1. The California Blood Bank Society Emergency Preparedness Plan
CBBS Annual Meeting
May, 2017
Joy L. Fridey, MD
Chair, CBBS Emergency Preparedness Committee
(ARC Regional Medical Director, Southern California)

2. Outline Introduction Fundamentals of the CBBS Emergency Plan
Centralization
Preparedness
Back up plans
AABB Inter-organizational Task Force on Domestic Disasters and Acts of Terrorism
New Realities

3. No conflicts of Interest

4. In 1983, CA population about 25 million (163,700 square miles)
For Consideration:
In 1983, CA population about 25 million (163,700 square miles)
2016: ~39 million people – 56% increase!
Increasing number of events that could disrupt our blood system

5. Events that could cause mass casualties and/or disrupt the blood system
Natural disasters
Earthquakes
Fires
Weather
Floods
Human-generated
Mass shootings
Acts of terrorism
Floods (burst water mains?)
Freeway shutdown/s
Emergence of highly contagious diseases
Power disruptions
Civil unrest

6. CBBS Plan Activation: Situations
1989 Loma Prieta Earthquake in the Bay Area - blood not accessible to BCP because Bay Bridge damaged
9/11: Through network of HAM radio operators, the lead AEOC in the CBBS Plan facilitated communication with the NY Blood Center which had no telecommunications service (sent blood!)
December 2015 mass shooting in San Bernardino
Less than perfect but instructive

7. Thinking about: Natural disasters – earthquakes
CBBS Emergency Preparedness Plan developed 1983
Thinking about: Natural disasters – earthquakes
Goal: Establish a network of blood centers in CA to:
Communicate in a disaster
Collaborate in collecting and transporting blood and specimens. Essential: 1) Get blood only to where needed without 2) Inadvertently creating shortages elsewhere!
Collaborate with State, Federal and other agencies

8. Clarifications
CBBS does not issue standards or regulations; participation in the Em Prep/Response plan is voluntary.
The State of California does not require participation in the CBBS Em Prep Plan, may collaborate with CBBS institutional members in disaster response
CBBS is not the “Blood Centers of California” (BCC)
BCC:
Primarily, legislative focus
Medical/Technical Advisory Committee (David Oh, MD, Chair)
Share institutional members, collaborate in discussions on disaster preparedness

9. What is a Disaster? An Event Associated with:
Sudden increase in the need for blood that cannot be met locally
Sudden, significant limitation on the ability to collect, test, process or transport blood or specimens
Event that disrupts communication related to blood needs

10. The CBBS Emergency Preparedness Plan
Available to the public on the CBBS Website
Primarily intended for institutional members
Six core sections in 13 pages:
Overview, definitions, emergency prep activities
Network activation and contact numbers
Communication – traditional and alternate
Transportation for blood products and specimens
Donor Processing
Record keeping and media contact
Appendices

11. Pillars of the CBBS Emergency Response Plan
Centralization
Preparedness
Backup plans

12. Participating CBBS Institutional Members
Community blood centers (12)
ARC, Northern California (Oakland)
ARC, Southern California (Pomona)
Blood Centers of the Pacific (San Francisco)
BloodSource ( Sacramento area)*
Central CA Blood Center (Fresno)
Delta Blood Bank (Stockton), now ARC Stockton
Houchin Community Blood Bank (Bakersfield)*
Lifestream (San Bernardino)
N CA Community Blood Bank (Eureka)
San Diego Blood Bank*
United Blood Services (San Luis Obispo)
United Blood Services (Las Vegas)
Major collecting hospitals
Cedars-Sinai Medical Center
City of Hope
Stanford Medical School Blood Center
UCLA Ronald Reagan Medical Center
Major donor testing laboratory
Creative Testing Solutions (Scottsdale, AZ)
*Area Emergency
Operations Centers

13. Locations of CBBS Emergency Response Blood Centers
Community Blood
Center
Area Emergency
Operations Center
Major Collecting
Hospital

14. Hospitals Area Emergency Operations Centers (AEOC) Northern:
BloodSource
Central:
Houchin
Southern:
San Diego BB
Participating Community Blood Centers
Hospitals

