Receive call from designated communication lead in clinical area:

‘This relates to massive haemorrhage situation’The caller will state: •Communication lead’s name and contact telephone number, name of consultant responsible, and the name and grade of the person activating the protocol•Patient’s ID (surname, forename, hospital number, DOB or minimum acceptable patient identifiers if unknown) •Requirements:

• Whether O Neg is to be/has been used • Order massive haemorrhage pack 1• Clarify urgency of requirements to decide on need for further emergency group O , or

time to wait for group specific or crossmatched red cells (issue as part of pack 1)• U+E, FBC, PT, APTT, Fibrinogen, ABG*, Calcium*, lactate* *may be near patient test

Receive call from designated communication lead in clinical area:

‘This relates to massive haemorrhage situation’The caller will state: •Communication lead’s name and contact telephone number, name of consultant responsible, and the name and grade of the person activating the protocol•Patient’s ID (surname, forename, hospital number, DOB or minimum acceptable patient identifiers if unknown) •Requirements:

• Whether O Neg is to be/has been used • Order massive haemorrhage pack 1• Clarify urgency of requirements to decide on need for further emergency group O , or

time to wait for group specific or crossmatched red cells (issue as part of pack 1)• U+E, FBC, PT, APTT, Fibrinogen, ABG*, Calcium*, lactate* *may be near patient test

Transfusion receives Call‘Massive Haemorrhage, Location, Specialty’

On standby

Transfusion receives Call‘Massive Haemorrhage, Location, Specialty’

On standby

TransfusionPerform Group, antibody screen and

crossmatch

Prepare MHP 1 Red cells* 4 units

(*emergency group O blood, group specific blood, XM’d blood depending on

urgency)FFP (group specific) 4 units

Platelets: ensure that 2 ATD are available in stock, or order from blood centre

TransfusionPerform Group, antibody screen and

crossmatch

Prepare MHP 1 Red cells* 4 units

(*emergency group O blood, group specific blood, XM’d blood depending on

urgency)FFP (group specific) 4 units

Platelets: ensure that 2 ATD are available in stock, or order from blood centre

HaematologyPerform FBC, PT, APTT, Fibrinogen

HaematologyPerform FBC, PT, APTT, Fibrinogen

Ring clinical area (communication lead) when blood / components ready

Ring clinical area (communication lead) when blood / components ready

Receive samples and request forms

Receive samples and request forms

Massive Haemorrhage Pathway Activated

Laboratory Management of Massive Haemorrhage

Ring results to communication lead when

available

Ring results to communication lead when

available

Receive further calls from communication lead in

clinical area:Repeat investigations

Order for MHP 2Liaise with on call haematologist

(consultant / SpR)Order for further components dependent on ongoing results

Stand down

Receive further calls from communication lead in

clinical area:Repeat investigations

Order for MHP 2Liaise with on call haematologist

(consultant / SpR)Order for further components dependent on ongoing results

Stand down

Restock Emergency Group O blood in satellite fridgesComplete traceability audit trail

Restock Emergency Group O blood in satellite fridgesComplete traceability audit trail

Prepare MHP 2Red cells 4 unitsFFP 4 unitsPlatelets 1 ATD

Cryoprecipitate 2 packs if requested

Prepare MHP 2Red cells 4 unitsFFP 4 unitsPlatelets 1 ATD

Cryoprecipitate 2 packs if requested

v2 2011