Webinar: Blood preparedness in times of peace, crisis and war

PowerPoint Presentations from Webinar Blood Preparedness Nov. 7th, 2023

Key stakeholders and process maps Nov. 7th, 2023

Question 1:

When you talk about having enough supplies to correspond to 6 months of use, are you talking about consumption corresponding to peacetime or wartime? Expect to use more supplies in times of war/disaster.

Answer:

The recommendation from the regional healthcare companies is that stocks of critical equipment should last 6 months. Equipment for drawing and transfusing blood must be considered critical equipment. A process at regional level with more specific recommendations for warehouses is underway. We can expect that the use of blood is different in war compared to peacetime, among other things the need for whole blood and pre-hospital transfusion will be greater in war compared to peacetime. This must be taken into account when planning warehouses.

Question 2:

Is there a national emergency stockpile for consumables (eg tap sets for the production of LTOWB and tap sets for fractionation)?

Answer:

Each individual hospital and each blood bank is responsible for having its own emergency stock, including bottling sets for the production of blood components and whole blood. Regional processes to map what is to be considered critical equipment for drawing and transfusion of blood are underway. A contract has been entered into for the national purchase of 20,000 CPDA-1 whole blood bags without leukocyte filter distributed among the four health regions. The emergency management in the four regions is responsible for purchasing. These whole blood bags can be used to draw whole blood of all blood types in a crisis situation. There is no agreement on the purchase of the associated transfusion set/infusion set.

Question 3:

Does it make sense to have a national standard for the entire chain regarding early bleeding control, hypotensive resuscitation, not giving clear fluids such as fluid shock, TXA, freeze-dried plasma and LTOWB both military and civilian, as well as both in-hospital and pre-hospital in place in this emergency plan? There are now slightly varying routines for this around the country.

Answer:

National standards have been established for the treatment of patients with severe traumatic bleeding, which are published in the National Trauma Plan (traumeplan.no).

Question 4:

It is very good that requirements for emergency storage are being quantified locally, but new hospitals are being planned and built without sufficient storage space, is this something that is being discussed?

Answer:

It is also a challenge that new hospitals are not built with sufficient storage space, but work is being done in some health regions with central regional warehouses. Nokblod recommends that storage is located in protected facilities.

Question 5:

The possibility of production of freeze-dried plasma together with Sweden and Finland?

Answer:

There is an ongoing Nordic collaboration on the start of production of freeze-dried plasma, see separate case on Nokblod's website.

Question 6:

Selection of blood donors and simplified blood donor selection in crises. Will work be done on this overall, if so how long do you expect to have this completed? Or should each individual blood bank create exception criteria? As of today, the general assessments regarding blood donor selection are somewhat different between the blood banks.

Answer:

Nokblod is working with deviation rules and will send its recommendations to the Directorate of Health in 2024.

Question 7:

Should all blood banks have 6 months' stock of material or should we think more at the enterprise level?

Answer:

All blood banks are responsible for their own emergency stocks. The extent to which this is to be organized at company level or for the individual blood bank must be decided internally. But it is necessary that the warehouse is located so that there is safe access to material in crisis and war.

Question 8:

They have prepared good contingency plans on paper, but preparedness is something you have to practice. Preparedness is something that lies in the fingers and one must not only know, one must KNOW if war/crisis strikes. Is it planned to practice/train preparedness at blood banks/hospitals?

Answer:

Our recommendations, national recommendations and overall regulations state that we must cooperate on emergency plans. This also requires that we practice and evaluate plans together at all levels.

Question 9:

Who decides that small blood banks should draw whole blood and keep it in stock? Preparedness for whole blood bags in each health enterprise/health region? Should all blood banks have a fully validated whole blood transfusion method "in case"? How about a national guideline for the production/storage of whole blood? As we have understood, there are different practices on this today.

Answer:

The blood banks are owned by the health company. All blood banks today draw whole blood for the production of blood components, but some also have equipment and procedures to draw whole blood for transfusion. The type of blood and amount of units in stock varies between hospitals. 40% of our hospitals do not have blood components containing platelets in stock, and therefore cannot provide an early balanced transfusion as recommended in the national trauma plans with erythrocytes, plasma and platelets.

Nokblod recommends that all blood banks have established procedures and have access to equipment for drawing whole blood. Emergency whole blood donation can be a life-saving measure to provide blood to patients with life-threatening bleeding in cases where one is about to empty blood stores or lack a platelet-containing product. Nokblod recommends that all blood banks are prepared to adjust production to deliver whole blood in crisis situations. It is good preparedness to have alternative plans ready.

In accordance with the national trauma plan, all hospitals in the trauma system must have a plan for obtaining blood in connection with mass casualty.

Nokblod can help in work with procedures and validation of the introduction of the whole blood programme. Contact us if necessary. 

 
Question 10:

Is the civil defense involved in the work that is being done now, or is it only concentrated on the defense and the blood banks?

Answer:

Nokblod wishes to contact and cooperate with voluntary organizations and other emergency organisations. We have taken the initiative to do this and have started cooperation with, among others, the Norwegian Civil Defense and the Red Cross.  

Question 11:

Where is the responsibility for preparedness? Is it the Health Authority that should get this process started, or is it all down to the blood bank level?

Answer:

In the national health preparedness plan it is stated that "Whoever is responsible for a specialist area or a service is also responsible for the necessary emergency preparations and handling of extraordinary events. The principle of responsibility is enshrined in Act of 23 June 2000 No. 56 on health and social preparedness (Health Preparedness Act) Section 2-1." This means that the individual blood bank is responsible for establishing a blood emergency plan that is valid for them. There must be emergency plans at all levels, local, regional and national.