1. MOCK NEBMC SCENARIO Why we are in Green Phase?
November 14, 2013
NEBMC
Notes prepared based on BUMP simulation model
M. Taher Sh. Rad

2. List of contents (1) National Blood inventory basic Data
National Red Cell Demand (Table-CBS)
National Red Cell Demand and inventory
Dynamics of National Blood inventory-Sudden shortage at 1
Dynamics of National Blood inventory-40% shortage (similar to this mocked scenario)

3. List of contents (2)
Dynamics of National Blood inventory Mock Trial – Brampton Scenario-1 (Day1)
Dynamics of National Blood inventory Mock Trial – Brampton Scenario-2 (Day6) – restoring 20% of lost capacity
Dynamics of National Blood inventory Mock Trial – Brampton Scenario-3 (Day6)-restoring 40% of lost capacity
Dynamics of National Blood inventory Mock Trial – Brampton Scenario-4 (Day14)-No idea what to do after two weeks
Notes on projected inventory
Final Conclusion 1 & 2

4. National Blood System – Basic Data
CBS DOH defined based on ~3000 RC/Day (CBS collects ~3000 RC ( )/Day)
Annual National RC Demand (12/13)  819,130
Daily National RC Demand (DRCD): 2,245 RC/Day
Average CBS Daily Inventory; 20, 000 RCs+/-10%
Based on DOH: days ( days)
Based on Inventory Index (DRCD): (9-10 Days)
Difference between DOH & Inventory Index: 25% (Calculation of inventory by DOH underestimates the available RC inventory within blood system; Hospitals & CBS)
Average Hospital Inventory: 8-10 days (~20,000 RCs)

5. National Red Cell Demand - CBS
RBC Units Issued by fiscal period, by province and territory
(Number)
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
CAGR
Canada (Excl Quebec)
762,289
776,783
792,884
802,313
834,845
832,178
820,487
833,318
819,130
0.9%
Nfld & Labrador
19,528
19,364
18,820
18,882
18,224
17,401
17,896
17,464
16,683
-1.9%
PEI
3,514
3,898
3,659
3,907
4,326
3,929
4,023
4,031
3,772
Nova Scotia
33,120
32,548
33,602
31,116
31,575
31,242
31,120
32,391
30,988
-0.8%
New Brunswick
23,065
23,481
24,542
24,325
24,937
24,027
24,109
24,190
23,936
0.5%
Ontario
390,013
392,693
395,997
395,387
418,173
415,495
409,610
415,952
409,001
0.6%
Manitoba
43,210
43,083
44,822
45,657
45,185
45,425
44,699
45,184
46,274
Saskatchewan
35,832
36,269
36,822
37,663
39,108
41,017
37,473
37,280
36,485
0.2%
Alberta
97,649
103,974
108,344
109,868
115,501
113,506
113,228
115,850
112,438
1.8%
British Columbia
114,318
119,561
124,319
133,704
135,838
138,172
136,439
139,190
137,447
2.3%
Yukon Territory
817
801
938
810
924
865
842
781
898
1.2%
Northwest Territories
923
820
739
732
751
798
747
659
826
-1.4%
Nunavut
300
291
280
262
303
301
346
382
3.1%
All Territories
2,040
1,912
1,957
1,804
1,978
1,964
1,890
1,786
2,106
0.4%

6. National Red cell Demand & Inventory Summary
Annual National RC Demand (12/13)  819,130
Daily National RC Demand (DRCD): 2,245 RC/Day
50-55% of National inventory is located at CBS (~9-10 days)
45-50% of National inventory is within Hospitals (~9 days)
Total National inventory : Days Days

7. Dynamics of National Blood inventory When Blood Supply Drops to Zero
Total National inventory : 18 Days (40,410)
If blood supply drops to zero (0), the available national inventory will last for 18 days (without intervention).
Considering group specific fluctuations, the fully functional inventory will last for 15 days (based on simulation of the ratio of O-neg & O-pos within hospitals-Data was provided in BUMP report; 2009)

8. Dynamics of National Blood inventory with Blood supply shortage at 40%,
Total National inventory : 18 Days (40,410)
If blood supply drops by 40%, the available national inventory will last for 7 weeks from the time of procedure of shortage (without interference).
Considering group specific fluctuations, the national inventory will last 6 weeks (based on the simulation of the ratio of O-neg & O-pos within hospitals - Data was provided in BUMP report; 2009)

