MHP 2.0 – An Educational Symposium

ORBCoN, Central Region

On November 9^th 2023, 109 multi-disciplinary healthcare professionals from across Ontario and beyond attended ORBCoN’s Massive Hemorrhage Protocol (MHP) 2.0 educational symposium. The goal of the symposium was to bring together stakeholders to present new topics relevant to the massively bleeding patient, provoke discussion and share the latest in evidence that may impact the current iteration of Ontario’s First Recommendations of Massive Hemorrhage Protocol.

The educational event focused on the following 3 fundamental questions:

1. What have we learned?

data on provincial survey results and pilot data on quality metrics portal

2. What can we expect?

Impending changes due to new products, new trials and new publications

3. What do we do next to update recommendations and improve current practice?

pre-hospital red blood cell transfusion; Tranexamic acid
clinical event debrief
addressing barriers to change

As illustrated in figure 1 below, a significant improvement in the number of hospitals with a formal MHP in place with a net increase of 25 hospitals since 2018.

Figure 1. Courtesy of Dr. Chantalle Grant

Figure 2. Courtesy of Dr. Chantalle Grant

47% (75) of hospitals have a formal MHP in place. A further 30% (47) indicated they were partially aligned with the Ontario Recommendations. 37% do not have an MHP in place however, 18% (29) of those who do not indicated that they were currently working towards a protocol and alignment with Ontario Recommendations. 7% (8) of hospitals (7 small and 1 large) in Ontario do not have an MHP in place and are not currently working towards one at the time of survey.

We hear you!! … but patients with massive hemorrhage can present to any hospital.

Ensure you have a policy to transfer the patient out for definitive damage control.
Leverage the resources you have. Consider a regional policy or learn how others with similar size and services manage or check out the non-definitive setting checklist available to you.

Although huge strives have been made in the province over the last five years to standardize the care of the massively bleeding patient, there remains room for improvement. As we work on MHP 2.0 in 2024 we will look to continue to reduce policy variability, increase inclusion of pediatric provisions for those hospitals that care for children (only 56 hospitals out of 101 who indicated they care for patients under the age of 18 include provisions for population) and continue to ensure quality assurance and adherence.

Presentations have been archived and can be found here