Provincial Massive Hemorrhage Toolkit
A comprehensive toolkit was developed to provide guidance for Ontario hospitals in the implementation of Ontario’s Recommendations for Massive Hemorrhage Protocol. The toolkit addresses select patient populations and differences in hospital sizes, resources and geographical challenges.
Released April 30, 2021
Contents
Patient Transport
Russell MacDonald (Chair), Andrew McDonald, Jacob Pendergrast, Robert Skeate, Jami-Lynn Viverios, Alison Wendt
The Patient Transport section will address the following recommendation statement: The transport service(s) should be promptly notified if the decision is made to transfer the patient to another hospital for definitive hemorrhage control. If required, the patient should be transferred as soon as and as safely as possible by appropriate staff and transport resources, to an institution where definitive hemorrhage control can be performed (Statement number 10).
This section will include additional information regarding: (1) Facilitation of Early Transfer (2) Patient Information Needed for Safe Handover (3) Patient Preparation (4) Transfusion Medicine.
5.1 Facilitation of Early Transfer
The transport medicine environment is challenging. To carry out the transport safely, the patient may need interventions prior to transport that would not be performed if the patient was not transported out to another hospital.
Can the patient receive definitive hemorrhage control in current facility?
If not:
- Consider need for immediate transfer to definitive care setting
- If transfer required, initiate request for transfer (CritiCall 1-800-668-4357). Refer to Adult Appendix H.
To minimize the time the transport crew needs to prepare the patient for transport, please consider the following before the crew arrives:
- Patient information
- Patient preparation
- Will blood components / products be necessary during patient transport?
If yes, contact the Transfusion Medicine Laboratory (TML) of sending facility immediately to have the blood components / products prepared.
Note: a dedicated transport team or transport personnel may not always be available to transport the patient.
5.2 Patient information
Have clinician available to communicate pertinent details to the dispatcher, transport physician or crew and answer further questions as required.
Physician to physician communication is often helpful, and Ornge has Transport Medicine Physician (TMP) for this purpose (if being transported by Ornge).
Communication by the sending physician:
- Determine care required in transport
- Communicate directly with receiving physician
- Ensure patient is optimized for transfer
- Make copies of all documentation for the transport crew to bring to the receiving hospital.
Provincial Massive Hemorrhage Protocol | Version 1, July 2020 | Page 21 www.transfusionontario.org
5.0 PATIENT TRANSPORT
Communication with the receiving physician: - Accept patient, ensure receiving facility can accommodate patient
- Provide advice if requested or necessary
- Notify relevant services – Admitting, Emergency Department (ED), Operating Room (OR), Diagnostic Imaging (DI), Intensive Care Unit (ICU), TML of patient’s anticipated time of arrival.
Refer to MHP Checklist/Handover tool in Adult Appendix C and Pediatric Appendix E.
Note: there are space limitations in the transport vehicle that may preclude taking more than one box of blood
5.3 Patient Preparation
To minimize the time the transport crew spends preparing the patient for transport, a number of things can be done prior to the crew’s arrival.
Consider the following as you prepare your patient for transport:
- Secure airway if compromised oxygenation / ventilation, or altered level of consciousness
- Recent arterial blood gas if mechanically ventilated
- Good intravenous access (≥2 large bore peripheral IVs)
- Consider a central and / or arterial line
- Insert urinary catheter and / or gastric tube if indicated
- Adequate supply of blood and blood products packaged for transport
- Spinal motion restrictions if concerned
- Splint extremity fractures if present
- Prevent inadvertent hypothermia: monitor temperature q30minutes
- Warm blankets, change q30minutes and immediately before handover to Emergency Medical Services (EMS)
Contents
Patient Transport
5.1 Facilitation of Early Transfer
The transport medicine environment is challenging. To carry out the transport safely, the patient may need interventions prior to transport that would not be performed if the patient was not transported out to another hospital.
Can the patient receive definitive hemorrhage control in current facility?
If not:
- Consider need for immediate transfer to definitive care setting
- If transfer required, initiate request for transfer (CritiCall 1-800-668-4357). Refer to Adult Appendix H.
To minimize the time the transport crew needs to prepare the patient for transport, please consider the following before the crew arrives:
- Patient information
- Patient preparation
- Will blood components / products be necessary during patient transport?
If yes, contact the Transfusion Medicine Laboratory (TML) of sending facility immediately to have the blood components / products prepared.
Note: a dedicated transport team or transport personnel may not always be available to transport the patient.
5.2 Patient information
Have clinician available to communicate pertinent details to the dispatcher, transport physician or crew and answer further questions as required.
Physician to physician communication is often helpful, and Ornge has Transport Medicine Physician (TMP) for this purpose (if being transported by Ornge).
Communication by the sending physician:
- Determine care required in transport
- Communicate directly with receiving physician
- Ensure patient is optimized for transfer
- Make copies of all documentation for the transport crew to bring to the receiving hospital.
Provincial Massive Hemorrhage Protocol | Version 1, July 2020 | Page 21 www.transfusionontario.org
5.0 PATIENT TRANSPORT
Communication with the receiving physician: - Accept patient, ensure receiving facility can accommodate patient
- Provide advice if requested or necessary
- Notify relevant services – Admitting, Emergency Department (ED), Operating Room (OR), Diagnostic Imaging (DI), Intensive Care Unit (ICU), TML of patient’s anticipated time of arrival.
Refer to MHP Checklist/Handover tool in Adult Appendix C and Pediatric Appendix E.
Note: there are space limitations in the transport vehicle that may preclude taking more than one box of blood
5.3 Patient Preparation
To minimize the time the transport crew spends preparing the patient for transport, a number of things can be done prior to the crew’s arrival.
Consider the following as you prepare your patient for transport:
- Secure airway if compromised oxygenation / ventilation, or altered level of consciousness
- Recent arterial blood gas if mechanically ventilated
- Good intravenous access (≥2 large bore peripheral IVs)
- Consider a central and / or arterial line
- Insert urinary catheter and / or gastric tube if indicated
- Adequate supply of blood and blood products packaged for transport
- Spinal motion restrictions if concerned
- Splint extremity fractures if present
- Prevent inadvertent hypothermia: monitor temperature q30minutes
- Warm blankets, change q30minutes and immediately before handover to Emergency Medical Services (EMS)