9. Dynamics of National Blood inventory Mock Trial – Brampton Scenario-1 (Day1)
Total National inventory - Nov 24th: 15 Days (CBS:13,477 + Hospitals: 20,000 = 33,477)
If blood supply drops by 40% and non of Brampton collections will be processed for the next 5 days  The total national inventory (5 day post shut-down of Brampton) will stand at 13 days of DRCD.
And the national inventory will last 5-6 weeks from May 1st (without intervention).

10. Dynamics of National Blood inventory Mock Trial – Brampton Scenario-2 (Day6) 5 Days post-shut down – Day 6 (20% restored)
Total National inventory : 13 Days (CBS:11,352 + Hospitals: 17,833 = 29,185)
If 50% of Brampton’s lost capacity (20% of national supply) gets restored (Transfer of collected blood to other plants)  The total national inventory has capacity to be extended and last for another 12 weeks (without any interference)
Conclusion: No need to announce amber phase prior this time (The situation will be re-evaluated in one week)
12 weeks provides adequate time to come up with solutions to return the operation to a normal levels.
 No need to announce the amber phase prior to this time.

11. Dynamics of National Blood inventory Mock Trial - Brampton Case Scenario-3 (Day6) 5 Days post-shut down – Day 6 (40% restored)
Total National inventory : 13 Days (CBS:11,352 + Hospitals: 17,833 = 29,185)
If 100% of Brampton’s lost capacity (40% of national supply) gets restored (Transfer of collected blood to other plants)  The total national inventory will return to normal operation (without any interference)
 No need to announce the amber phase prior to this time.

12. Dynamics of National Blood inventory Mock Trial - Brampton Case Scenario-4 (Day14) 14 Days post-shut down (May8) - No idea what to do after 2 week
Total National inventory : 10 Days (CBS:6,792 + Hospitals: 15,715 = 22,507)
If no any change in 100% of Brampton’s lost capacity  The total national inventory will Stand at 10 Days inventory (DRCD) (without any interference)
With no intervention, the national inventory will last for another 4-5 weeks.
With implementation of 25% saving plan, the national inventory could be extended for another 8 weeks.
We will be entering Amber phase if no actions will be taken to restore the supply and component production at this time.
No need to announce the amber phase prior to this time.

13. Notes on Projected inventory
CBS projected inventory shows 660 O+ RCs at May 8th. Considering that only 40% of supply has been compromised and still 60% of daily components should be available, CBS will be provide at least 720 O+ RCs/day (60%X1200 daily collection at regular times) which has not been projected on this table (the same for O-Neg).
In May 8th, the hospital inventories (50% of inventory) are still available with no significant change as daily utilized RCs will be replaced by CBS (Scenario assumes normal operation)
Therefore with taking 60% of continuing supply into the account, even hospital inventories will last for another 3-4 weeks (similar to CBS’s projected inventory table)
National inventory (CBS + Hospitals) have capacity to last for seven weeks. With implementation of 25% saving strategy, the national inventory can extended to at least weeks.

14. Final Conclusion -1
Delaying Amber phase will prevent unnecessary interruption of medical & surgical services nationally or in Ontario (which holds 50% of the nation)
There is adequate time to re-evaluate the situation during next 1-2 weeks after occurrence of this interruption without intervention on utilization side
Decision about the phase of shortage should be based on collective inventories of CBS & hospitals and the available empirical and historical data of blood system.
Dynamic management of inventory at regular times or during shortage requires very sophisticated software as well as application of advanced mathematical indicators to precisely outline the extent and impact on national inventory during the normal operation and during shortage.

15. Final Conclusion -2 Notes on Projected inventory
Application of DOH in forecasting of projected inventory in MOCK NEBMC SCENARIO, underestimates the inventory of group specific red cells.
This is the possible source for unusual ratio of specific blood groups within the projected inventory table
This underestimation may contribute to the different extreme opinions for the phase of shortage during the discussions.
Even restoring 50% of lost capacity of Brampton scenario will provide adequate time to come up with solutions to restore the normal operation without announcement of amber phase.