The development and implementation of, and first years' experience with, a massive/emergency transfusion protocol (damage control hematology protocol) in a Veterans Affairs hospital.

Published reports of massive or emergency transfusion protocols (MTP/ETPs) focus primarily on large trauma centers. There is little guidance available in the literature to assist nontrauma, hospital-based blood banks in the development of an MTP/ETP for occasional bleeding emergencies. Here, we describe the design of an MTP/ETP at the Veterans Affairs Connecticut Healthcare System in West Haven. The MTP/ETP consists of a protocolized distribution of red blood cells (RBCs), fresh frozen plasma (FFP) and platelets (PLTs), with cryoprecipitate and recombinant factor VIIa also available. In the first year of operation, the MTP/ETP was activated five times on five separate patients. All of the MTP/ETP patients received RBCs, FFP, and PLTs. Two out of five patients received cryoprecipitate. None of the patients received recombinant factor VIIa. Four of the five patients who underwent MTP/ETP survived at least 21 days following the event. A total of 2 units of FFP and 4 units of RBCs issued as a part of the MTP/ETP were wasted. The development of an MTP/ETP at our Veterans Affairs hospital helped to ensure that patients requiring massive transfusion received RBCs, FFP, and PLTs in a protocolized fashion as part of their resuscitation with relatively little product wastage.