina ◽  
Disaster Response ◽  
Trauma Center ◽  
Lessons Learned ◽  
Level I

Implementing a REBOA program outside of the ivory tower: initial case series and lessons learned at a community trauma center.

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
Jacob J Glaser ◽  
Adam Czerwinski ◽  
Ashley Alley ◽  
Michael Keyes ◽  
Valentino Piacentino ◽  
...  
Keyword(s):  
Acute Care ◽  
Trauma Center ◽  
Systolic Pressure ◽  
Case Series ◽  
Lessons Learned ◽  
Hospital Environment ◽  
Open Approach ◽  
Improvement Program ◽  
Clinical Series ◽  
Community Trauma

Background: REBOA has become an established adjunct to hemorrhage control. Prospective data sets are being collected, primarily from large, high volume trauma centers. There are limited data, and guidelines, to guide implementation and use outside of highly resourced environments. Smaller centers interested in adopting a REBOA program could benefit from closing this knowledge gap. Methods: A clinical series of cases utilizing REBOA from Grand Strand Medical Center, Myrtle Beach, South Carolina were reviewed. This represents early data from a busy community trauma center (ACS Level 2), from January 2017 to May 2018. Seven cases are identified and reported on, including outcomes. Considerations and ‘lessons learned’ from this early institutional experience are commented on.   Results: REBOA was performed by trauma and acute care surgeons for hemorrhage and shock (blunt trauma n=3, penetrating trauma n=2, no- trauma n=2). All were placed in Zone 1 (one initially was placed in zone 3 then advanced). Mean (SD) systolic pressure (mmHg) before REBOA was 43 (30); post REBOA pressure was 104 (19). N=4 were placed via an open approach, n=3 percutaneous (n=2 with ultrasound). All with arrest before placement expired (n=3) and all others survived. Complications are described.   Conclusions: REBOA can be a feasible adjunct for shock treatment in the community hospital environment, with outcomes comparable to large centers, and can be implemented by acute care and trauma surgeons. A rigorous process improvement program and critical appraisal process are critical in maximizing benefit in these centers.

Characteristics of Physician Relocation Following Hurricane Katrina

2009 ◽  
Vol 95 (1) ◽  
pp. 6-12
Author(s):  
Kusuma Madamala ◽  
Claudia R. Campbell ◽  
Edbert B. Hsu ◽  
Yu-Hsiang Hsieh ◽  
James James
Keyword(s):  
Hurricane Katrina ◽  
Gulf Coast ◽  
General Medicine ◽  
The United States ◽  
Lessons Learned ◽  
Bivariate Analysis ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Factors Associated ◽  
The Impact

ABSTRACT Introduction: On Aug. 29, 2005, Hurricane Katrina made landfall along the Gulf Coast of the United States, resulting in the evacuation of more than 1.5 million people, including nearly 6000 physicians. This article examines the relocation patterns of physicians following the storm, determines the impact that the disaster had on their lives and practices, and identifies lessons learned. Methods: An Internet-based survey was conducted among licensed physicians reporting addresses within Federal Emergency Management Agency-designated disaster zones in Louisiana and Mississippi. Descriptive data analysis was used to describe respondent characteristics. Multivariate logistic regression was performed to identify the factors associated with physician nonreturn to original practice. For those remaining relocated out of state, bivariate analysis with x2 or Fisher exact test was used to determine factors associated with plans to return to original practice. Results: A total of 312 eligible responses were collected. Among disaster zone respondents, 85.6 percent lived in Louisiana and 14.4 percent resided in Mississippi before the hurricane struck. By spring 2006, 75.6 percent (n = 236) of the respondents had returned to their original homes, whereas 24.4 percent (n = 76) remained displaced. Factors associated with nonreturn to original employment included family or general medicine practice (OR 0.42, 95 percent CI 0.17–1.04; P = .059) and severe or complete damage to the workplace (OR 0.24, 95 percent CI 0.13–0.42; P < .001). Conclusions: A sizeable proportion of physicians remain displaced after Hurricane Katrina, along with a lasting decrease in the number of physicians serving in the areas affected by the disaster. Programs designed to address identified physician needs in the aftermath of the storm may give confidence to displaced physicians to return.

scholarly journals Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlie A. Sewalt ◽  
Benjamin Y. Gravesteijn ◽  
Daan Nieboer ◽  
Ewout W. Steyerberg ◽  
Dennis Den Hartog ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Trauma Center ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Absolute Benefit ◽  
Predicted Probability ◽  
Prehospital Triage ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Level 2

Abstract Background Prehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers. Methods We used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS > 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit. Results We included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92–0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (n = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS > 15 were predicted to benefit from transportation to Level-1 centers (n = 26,522, 22%). Conclusions Benefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles.

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