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Blood and catastrophe
Louis M. Katz MD
Executive Vice President, Medical Affairs Mississippi Valley Regional Blood Center Davenport, IA
U of I College of Public Health
December 9, 2005
Fritz the Horse and ANNA
Adequate blood…is vital for
America’s preparedness*
- Natural disasters and terrorists acts require immediate access to large amounts of blood and blood products.
- …The need to have adequate supplies of blood and blood products abroad for our soldiers is well understood. The events of September 11, 2001 and the anthrax letters… and other similar events abroad have made it clear to us all that a new asymmetric warfare can bring the need for blood and blood products to a critical point quickly.
- Preparedness to have adequate, safe blood and blood products is an important aspect of our national security needs. *National Response Plan
Neel, Medical Support of the U.S. Army in Vietnam ‘65-70, Washington, DC, Department of the Army, 1973, p 155
Blood program in Vietnam
Nairobi embassy bombing
- Above ground “double” detonation: huge
numbers of survivable injuries
- Head and torso injuries predominate
- Lacerations
- Penetrating injuries
- Ocular injuries
- Fractures
- Actual blood use unknown est. 800–1500 U.
National Response Plan
Emergency Support Function #8-5, December 2004
- HHS monitors blood availability and maintains contact with the AABB Interorganizational Task Force on Domestic Disasters and Acts of Terrorism and, as necessary, its individual members, to determine: - The need for blood, blood products, and the supplies used in their manufacture, testing, and storage; - The ability of existing supply chain resources to meet these needs; and - Any emergency measures needed to augment or replenish existing supplies.
The US blood supply
- Whole blood: almost no one uses this any
more because it is wasteful
- Components: the individual constituents of
whole blood that are used therapeutically
- Red Blood Cells: shelf life 42 days
- Platelets: shelf life 5 days
- Frozen plasma: shelf life 1 year
Adequacy of the US blood supply
0
2
4
6
8
10
12
14
16
1989 1992 1994 1997 1999 2001
RBCs (millions) Collected Transfused
Source: NBDRC 2001 Biennial Survey
The impact of 9-
Pers. comm. Jones, R.
“Local” disasters and the blood supply
Modified from Schmidt, P. NEJM. 2002. *National stocks
9-11{
Totals 3596 686 17,137 >487,802 739
DC 2001 189 61 12,000 34
**224
475,000***
NYC 2001 3,000 139 NA
Denver 1999 15 30 1,924 1,700 105
Okla. City 1995 167 83 NA >9,000 131
Sioux City 1989 111 185 713 602 119
KC 1981 114 188 2,500 1,500 126
City & year Killed Admitted On hand Drawn Used
Inventory, collections and transfusions
Health outcomes
Why we need so little (new) blood after catastrophe (so far)
- ~3 days on shelves nationally; 7 d. in some areas
- Elective use goes away during disasters
- Blood moves daily center to center to hospitals
- Under ideal circumstances, when transportation and communication are optimal
- The interval from donation, through processing, testing and to hospitals is in the order of 48+ hours - Disaster blood needs tend to be immediate
The blood on the shelves saves lives
Conclusion: “ there’s something
about blood”
“The terrorist attacks on September 11, 2001…had a predictable effect: people wanted to donate blood. This altruistic and commendable response may have boosted the morale of the blood donors, but it did nothing for the victims .” Schmidt, P. NEJM. 2002
- Suddenly requires a much larger amount of blood than usual OR
- Temporarily restricts or eliminates a blood collectors ability to collect, test, process and distribute blood OR
- Temporarily restricts or prevents the local population from donating blood or restricts or prevents the use of the available inventory of blood products requiring immediate replacement or re-supply of the region’s blood inventory from another region OR
- Creates a sudden influx of donors requiring accelerated drawing of blood to meet an emergent need elsewhere
Definition of (blood) disaster
- Purpose
- Preparation
- Activation
- Education
- Extras
- Hospital supplement
Purpose:
- Assess medical need
- Facilitate transportation
- Common messages
Preparation:
- Communication strategies
- Transportation options
- Working with EMA(s)
- Identification of blood as a local priority
- Vendor management
- Utilities
- Managing donors
- Media relations
- Safety
Step-by-step activation:
- Medical needs assessment (local blood establishments!!)
