Blood, bombs, and bugs; business continuity matters.
Introducing the authors
Dr Heidi Doughty
Consultant in Transfusion Medicine (NHSBT); Chair of the NBTC Emergency Planning Working Group
Dr Fateha Chowdhury
Consultant Haematologist in Transfusion Medicine (NHSBT & Imperial College Healthcare NHS Trust); Secretary of the NBTC Emergency Planning Working Group.
Head of Business Continuity at NHSBT
The current Covid-19 pandemic crisis reminds all of us in the transfusion community of the importance of business continuity and being prepared for emergencies.1
Transfusion emergency preparedness is increasingly being recognised as an important element of healthcare planning. It is also required by law.
The Civil Contingencies Act 2004 requires healthcare providers to demonstrate that they can deal with major incidents while maintaining critical services. Whereas emergency planning together with business continuity is a very pragmatic management activity, it also requires an evidence base.
There are excellent general emergency planning guidance documents from NHS England. However, one of the challenges for the blood service is that it straddles many organisational boundaries, for example there are 42 local resilience forums nationwide.
However, it is the balance between demand and supply that chiefly concerns us. Hospitals, blood services, patients and donors must work in partnership to reduce the impact of transfusion related emergencies.
The National Blood Transfusion Committee (NBTC) brings these stakeholders together and thereby plays a key role in supporting Emergency Preparedness, Resilience and Response (EPRR) across the wider transfusion community.
In late 2017, the NBTC re-established the Emergency Planning Working Group to provide a new forum to provide transfusion preparedness guidance for hospitals following several UK based Major Incidents and Mass Casualty Events that year. The group included trauma and transfusion staff together with business continuity and customer services colleagues. The remit was primarily informed by published and personal practical accounts of events involving bombs, bullets, and ‘bugs’ in the guise of malware. The format was drafted followed an existing hospital plan and refined following Regional Transfusion Committee workshops.
The document complements updated integrated shortage plans together with a range of supporting tools available from the JPAC NBTC webpages and NHSBT Hospitals Science sites. The main theme of the EPRR guidance was that Hospital Transfusion Teams (HTT) should be familiar with their organisation’s Major Incident, Mass Casualty Event (MCE), and Business Continuity (BC) plans.
Robust BC plans should mitigate the impact of clinical emergencies and other incidents, such as computer service disruption and adverse weather, which may threaten the delivery of hospital-based transfusion services.
One of the key messages was a joint understanding of blood requirements following bomb attacks. Recent publications have shown that not many casualties need blood and the overall transfusion requirement is modest. One of the factors may be the improvement in pre-hospital care with a focus on early haemorrhage control. Whereas, the demand for blood has not been significant during recent Major Incidents and Mass Casualty Events, road closures and confusion have been common.
A good management plan is essential to maintain critical transfusion services.
The human factor
One of our main findings was that many transfusion staff are not aware of the ‘bigger picture’. We have advised that hospital transfusion and laboratory staff should be aware of both the wider Trust and regional plans for whatever disaster they are dealing with. Although it may be difficult to release transfusion staff from bench-work, they should be trained and exercised as part of wider Trust preparation.
We introduced novel concepts including a more proactive approach to transfusion support and ‘transfusion triage’. Triage – or prioritising activity – can be applied throughout the transfusion pathway. We suggest that Transfusion Practitioners are uniquely placed to assist triage across the clinical laboratory divide, supporting patient safety and regulatory compliance.
Local transfusion team leadership was emphasised. Senior staff should both lead the response and prepare early on for recovery providing a continuity of service beyond the incident. Key decisions should be logged and regularly communicated until Stand-Down from the event.
Post-incident debriefing sessions are important for staff support and for sharing lessons identified. Caring for colleagues is essential to the road to recovery. In the current climate we should acknowledge the unusual pressure caused by a prolonged event such as Covid-19, which has impacted on both our personal and professional life.
The road to recovery
An important part of the recovery process is capturing the lessons identified from each event. The current threat is not blood for bombs, although this has occurred elsewhere during ‘lockdown’. It is bugs. The response to pandemics such as Covid-19 will be fundamentally different from the response to an improvised explosive device.
Lessons are already being identified, for example an acknowledgment of a restoration/stabilisation phase before full recovery. We need to understand the process of Trusts returning to a new normal activity whilst maintaining the capability to deal with further waves of the virus. There will be lessons to learn and policies to update. We encourage the whole transfusion community to reflect on, and record, their experience. It is through reflective practice combined with academic rigour that we advance business continuity policy and practice in transfusion.
1 Doughty, H. and Rackham, R. (2019). Transfusion emergency preparedness for mass casualty events. ISBT Science Series. 14(1):77-83. (First published online 04 September 2018).
2 Doughty H, Chowdhury F, on behalf of the National Blood Transfusion Committee Emergency Planning Working Group. Emergency preparedness, resilience and response guidance for UK hospital transfusion teams. Transfusion Med. 2020;1–9. https://doi.org/10.1111/tme.12665