1. Practical aspects of emergency response in blood establishments BPAC, August 2011, Gaithersburg Louis M. Katz MD Mississippi Valley Regional Blood Center Davenport, IA

2. Blood use following US disasters: Historical perspective US civilian disasters 105-131 units o Skywalk collapse in KC hotel o Airliner Sioux City Iowa o Oklahoma City Govt. Center bombing o Columbine High School 9/11/2001 o 258 units 1 st day (  1000 collections/d NYBC) Hess and Thomas. Transfusion. 2003)

3. Sept. 11, 2001: Courtesy of the New York Blood Center

4. ABC/BCA Spoke and Hub system: 2011

5. Many useful resources for planning templates AABB plans www.aabb.org/programs/disasterresponse/Pages/default.aspx www.aabb.org/programs/disasterresponse/Pages/taskforcepibs.aspx CHEST: triage of limited resources in disaster: Definitive care for the critically ill during a disaster: a framework for optimizing critical care surge capacity: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Rubinson L et al. Chest. 2008. 133(5 Suppl):18S-31S. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007. Devereaux AV et al Chest. 2008 May;133(5 Suppl): 51S-66S.

6. If you’ve seen one pandemic, you’ve seen one pandemic Kamp et al. Transfusion. 2010

7. Response in (extended) blood emergencies: a question of balance Supply: enough qualified donors (and enough supplies, personnel, equipment etc.) to accommodate “needs” Demand: effective control of blood use to accommodate supply

12. RBCs: supply side Increase collections by established groups and general appeals Increase O positive (and negative) inventory Use of frozen blood reserve if available Autologous Adjust donor eligibility: a large, immediate source of already committed donors Reduced interdonation interval Travel (malaria-deferred donors) TSE deferrals Hemoglobin 2-RBC qualifications

13. RBC: demand side Peri- and post-operative salvage Autologous predeposit ESAs for appropriate chronic anemias Limit O negatives to fertile females Enforce conservative transfusion triggers Postpone elective surgery "Triage" elective blood-intensive care Ration based on the expected survival of candidates for transfusion

14. The Supply Side: global red cell use rates: 2008-09 Devine D et al: International Forum: Inventory Management. Vox Sang. 2009

15. MVRBC 2009-11

16. MVRBC hospital service contract: you can lead a horse to water… Hospital will develop…written plan for the distribution of blood and blood product during a shortage…. Such …plan must include, but is not limited to, management of blood and blood product distribution. Hospital will also provide updates to the …plan to blood center as updates are completed. Blood center will assist in the development of this plan upon request by hospital.

18. Summary and conclusions There is no history of local disaster that has stressed our ability to provide adequate blood and components – Protecting transportation and communication is key The blood community, in response to the 2009 influenza A pandemic, generally produced response plans for a widespread and prolonged event (and feels confident) Those plans have not been adequately exercised The blood community welcomes “prospective” regulatory flexibility for donor/donation qualification Management of the demand side at hospitals via planning and triage must be formally implemented