- Collectors and hospitals
- Type O inventory
- 3 type O units/admit
- Contact AABB
- Task force convenes
- Implementation
Activation step 2: Affected
collector(s) contact AABB (≤1 hour)
- Contact AABB
- (800) 458-9388 (landline)
- (240) 994-6700 (cell)
- Ham radio
- nbe@aabb.org (wireless e-mail: e.g., Blackberry (if they don’t lose their suit)
- Report medical need and local blood
inventories
Extras:
- Preparation checklist
- Emergency offices
- Press releases
- Transportation options
Hospital supplement
- Hospital role
- Needs assessment
- Regulatory concerns
- Working with media
Overview of blood center response plan
EVENT
AABB
HHS
Messages to the public
ABC
ARC
FDA
HHS
AABB
Blood task force
ASBPO
CDC
Affected blood center(s)
H
H
H
H
H
H Blood community and donor messages Assistance to the blood center(s)
Has the new system worked??
0
5
10
15
20
25
7-197-268-028-098-168-238-309-069-139-209-2710-0410- Week
Percent < day RBC supply
2004 2005 Katrina
www.americasblood.org
TOPOFF-2 lessons learned
May 12 to May 16, 2003: terrorists detonate radiological dispersal device (RDD) in Seattle, and release pneumonic plague at several Chicago sites
- 24/7 emergency contacts
- Media spokesperson (control of message)
- Redundant communication channels
- Donor areas by zip code (the “hot plume”)
- Critical role of CDC (epi and pathogenesis)
- Rapid blood needs assessment program
TOPOFF- National exercise testing emergency blood supply coordination and transportation during bioterror outbreak of pneumonic plague in NJ, Conn and NYC on April 4-6, 2005
- Outbreak resulted in a precautionary quarantine of all blood products collected three weeks prior to April 4th and deferral of all donors for at least 3 weeks
- Resulted in immediate need to ship over 14,000 RBC & 140 single donor platelets
- Additional support up to 42,000 RBC and 520 single donor platelets could have been required during 3 week deferral period
Influenza (incl. H5N1) and the
blood supply?
- Is it transfusable?
- Impact on donor base?
- Impact on blood center
operations
Probably not
Could be awful
Could be awful
H5N1 + strand RNA (mRNA and replicative) in
lung and gut only (human autopsy x 1)
Uiprasertkul, M et al. EID July 2005
This is a different disaster paradigm
“My conclusions are that in influenza pandemic, there will be a decrease in blood supply, a decrease in demand and blood drawing capacity, but no major impact on the safety of blood itself.”
- Benjamin Schwartz, MD CDC National Vaccine Program Office ACBSA May 16, 2005
“This is a disease that spreads
rapidly across the country and the
idea that you can take resources
from one area that’s not affected
and transfer to another just doesn’t
work in a pandemic.”
- Benjamin Schwartz, MD CDC National Vaccine Program Office ACBSA May 16, 2005
Our major concerns
- Donor deferral for illness and donor absence
due to flu, “fear” or to care for family
- Staff absences for flu, fear or family
- Unknown blood needs
- Elective surgical needs will decline
- While some assume flu victims will need few products, this is likely incorrect in an ICU setting
- Platelet needs to support hematologic malignancy and hematopoetic progenitor cell transplants will not decrease
Blood pandemic planning
- Surveillance
- Local and national liaison should be ongoing to allow inventory expansion when pandemic predicted
- Communication
- Central donor and hospital messaging about planning and supply contingencies?
- Center and transfusion service activities
- Work restrictions for exposure?
- Staff immunization (compulsory?)
- Prophylactic antivirals: staff and donors?
- Donor immunization messages or activities