15. Area Emergency Operations Centers (AEOC)
Northern: BloodSource
State Disaster Control Center for Blood
Blood center liaison with CA Emergency Management Agency
(Cal-EMA)
Central: Houchin
Southern: San Diego BB
(Backup AEOC for N AEOC)
(24/7)
(Reg. bus. hrs)

16. How Does the Emergency Response Plan Work?
Friend
HAM Radio
News media
Agency
Blood Center
Social media
Spouse
Hospital
Area Emergency Operations Centers (AEOC)
1. Obtain preliminary information
Nature of the event?
Injuries? Blood needs?
Accessibility?
2. Contact other AEOCs, possibly gov’t agencies
3. Coordinate

17. Hospitals Area Emergency Operations Centers (AEOC) Northern:
BloodSource
Central:
Houchin
Southern:
San Diego BB
Participating Community Blood Centers
Hospitals

18. Information Flow - Hospitals
To issue an ALERT about an event that may effect you:
Contact your main blood provider
Another blood center/system if your main supplier is inaccessible
Area Emergency Operations Center
To OBTAIN blood, work through your blood center or whomever the coordinating AEOC instructs you to contact

19. How to Contact Participating CBBS Institutional Members
“Appendix A” of the CBBS Emergency Preparedness Plan
Contact names and information for all CBBS institutional members
Just updated by the CBBS Office Management team and Emergency Preparedness Committee
Available to CBBS institutional members

20. Preparedness – Blood Centers
Important resources in the Plan
Minimum requirements:
Emergency response team
Off-site alternate command center
Alternate means of communication
Plans for self-sufficiency for at least 6 days
Triage system for blood orders
Keep AEOC and other blood center contact information accessible at all times
Cell, flash drive, hard copy lists in car, home, office, refrigerator door, wallet

21. Preparedness- Hospitals
The Joint Commission and AABB require that hospitals have emergency management plans
AABB Standards for Blood Banks and Transfusion Services, 30th Ed: “The blood bank or transfusion service shall have emergency operation policies, processes, and procedures to respond to the effects of internal and external disasters. The emergency management plan, including emergency communication systems, shall be tested at regular intervals.”

22. Preparedness - Hospitals
At a minimum:
Hospital Emergency Response Team
Blood bank relocation site
Communication system with blood provider
Communication means for vendors of critical supplies
Contact information, updated at least annually
Alternate communications
Satellite phone
Priority access to government emergency phone or wireless systems
HAM radio operator
Texting

23. Preparedness - Hospitals
Emergency power and backup fuel source
Rapid communication with ED
Emergency transfusion management:
Massive transfusion protocols
ABO typing policies
Use of O neg RBCs and AB plasma
When to switch from O neg to O pos
First units: A vs. AB plasma for adults
Rapid inventory assessment procedure

24. Backup Systems
Assume that all primary systems could fail, and plan accordingly CBBS has integrated this assumption into the Emergency Preparedness Plan

25. AEOC Backups Any AEOC can activate the network
Model is quasi-geographic: Blood centers will reach out to the nearest operational AEOC, but can contact an alternate
If none of AEOCs accessible, blood centers can contact:
Large blood system
American Red Cross
BloodSystems
National Blood Exchange

26. Communication Backups
Usual forms of communication that could fail:
Electricity-powered phone lines
Fax, Scanners
Cell phones
Hospital switchboard

27. Communication Backups
Blood provider restricted line
Restricted line for your transfusion service
Check quarterly to see if still current (impact of remodels, re-organization, personnel changes)
Satellite phone

28. Priority Access Phone Services
Government Emergency Telecommunications Services (GETS)
Priority access to LANDLINE networks
No charge to sign up; 7-10 cents/min in US or
DHS.gov/GETS to register your organization; select “non-federal”
Wireless Priority Services (WPS)
Priority access to CELL PHONE networks
Carriers that participate:
Verizon, AT & T, Sprint, T-Mobile, Cellcom
Charged and paid to your existing commercial plan
Same sign up process as GETS

29. Communication Backups
Not officially “endorsed:”
Texting – less bandwidth than calling
Social network sites
Lack of confidentiality
Handling of complex messaging?
Gvmealluronegs&Abplasma
#massiveelephantstampede

30. Communication Backups
CBBS Plan – Alternate Communication
HAM Radio Operator System
AEOC would activate the radio network
RadioNet Control would coordinate communication

31. Communication Backups – Finding HAM Radio Operator
American Radio Relay League (AARL)
225 Main St. Newington, CT 06111
Online: “Amateur Radio Club”
Connect with a local HAM radio operator
BEFORE the disaster occurs!

