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Disaster Planning and Blood Resource Management
By William Bullock, EMT-P, MPA
Emergency medical systems and community health agencies throughout the nation are prioritizing mass casualty disasters. Emergency medical professionals have underscored the significance of blood supplies in treating disaster victims. The 2016 Pulse Nightclub shooting in Orlando Florida preparations. It has been well documented that victims of a mass casualty disaster will inevitably suffer from a variety of traumatic injuries and that the leading cause of preventable death from trauma is hemorrhage.1
The most effective treatment for patients in hemorrhagic shock is the practice of immediate blood transfusion.2 Blood transfusions complement the efforts of basic hemorrhage control in emergency situations and have resulted in improved patient outcomes.1 Medical professionals who work on the front lines of major disasters agree that one of the greatest threats to patient survival is the time between injury and hemodynamic stabilization.3 The Assistant Secretary of Preparedness and Response has reported that emergency physicians and surgeons will benefit tremendously from a robust supply of blood at their hospital in a mass casualty situation to prevent fatal hemorrhage.
Emergency medical professionals have underscored the significance of blood supplies in treating disaster victims. The 2016 highlighted the extreme need for a blood resource cooperative as emergency medical professionals reported that they “scrambled to acquire over 440 units of blood” in a timely fashion to treat victims of that tragedy.4 Blood supply and distribution logistics in mass casualty emergency situations are unique because time is an incredibly critical component for life preservation.
The U.S. Department of Health and Human Services recognizes the tremendous importance of blood and they have directed public healthcare providers and political leaders to always ensure the security of national blood supplies.5 The Assistant Secretary for Preparedness and Response within the Health and Human Services acknowledges that the safety and that the safety and availability of blood supplies are one of the core functional areas of Emergency Support & Biotherapies (AABB), America’s Blood Centers, and the American Red Cross, the national blood supply is often an contained within the National Response Framework for large scale emergencies.5
According to the three major stakeholders in national blood operations, the Association for the Advancement of Blood Biotherapies (AABB), America’s Blood Centers, and the American Red Cross, the national blood supply is often an overlooked and misunderstood aspect of emergency preparedness and response systems.6 The nation’s leading blood organizations recognize that aspects of the blood industry are foreign to some political and medical leadership, and a plan to bridge this operational and knowledge gap is slowly taking root.
The Department of Health and Human Services has instructed hospitals to plan internally and with external suppliers to ensure adequate blood supplies in the event of a mass casualty event.5 That call to action may appear to be a relatively simple task, but the complexities around blood supplies and emergency preparation are a multifaceted process. According to the FDA’s Blood Establishment Registration database, there are 53 community blood organizations and 90 hospital-based blood organizations in the United States. Together the community and hospital-based blood organizations collect 60% of the nation’s blood supply while the American Red Cross collects the remaining 40%.
A select number of community blood suppliers across the nation have developed a system to effectively manage the possibility of a sudden temporary increase in demand. Dr. John Armitage, President & CEO of Our Blood Institute, had a vision to create a cooperative among independent community blood centers where they would support one another in times of mass casualty disasters.
In September 2021, seven community blood suppliers across the nation joined the collaborative that would be named the Blood Emergency Readiness Corps (BERC).7 The members of the BERC developed a system whereby a schedule was created in which blood from designated organizations would be available for other members in the partnership during times of catastrophic emergency. The blood earmarked for possible distribution to other members is not to be issued for any reason other than a major emergency. The designation of a major emergency was not specifically outlined, but rather defined when one of the members requested assistance. In the BERC a participating organization has a uniform amount of blood, 14 units of O-type blood, available for their other partners.7 The stakeholders have established a rotation system in which each organization transfers the responsibility of providing emergency blood to the other organizations on a weekly basis. This agreement allows all participating suppliers to have a contingent supply available if their organization is faced with a major catastrophe, while unused blood units enter standard distribution channels at the end of an agency’s week of responsibility.
The idea of a rotational supply agreement grew in popularity and membership in BERC has increased in short time. To date there are 36 participating agencies that have been divided into three groups using a three-week “on-call” rotation supporting one another.7 Blood units are shipped by the highest priority method available upon request to refill the agency’s supply.
As noted previously there are 53 independent community blood centers throughout the nation, so further increased participation would fortify the program tremendously. Since program inception, there have been six activations of the BERC as detailed below. In each case, the blood needs of the requesting agency were met in full by the other members of the BERC.
Activation 1—September 27, 2021
A mass shooting in a grocery store in Memphis, TN, left 12 victims in need of blood. The blood centers of Houchin Community Blood Bank, South Texas Blood & Tissue Center, & We Are Blood assisted Vitalant with an immediate resupply.7
Activation 2—December 1, 2021
A mass shooting in a school in Oxford, MI, left eight victims in need of blood. The blood centers of Central Pennsylvania Blood Bank, Coastal Bend Blood Center, and the Oklahoma Blood Institute assist Versiti Blood with an immediate resupply.7
Activation 3—December 11, 2021
Catastrophic tornados and resulting injuries had the Sun Coast Blood Center, Community Blood Center, Carter Blood Care, and The Blood Connection provide Blood Assurance in Chattanooga, TN, with enough supply to assist those in need.7
Activation 4—May 25, 2022
A mass shooting at a school in Uvalde, TX, resulted in The Community Blood Center, Sun Coast Blood Center, Carter Blood Care, The Blood Connection, Vitalant, Rock With ever-present concerns over insufficient national blood supplies, it may seem counterintuitive to have EMS agencies now offering prehospital blood transfusions. River Valley Blood Center of the Ozarks, Life Serve Blood Center, The Blood Center, and Miller Keystone Blood Center resupplying the South Texas Blood & Tissue secondary to their support of blood needs in the area.7
Activation 5—June 16, 2023
After a large destructive tornado in Perryton, TX, led to multiple casualties, the Blood Bank of Hawaii, Cascade Regional Blood Bank, ImpactLife, Inova Blood Center, LifeStream Blood Bank, Mississippi Blood Services, Northern Community Blood Bank, South Texas Blood & Tissue, and We Are Blood all sent blood supplies to the affected region.7
Activation 6—June 16, 2023
A series of destructive tornadoes in the north Texas Metroplex region led to many casualties and another activation of BERC. A dozen blood suppliers from across the nation answered the need in this disaster.
