The role of adjusted massive transfusion protocols in emergency preparedness for mass casualty incidents
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Abstract
BACKGROUND: In the United States, trauma is the leading cause of death for individuals less than 40 years of age. Massive hemorrhage and coagulopathy are known contributors to trauma mortality. Mass shooting incidents (MSIs) are a unique source of major trauma which can strain hospital resources. Various strategies to reduce the blood product requirements for the management of massive hemorrhage have been studied. Some of these strategies have been used in the management of recent MSIs. It is unknown what protocols are in place for managing resource scarcity in mass shooting incidents at trauma centers across the country.
OBJECTIVE: This is a proposed cross-sectional study to investigate the protocols that trauma centers have in place for emergency response to mass shooting incidents. This study hypothesizes that the implementation of an adjusted massive transfusion protocol (MTP) for mass shooting incidents is not universal practice in trauma centers. METHODS: This study will consist of a brief outreach period to the American College of Surgeons (ACS) network, local and state trauma committees followed by the distribution of an electronic survey to all verified trauma centers. Distribution of the survey will be focused on the existing ACS database of verified trauma centers as they reflect the different geography and city size served by trauma departments across the United States. The survey response will first determine which trauma centers have an emergency response plan (ERP) in place for MSIs. For institutions with an ERP in place, additional questions will gather nominal and categorical data on the features of those protocols, specifically looking at adjusted massive transfusion protocols. Demographic data will be analyzed using descriptive statistics. Nominal and categorical data will be analyzed using chi-square statistics. Demographic data may be used for subgroup analyses.
CONCLUSION: Mass shooting incidents are the most common mass casualty event in the United States with the frequency and intensity increasing over time. The major cause of death from gunshot wounds in the first 24 hours is from massive hemorrhage. Adjusted massive transfusion protocols are an important strategy to manage massive hemorrhage in a MSI. Recommendations for emergency preparedness to manage mass shooting incidents have been made. However, there has been no large scale study to understand what practices are currently in place. By identifying areas with low levels of preparedness, we may be able to direct resources to reduce disparities in outcomes and overall mortality from mass shooting incidents.
Description
2024