RESUSCITATION OUTCOMES CONSORTIUM Version 15: The Final BLAST Countdown 3-2-1

Inclusion Exclusion Meter Use Review Required Data Points Acceptable Ways to Collect Blood Sample BLAST! Review to Include:

1. Patients meeting local trauma triage criteria for traumatic injury 2. Placement of an IV and… 3. Transported to a level I or II trauma center or died in the field or en route. Quick Guide: Inclusion Criteria

Age <15 Hanging; drowning Prisoners Obvious isolated penetrating head injury Primary Burn trauma or blunt or penetrating injury with burns >20% TBSA. Quick Guide: Exclusion Criteria

Please do not remove the red tape from the meter until after you have transferred care. Receiving hospital MDs are to be blinded from the lactate value… Blinding PLEASE DO NOT TELL THEM WHAT IT IS

3 BLAST Strips 1. Lactate Test Strip 2. Lactate Calibration Strip (F5) 3. Lactate Test Strip

1. Prepare meter for use 2. Open single sealed test strip  Fold foil back half-way and hold only by foil 3. Place strip gently in meter inlet with tab pointing to the RIGHT of meter Quick Guide: using meter

A “beep” will sound, “888” will briefly be displayed.  In 2 seconds, the function number (e.g., F-2) and the last test result will blink alternately.  Make sure the function number matches the number printed on the test-strip foil packet. The meter times out in 3 minutes. Remove the strip to reset. Is the F flashing? Quick Guide continued…

Obtain a drop of blood from patient’s IV. Do not delay transport to obtain the lactate. Place drop of blood on distal end of strip. Do not remove strip before 60 sec.  Dispose of strip in sharps container. Quick Guide: The Test

1. Use of Residual Blood from IV Catheter Insertion  Flashback of blood when starting an IV. After the insertion housing is detached from the catheter hub, a drop of blood is placed on the test strip. 2. When ensuring line patency.  Clamp tubing above side port, aspirate 5 ml of IVF/blood and discard. With a new syringe, aspirate a drop of blood. 3. Blood Drawn by Venous or Arterial Puncture for Clinically Required Laboratory Testing.  A drop of blood obtained can be used to perform the point of care test. Acceptable Ways to Collect Blood Drop

1. Place yellow check strip in meter. 2. After beep and “888” displayed, second beep is heard, then:  Memory sequence starts with screen reading: A (average), then (value).  Then 1→ (most recent value), 2→ (…20 th value). 3. Remove check strip when done and place in baggie in meter case. Retrieving Test Results from Meter

1. Complete the ROC BLAST documentation. 2. A second point of care lactate will be done by you in the trauma bay.  Obtain a blood sample from the nurses in the trauma bay and repeat the process. 3. Call BioTel: Quick Guide continued… After patient care is transferred…

EMS uses the same meter to perform both the field lactate and ED lactate:  Follow the same procedure.  Record the result labeled “1” for the most recent (ED) test. Either arterial or venous blood can be used to obtain the in- hospital lactate. Record the result labeled “2” for the field lactate test. Clear all results from the memory following each patient, to prevent confusion for the next patient’s results. Recording Both Field & ED Results

1. IVF amount prior to field lactate and total at ED arrival 2. Site where blood drop was collected; was it collected during IV start or from an existing line? 3. Time of field and hospital lactates Documentation

235 is the total number of air enrollments needed 129 is the total number of enrollments to date 3 ways to collect a drop of blood 2 drops of blood needed in field and ED 1 drop of blood per test BLAST The Final BLAST Countdown

Dr. Ahamed Idris, Principal Investigator Dr. Robert Simonson, Co Principal Investigator Dixie Climer, RN Main Coordinator Melinda Moffat, RN Trauma Coordinator Pam Owens, Operations Coordinator BLASTed to you by: