In a significant progression in emergency healthcare capabilities, AUSMAT has recently completed a comprehensive review and update of its blood transfusion protocols, aimed at elevating care standards within challenging and resource-limited environments. The strategic overhaul presents a pivotal component of AUSMAT's ongoing commitment to enhancing health emergency responses, ensuring the provision of the highest level of care for individuals in need.
The utilisation of Fresh Whole Blood (FWB) transfusion, a critical procedure in emergency scenarios, becomes imperative when traditional blood and blood products are unavailable. This potentially life-saving method involves transfusing fresh whole blood from a donor to a recipient, in situations where component therapy, the process of separating whole blood into its individual components such as red cells, plasma and platelets is unavailable. FWB proves advantageous in austere environments where traditional blood transfusion methods pose logistical challenges, given its immediate availability and comprehensive composition. This makes it crucial in treating severe blood loss and coagulopathy, a condition marked by impaired blood clotting ability.
At the forefront of implanting these best practice standards and policies is Leanne Jones, Senior Medical Scientist at the National Critical Care Trauma and Response Centre (NCCTRC). Her instrumental contributions include the formulation of a suite of new and updated policies and procedures, the development of training and competency programs for blood donation, blood grouping and transfusion, as well as procedures for managing adverse transfusion events and updating the laboratory design to enhance AUSMAT’s Emergency Medical Team (EMT) capabilities.
“The Fresh Whole Blood approach has been around for centuries, however it was not until the discovery of the ABO blood group system in the early 20th Century that it became less hazardous. Whole blood was a primary blood product for battlefield resuscitation during the wars of the early and mid-20th century. In remote and resource-limited settings, immediate access to blood can often be the decisive factor between life and death in critical situations" explained Ms Jones.
To facilitate FWB transfusion, a ‘walking blood bank’ is established by AUSMAT. In this system, volunteer blood donors undergo on-site identification and screening ensuring a rapid response to emergency demands.
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The process involves a comprehensive risk assessment, considering factors such as community infection prevalence and the feasibility of accessing component therapy. Rapid screening for blood type and basic infectious diseases is conducted, with the blood collected and transfused using simple equipment, prioritising speed and practicality. While immensely beneficial, managing FWB transfusion in disaster emergencies necessitates a delicate balance between its life-saving potential against inherent risks and challenges.
A recent addition to the AUSMAT Surgical Team Course is a module on blood grouping and the intricacies of medical procedures and donor collection in remote settings. Ms. Jones emphasised the importance of training, “It’s central to AUSMAT’s success, equipping our teams with not just the theoretical knowledge but also the practical skills to handle complex medical situations.” This training equips participants for situations where conventional medical support systems are inaccessible, necessitating a shift from external reliance to self-sufficiency in blood transfusion management.
AUSMAT's updated blood transfusion protocols prioritise safety and quality assurance. This initiative includes rigorous pre-deployment training, equipping AUSMAT personnel with detailed processes and procedures to minimise the risk of transfusion-transmissible infections. Updated consent forms ensure that both donors and recipients are fully informed of procedures and associated risks. Additionally, the introduction of new laboratory designs ensures the safe handling and integrity of blood products in controlled environments, reducing the risk of contamination and ensuring the integrity of the blood supply.
Ensuring the delivery of blood transfusion services is provided in a culturally safe and responsive way remains an ongoing priority for AUSMAT. Recognising the diversity of beliefs and practices in communities, AUSMAT's approach is to work closely with health services in country to ensure that blood donation and transfusion practices are locally led. These practices enhance smoother operations but also builds trust within communities, essential for the effectiveness of medical interventions. The protocols include provisions for scenarios where consent for blood transfusions may not be readily given due to cultural or religious reasons, ensuring that AUSMAT's services remain inclusive and respectful of individual beliefs.
These enhancements to the blood transfusion protocols stand as a testament to AUSMAT's unwavering commitment to delivering the highest standard of emergency medical care. They reflect a nuanced understanding of the complexities of working in diverse and often challenging environments. The updated practices not only raise the bar for clinical safety and efficacy but also ensure that AUSMAT's operations are conducted with a deep understanding of and respect for the cultural landscapes in which they serve.
Carla Yeung
Communications and Digital Engagement Officer