Blood transfusion preparedness for mass casualty incidents: Are we truly ready?

Mass casualty incidents (MCI) are high profile contributors to the number of annual trauma-related deaths in the United States. A critical aspect of MCI care is the ability to provide blood components in sufficient types and quantities to prevent deaths due to hemorrhage. For transfusions to play an optimal role in the prevention of trauma-related hemorrhagic death, including MCI, there appears to be a very tight time window after injury to initiate transfusion therapy. In order to meet this tight window, blood components of appropriate numbers and quantities must be immediately available. Currently, it is questionable whether standing blood inventories at US healthcare facilities are sufficient to appropriately meet the transfusion needs of a surge of MCI victims. Previous models of blood supply adequacy have focused on the availability of red blood cells, and the ability to move blood components quickly from blood suppliers to impacted healthcare facilities. These models have not considered the adequacy of other critically necessary blood components, such as platelets. A recent simulation of blood product demand after MCI showed that, in order to meet the defined RBC needs of 100 percent of casualties, a hospital would need 13-14 units in inventory per casualty. This simulation did not evaluate requirements for platelets and plasma, which would likely be extensive. Meeting balanced resuscitation demands in the timeframe necessary to minimize the number of preventable hemorrhagic deaths is probably not realistically achievable for most healthcare facilities in the United States. Alternative approaches to treat hemorrhage are likely necessary to solve this problem.