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Paucity of Blood Products Transfused Following the I-35W Bridge Disaster.

Jed Baron Gorlin, Sertac Kip, Dawn Hansen and Jonathan Pohland

Abstract

Following 9/11 and Hurricane Katrina there has been a concerted effort to prepare and organize for disasters. Blood transfusion, a key element of disaster response, has been previously documented to be an important factor in decreasing fatalities from disaster-related injuries, provided there is an organized system of transfusion. Reviews of blood usage following other domestic disasters have generally revealed only modest use of transfusable products that generally do not overwhelm local supplies of blood. We conducted a survey to enumerate the amount of blood and blood products used in Minnesota following the I- 35W bridge collapse that took place on 8/1/07. The bridge is for a major interstate highway that crosses the Mississippi river collapsed under the weight of evening commute traffic. The bridge normally carries 140,000 vehicular trips daily. About 100 individuals presented to local hospitals the evening or day following the incident and 9 individuals died at the scene or by the time of arrival at the trauma center. All critically injured were brought to Minnesota’s largest level 1 trauma hospital that fortuitously was adjacent (less than 1/2 mile) to the disaster site. Within 1/2 hour of the event, the local community blood center sent additional blood to all customer hospitals likely to receive patients, prior to any estimates of the number of injured patients expected at that hospital. However, no blood products were transfused for bridge accident victims at the other surrounding hospitals. Of 25 patients presenting by ambulance to the level 1 trauma center, only 5 received blood following the event. Only 2/5 received emergency group O units, and since both were male, they each received 2 group O Rh(D) + before being switched to type specific units. In total, 14 units of red cells were transfused the evening of the disaster to four of those patients. 30 additional units were required for the 5 patients requiring transfusion over the ensuing week-10 days following hospitalization. One apheresis platelet, 2 jumbo cryoprecipitate units (derived from 600 ml plasmapheresis donations) and 4 FFP were also administered to these same 5 patients the evening of 8/1. The FFP included 2 units of thawed AB plasma that are maintained in the transfusion service for immediate release to emergency patients at all times. Media response uniformly encouraged blood donation and community response was overwhelming resulting in one local community blood center receiving over 11,000 phone calls in the two days following the disaster. The usual collection of ∼400 units/day was doubled to almost 800 units and on the second day after the disaster (8/3/07) the blood center issued press releases noting that the immediate needs had been met. Lessons learned include the importance of disaster drills to prepare staff for such events. In addition, the best disaster preparation is to have adequate supplies at all times, since components from donations that follow the event may not be available for several days.