On May 25, 2022, subsequent to the Robb Elementary school shooting, a request from Uvalde officials was issued to the Texas regional emergency healthcare team for a large blood cache. Local blood supplier and BERC member, South Texas Blood & Tissue, fulfilled this request with exceptional efficiency.
In a predesignated regional operational mass casualty plan, a large volume of blood was airlifted from South Texas Blood & Tissue in San Antonio to Uvalde to immediately treat victims of the school shooting. Additional units of blood were transported to the scene by ground ambulances. Simultaneous to this action, South Texas Blood & Tissue Center sent a large allotment of blood to the Level 1 trauma hospital in San Antonio where more victims of the shooting would receive treatment with lifesaving blood.
As the blood was allocated to the requested areas, South Texas Blood & Tissue, contacted the BERC to request replacement of the distributed blood units. The BERC team members immediately answered the need and fulfilled the South Texas Blood & Tissue request in full.7
The coordination of the regional plan to request, package, ship and receive blood in a timely and organized manner was the result of detailed preplanning by the Southwest Texas Regional Advisory Council.8
The Southwest Texas Regional Advisory Council (STRAC) has been designated by the Texas Department of State Health Services for the development and implementation of regional trauma and emergency healthcare services.8 Blood resource management is commonplace for STRAC as dozens of EMS agencies in a 22-county service area through south Texas have regularly transfused blood as part of their standard operations for over five years.8 The framework of blood distribution in a regional mass casualty developed organically with stakeholders holding regular preparatory meetings.
The STRAC region has coordinated with local supplier South Texas Blood & Tissue to have blood distributed to every reach of the state upon the request of appropriate officials. The dedicated group of donors in South Texas known collectively as the Heroes in Arms provide the blood supply used by local EMS agencies and hospitals in both daily emergencies and large scaledisasters. Their sacrifice can serve as a blueprint for other regions' preparations.
In 2020 the U.S. Department of Health and Human Services published the Adequacy of the National Blood Supply report to Congress.5 This document stands as a comprehensive analysis of numerous aspects of the national blood supply network.
With ever-present concerns over insufficient national blood supplies, it may seem counterintuitive to have EMS agencies now offering prehospital blood transfusions. With a limited supply available for hospital use, the addition of EMS consumers would appear to further strain the system. A recent study in the Journal of Trauma and Acute Care Surgery revealed that patients who received prehospital whole blood receive fewer mass transfusions in the hospital compared to those that did not.9
Although EMS is pulling blood units from the grand total produced by blood suppliers, their proactive interventions are generating a net gain for blood supplies in their regions and improved patient outcomes. Comprehensive planning is a multidisciplinary endeavor that requires tremendous coordination to prioritize blood resource management to maximize life safety.
1. Braverman M, et al. From Battlefi eld to Homefront: Creation of a Civilian Walking Blood Bank. Transfusion 2020: 60 (3S), 167-170.
2. Strandenes G, DePasquale M, Cap A. Emergency Whole Blood Use in the Field:A Simplifi ed Protocol for Collection and Transfusion. SHOCK 2014: 41 (1), 76-83. https:// rdcr.org/wp-content/uploads/2018/05/Strandenesemergency-whole-blood-use-in-the-fi eld-SHOCKVol.-41-Supplement-1-2014.pdf
3. Stubbs J, Jenkins D. (2019). Blood Transfusion preparedness for mass casualty incidents: Are we truly ready? American Journal of Disaster Medicine 14 (3), 201218.doi. 10.5055/ajdm.2019.0332
4. Muller B. (2021, December 13). Sun Coast Blood Centers Donating Blood to Midwest Hospitals after Deadly Tornadoes. WFLA Tampa News. https://www.wfl a.com/ news/local-news/suncoast-blood-centers-donating14-units-of-blood-to-midwest-hospitals-after-deadlytornadoes/
5. Health and Human Services. (2022, June 20). Blood and Tissue Preparedness and Response. U.S. Department of Health and Human Services. https://www.hhs.gov/ oidp/topics/blood-tissue-safety/blood-and-tissuepreparedness-and-response/index.html
6. Murphy M, Fry K, Hrouda J. Joint Letter to ASPR regrading Four Pillars of Safety. 2018 AABB, America’s Blood Centers, American Red Cross. https://www.aabb.org/docs/ default-source/default-document-library/positions/ joint-letter-aspr-four-pillars.pdf?sfvrsn=9a516af7_6
7. Blood Emergency Readiness Corps (BERC). 2024. https:// bloodemergencyreadinesscorps.org
8. Southwest Texas Regional Advisory Council. (2022, May 19). STRAC Trauma Service Area Blood Program. https:// www.strac.org
9. Braverman M, et al. The Impact of Prehospital Whole Blood on Hemorrhaging Trauma Patients: A Multi-Center Retrospective Study. The Journal of Trauma and Acute Care Surgery 2023: (95) (2), 191-196.
