Blood and Blood Products
Topic Collection
April 18, 2024

Mass casualty incidents (MCIs) rarely place significant stress on the blood supply. However, for victims of blast and penetrating trauma requiring massive transfusion, the blood components already on the shelf in hospital transfusion services save lives. When multiple victims requiring emergency transfusions present at once, multiple massive transfusions protocols may create inventory challenges for local hospitals and their blood suppliers. The blood supply may also be affected by other disasters or infectious diseases, which can potentially be transmitted by transfusion (e.g., Zika virus) or disrupt blood donations (e.g., COVID-19).

Additionally, transfusion medicine professionals provide blood components to patients experiencing hemostatic abnormalities and coagulopathy that can accompany massive transfusion. Therefore, critical transfusion needs are not limited to massive transfusion because there is likely to be a concurrent increased need for routine crossmatching to provide compatible blood products for numerous patients in a short period of time.

More than 400 units of packed red blood cells were used after the Aurora (CO) movie theatre shooting.  A similar number were used after the Pulse Nightclub shooting in Orlando, and 222 were given by a Las Vegas trauma center after the 2017 mass shooting. Hospitals should plan internally and with their external blood suppliers for these types of MCIs to ensure adequate supplies are available. Local and regional preparedness training and drills support planning and benefit patients as well as professionals providing transfusion services and emergency services.

Transfusion strategies are beyond the scope of this Topic Collection, though we include selected relevant articles. This domain is rapidly evolving, and providers should include their blood bank and blood supplier in planning to ensure their resuscitation strategies are optimized, they understand limitations, (e.g., availability of whole blood) and plan adjustments during periods of critical demand.

In the aftermath of MCIs and natural disasters, people from affected communities and across the nation often feel the urge to “do something” to help. This may cause people to rush to donate blood locally, including presenting to the hospital or other locations to donate, which can add another challenge to incident management. Realistically, hospitals must rely on their blood suppliers for blood products donated well in advance of the need to treat the patients affected by the incident. Every blood collection undergoes extensive testing to protect patient safety (requiring about 2 days or more to complete labeling and distribution) and has a limited shelf life that varies by blood component, ranging from days to weeks.

Ensuring that an adequate supply of the various blood components is available at hospitals for transfusion during a mass casualty incident presents another planning challenge. Communications through the media and community organizations can help educate community members about the importance of proactive blood donation to help ensure lifesaving blood products are immediately available to emergency patients. With a greater awareness that blood collected on community blood drives is the blood that saves lives in a crisis, the public hopefully will proactively donate rather than rush to donate after the crisis that could overwhelm blood donor centers and hospitals actively responding to emergency events. However, to the degree possible, motivated donors following a disaster should be captured and hopefully will become repeat blood donors.

This Topic Collection includes links to guidance, lessons learned (from disasters, no-notice incidents, and specific to transfusions), plans, tools, and templates, general research, and research specific to the disaster blood supply chain. Related information can be found in the following ASPR TRACIE resources (listed alphabetically): Burns; Crisis Standards of Care; Disaster Ethics; the infectious disease-specific guidance on blood issues in the VHF/Ebola and Zika Topic Collections; the Mass Gatherings/Special Events and Pre-Hospital Topic Collections; and the Select Materials on Drug Shortages and Scarce Resources web page.