A Review of Interfacility Blood Transportation by Ambulance to a Regional Trauma Center

Abstract

There are no published data on the fate of blood components (BC) sent with patients transferred from peripheral hospital emergency departments to regional trauma centers in Canada, unlike in the US or UK. Thus, our goals were to describe the fate of such BC and to highlight possible areas for utilization improvement. As a blood bank quality improvement audit, we retrospectively reviewed the disposition of BC received at a single tertiary care trauma facility, from January 2013 to December 2015. In total, 141 patients were transported with 357 units of BC over the 3-year period: 317 (89%) were red blood cells (RBC), 37 (10%) were plasma, and 3 (1%) were platelets. One hundred twenty-seven units (35%) were transfused en route, 191 (54%) were successfully placed into inventory at the receiving site, and 39 (11%) were discarded. RBC were discarded if the storage container temperature exceeded 10°C, plasma if thawed but not used, and platelets were discarded if they were stored in the cooler with the RBC. More wastage occurred when N1 type of BC was transported, as compared to just one (16/67 vs 23/251; Fisher’s Exact Test, p=0.007). Although therewas significant correlation between the number units and the number of types of BC transported (Spearman’s rho = 0.472, P b .001), N1 BC type remained significantly correlated to wastage, even after controlling for the number of units (partial correlation, r=0.310, P b .001). When comparing N1 type of component to only one type transported, the odds ratio of wastage was 2.6 and the ROC curve had an area of 0.770 (P = .001). Overall, 1 in 10 units was discarded due to improper storage. Given the above findings, it is recommended that emergency physicians sending BC with a patient to a referral center, where possible, limit transfer to RBC unless there is clear evidence to support the need for multiple components. Appropriate attention to BC packaging within storage containers by the transferring facility is also critical to mitigate unnecessary loss. Such a strategy could help reduce the wastage of a limited and valuable resource.