Post on 05-Jan-2020
transcript
di
massive transfusion protocolexpanding
massive transfusion protocolinto the prehospital system of care
Andre Tra ersAndrew TraversMD MSc FRCPC
Provincial Medical DirectorProfessor Emergency MedicineProfessor Emergency Medicine
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ConflictConflict of Interest
•• AcademicAcademicNoneNone–– NoneNone
•• FinancialFinancialFinancialFinancial–– Contract with DHWContract with DHW–– ED PhysicianED Physician
Outcome
System
P
System
Process
Structure
Outcome
System
P
System
Process
Structure
154
Outcome
System
P
System
Process
Structure
Medical OversightMedical OversightKnowledge TranslationResearch
Knowledge TranslationResearch
Medical First Responder
Medical
Medical First Responder
Medical
ResearchResearch
SimulationLifeflight
SimulationLifeflightMedical
CommunicationsGround Ambulance
Medical Communications
Ground Ambulance
LifeflightTrauma Program
LifeflightTrauma Program
Outcome
System
P
System
Process
Structure
Injury 911 ED DC
CommunitySOC
Out-of-HospitalSOC
HospitalSOC
P ti tPatient Patient
Patient Sprint RelayPatient Sprint Relay
4 Definitive Care
3 EDIndividual superstars cannotIndividual superstars cannot
win without teamwork
Hand offs and smooth
Finish
transitions are critical
Not a turf battle
2 TransportStartEach expected to move fast
1 PatientIvan C. Rokos, MD, FACEP
P fPerformance measures:structure, process & outcomestructure, process & outcome
OptimalSystemsyIntegratedRealtimeFeedback
System of Care: Ideal StateSystem of Care: Ideal State
System of Care: TraumaSystem of Care: Trauma
RegistryPrehospitalActivationActivation
System of Care: Cardiac ArrestSystem of Care: Cardiac Arrest
EHS CPG
TNTNK
TNK
TNK
TNTNK
KK
TNK
TNK
TNK
TNK
KK
TNK
TNK
TNK
TNK
PCI vs TNK
TNK
TNK
TNTN
TNK
TNK
TNK
TNK
PCIK
TNKTN
KTNK
TNK
TNK
TNK
TNK
TNTNTNK
TNK
KKKK
Advanced ‘Time’ Recording
CurrentCurrent Door FlowOnsetOnsetf MIf MI
Drug Data DecisionPatient
Advanced Time Recording
CurrentCurrent ooRestoredof MIof MI Started
PCICathPrimary
Fibrinolysisresponse
Primary PCI
Decision
Onset
Response
First Med
Data
Decision
Drug
Door
Sheath
Balloon
ED
Waite d C
ontact
to Delta
Basic ‘Time’ Recording
CurrentCurrent Door FlowOnsetOnsetf MIf MI
Drug Data DecisionPatient
Basic Time Recording
CurrentCurrent ooRestoredof MIof MI Started
PCICathPrimary
Fibrinolysisresponse
Primary PCI
Onset 1st
ContactReperfusion
Sharing DataSharing DataOptimizing STEMI Care
Time Symptom
Onset
Time1st Medical
TimeReperfusion
PatientOutcome
Onset Contact Started
Prehospital Datap
ED Data
CardiologyData
ED Data
STEMI Performance Scorecard
System of Care: STEMISystem of Care: STEMI
RESTOREPrimary PCI
Low Overtriage Target
System of Care: STROKESystem of Care: STROKE
EHS PARAMEDIC contacts ED CHARGE PHYSICIAN providing ETA
EHS PARAMEDIC identifies MTP ELIGIBLE PATIENT
EHS PARAMEDIC contacts ED CHARGE PHYSICIAN providing ETA
ED CHARGE PHYSICIAN designates ED NURSE to initiate MTP
ED CHARGE NURSE or ED NURSE□ Initiate UNIDENTIFIED PATIENT POLICY if required - patient may be transferred from another
facility ‘identified’. □ Call LOCATING at 473-2220
1. This is a PRE-HOSPITAL MASSIVE TRANSFUSION ACTIVATION 2 Estimated Time of Arrival (ETA) is (Confirm the patient has not arrived)2. Estimated Time of Arrival (ETA) is … (Confirm the patient has not arrived)3. Physician requesting the MTP is … & the phone number is XXX-XXXX
□ Prepare patient chart, if possible
Call BTS 473-4257 to activate MTP Page DPC to initiate registration process
LOCATING
BLOOD TRANSFUSION SERVICE (BTS) □ Call DPC for patient identifying information – 473-4998 or 473-4961
Initiate Porter Services 473-2557 Notify Pathologist-on-Call for BTS
PORTER SERVICES □ Deliver blood
LOCATING
BLOOD COMPONENT STORAGE Blood components (RBC/Plasma/Platelets/Cryoprecipitate) MUST
□ Prepare RBC - O NEG 6 units & AB plasma 1500 mLs □ Platelets supplied as requested
□ Deliver blood components to ED
Compile data for remain in the BTS transport container until administered to patient.quality review
PATIENT ARRIVAL to QEII ED
CHARGE EHS ED NURSE
PATIENT ARRIVAL to QEII ED
PORTER PHYSICIAN
□ Receive EHS report
□ Provide resuscitation
PARAMEDIC □ Transfer of
care □ Document time
of medical
□ Prepare administration supplies for patient arrival. Blood components remain in transport container until infusion.
□ Obtain STAT blood specimens
SERVICES □ Transport
specimens to lab □ Deliver blood
components to care based on MTP Guideline
contact and time of MTP request
PRIOR to blood component administration, if possible
□ Document blood administration times
ED
Changing a patient’s status from ‘unidentified’ to ‘identified’ will require a new blood sample for crossmatch for BTS. The patient’s identification status should only be upgraded to ‘identified’ when the patient is
hemodynamically stable as determined by the physician providing the care. Once the identification status can be upgraded, any staff member can notify Health Information Services.
System of Care: MTPSystem of Care: MTP
Outcome
System
P
System
Process
Structure
H i lEHS
Hospital
Advantages to Prehospital IdentificationAdvantages to Prehospital IdentificationAdvantages to Prehospital IdentificationAdvantages to Prehospital Identification•• TraumaTrauma
–– Rx: Massive transfusion protocolRx: Massive transfusion protocol• Stroke
– Rx: reduced D2N–– DxDx: reduced time to CT: reduced time to CT
•• STEMISTEMI
– Dx: reduced time to CT
• SepsisSTEMISTEMI–– Rx: reduced E2N and E2B timesRx: reduced E2N and E2B times–– DxDx: access old ECGs: access old ECGs
Sepsis– Rx: reduced time to antibiotics– Dx: reduced time to CBC
•• Oncologic EmergenciesOncologic Emergencies–– Rx: reduced time to antibioticsRx: reduced time to antibiotics
DD d d ti t CBCd d ti t CBC
• Cardiac Arrest– Rx: PCI– Dx: NOK notification, DNR, etc–– DxDx: reduced time to CBC: reduced time to CBC , ,