32. Transportation Backups
Government resources
Public Health Department Communications Directors and Regional Disaster Medical Coordinators) (Deliver blood where needed, don’t deliver where not needed)
Last resort: Air transport delivery of blood and specimen tubes – Section 4
Angel Flight West (package, label clearly)
CA Highway Patrol Aero Division
Salvation Army Territorial Disaster
USAF Civil Air Patrol

33. What regulatory requirements in the blood supply chain can be waived?
AABB Interorganizational Task Force on Domestic Disasters and Acts of Terrorism (“Task Force”) culmination of work by numerous blood organizations and the government after 911
“Coordinate efforts to determine the medical need for blood in a disaster and facilitate the movement of blood to affected communities.” (Carr-Greer A and Theresa Weigman, Fall 2014 CBBSToday)

34. What regulations can be “loosened”?
Assumption that “disaster” would be local; Variances from FDA regulations allowed only in affected areas
Limited to the time during which blood needs might not be met
Case-by-case basis

35. 911 – FDA “Variances” September 11, 2001:
Adequacy of training of emergency staff determined by trainer, documentation abbreviated
Shipping unlicensed products potentially allowed if labeled: “Unlicensed – for emergency use only”
Products released under above conditions had to be tracked
Note: Eligibility criteria and testing requirements not altered!
September 14, 2001
First three bullets (above) revoked
QA departments had to quarantine all “unsuitable” units still in inventory
Other requirements about samples sent to labs not routinely used by the collecting blood center

36. Other Helpful Documents
AABB Disaster Operations Handbook (PDF)
FDA: Guidance for Industry: “Recommendations for Blood Establishments: Training of Back-Up Personnel, Assessment of Blood Donor Suitability and Reporting Certain Changes to an Approved Application.” (11/2010)

37. New Realities
The three current AEOCs chosen because not aligned with large blood system… 34 years ago
Red Cross and BloodSystems now have major footprints in CA and US
Several previously “independent centers” have joined ARC or BS – effect on CBBS structure?
Current White House budget: decreased funding for emergency preparedness and disaster response

38. Questions raised by New Realities
Is a California-focused plan still necessary?
Blood Systems and ARC have national networks
How quickly can blood be moved into CA? (What if transport systems down ?)
Should blood centers follow parent company’s procedures for obtaining blood in disaster or CBBS’s?
Possible scenario: “Whatever means necessary”
If aligned with national entity – follow procedures to extent possible; if blood not available in timely way, consider CBBS plan for immediate needs
If independent center – follow institution’s plan; consider CBBS plan, institutional members
Changes in federal funding may impact disaster response and relief efforts

39. Questions raised by New Realities
Impact of CA blood center realignments on CBBS Em Prep Plan
More infrastructure, blood access for “independents” newly aligned with large systems (Red Cross, BloodSystems)
Role for AEOCs that become part of a larger organization? (Timely internal discussions within the parent companies important)
For foreseeable future, will likely remain essentially unchanged because:
CBBS institutional membership stable
Strong , collaborative, patient-focused relationships among CA blood centers
Stable Emergency Preparedness Committee – All AEOCs represented
CBBS Board engaged
Institutional memory relatively intact

40. Pop Quiz What does AEOC mean? Where are the CA AEOCs located?
Where can the CBBS Emergency Disaster Plan be found?
What are two backup phone services?
How can a local HAM radio operator be found?
You hear of an incident in your area that could result in a sudden demand for blood – who do you contact? (Not “Ghost Busters”)