Blood transfusion in disasters, war, and emergencies

Historically, the needs of those wounded in war have led to many major advances in blood transfusion. The most important of these is probably the ability to draw blood in one location and transfuse it, at a later time, in a distant location. Another important lesson is the need for meticulous planning. Every hospital and blood center should have a disaster plan consisting of five components. What fluids to use, from where are they to be obtained, to what degree are they to be tested, how will they be transported to the disaster scene, and, once there, how will they be stored. Once drawn up, this plan must be regularly exercised and periodically revised. This will ensure rapid and efficient implementation when an emergency arises. Triage is vital in mass casualty situations, ensuring that scarce resources are used for those with the best chance of recovery. Although patients survive with low hemoglobin levels for considerable periods, speedy treatment of hypovolemia is imperative. When perflourochemicals and hemoglobin solutions are available for general clinical use, they will have a major role to play in disasters. Similarly, a simple method for the cryopreservation of red cells will allow stockpiles to be established. Unfortunately, none of these are presently available, although some are undergoing clinical trials.