THE VALUE OF BLOOD CARE PROGRAMME AS A COMPLIMENT TO MEDICAL ASSISTANCE COMPANIES

by Colonel Michael JG Thomas, MA, MB, FRCP (Edin), DTM&H, Clinical Director

The provision of blood for those members of an organisation who are based in, or who travel to those parts of the world where the blood supplies fail to meet standards set in the UK, requires careful consideration. This is especially pertinent as medical assistance companies do not normally provide blood for a patient in advance of an evacuation, nor recommend, for reasons of legal liability, from where blood should be sourced.

The problems with supplying blood to distant countries are fourfold, namely: obtaining a supply of blood whose quality matches UK standards; providing an alarm system which can instantly react to an emergency requiring blood; safely transporting the blood to the patient and, finally, ensuring the correct blood is actually transfused.

To be confident blood will be available in an emergency, the first requirement is a written agreement with the national authority governing blood donation in the particular country from which the supplies are to be obtained. The Blood Care Foundation has agreements with two national blood authorities and is actively pursuing agreements with three others. The National Blood Authority of England and Wales has confirmed the Department of Health's statement that the task of the UK National Blood Services is to provide blood for the treatment of patients within the UK. This statement precludes the supply of blood to meet the requirements of patients overseas. Should any organisation claim that they can source blood from the UK, they are either being overoptimistic or they are obtaining supplies via an unofficial route, which could lay all the parties involved open to future litigation.

The next step is the inspection of the methods of processing, storage and documentation in the proposed sourcing blood banks. It is essential for a properly qualified Quality Assurance Manager to be responsible for ascertaining the blood to be provided is of an acceptable standard. The Blood Care Foundation has strict Standard Operating Procedures ( SOPs ) for these inspections.

Once a satisfactory source of blood has been found, it is then necessary to agree the method of requesting blood and the provision of the necessary issuing documentation. These procedures again need to be carefully set out in Policy Documents ( PDs ) and SOPS.

Although most medical assistance companies provide Alarm Centre facilities, it is perhaps understandable that few of their doctors have any real knowledge of Transfusion Medicine. To illustrate this point, one client company recently consulted its assistance provider in the UK for advice about the latest outbreak of haemorrhagic Dengue fever in India. The client company was assured that, should a member of their staff require blood as a result of contracting Dengue fever, there were no problems with the availability or quality of blood in India. This demonstrates a lack of understanding of the problem. Firstly there is an acute shortage of blood in India and much of that available is of questionable quality. Secondly the usual requirement in haemorrhagic Dengue is platelets and/or clotting factors rather than blood. To keep its own medical teams up to date, the Foundation has designed training .courses for the doctors on call in its alarm centres and supplies them with explanatory literature. In addition consultant cover is provided at all times to discuss any problems which may arise when a call for blood is received.

The transportation of blood is not simply a matter of putting the blood in a box and sending it via airfreight. Numerous shipments of blood have been destroyed by inadequate packaging. In addition, blood can become totally haemolysed as a result of improper temperature control. Such blood, if transfused, could well lead to a fatal outcome. The Foundation has strict packaging standards, and its couriers are trained to re-ice the blood if the journey takes more than 15 hours. Blood is taken as hand luggage by the courier so that he, or she, can be certain that it has not been subjected to undue changes in temperature.

Finally there is the question of ensuring the patient receives the correct blood. In most of the countries where blood is required in an emergency, it is in very short supply and there is a thriving market for "good quality" blood. To ensure the Foundation's patients do receive the blood supplied, the courier keeps the blood in the transport container until it is required for transfusion. As all Foundation couriers are trained in transfusion techniques, they are usually the ones to administer the blood but, even if they do not physically put the blood up, they stay with the patient until the transfusion is completed. Once the transfusion has been finished, they bring back the empty blood bags so that these are available for examination should any post-transfusion problems arise.

On occasions, an assistance company will claim they can provide blood in an emergency, in addition to the small quantity they may carry in the air ambulance for use during the evacuation mission itself. In such cases, potential clients are strongly recommended to ask the assistance company for a copy of the agreement with their blood provider and for copies of the PDs and SOPs that cover the requesting, transportation and administration of blood for their patients. Enquiries should be made as to whether the assistance company has an adequate look-back programme in case the patient develops a transfusion-transmitted illness. Finally, the potential client needs to enquire as to product liability. Does the assistance company have the expertise and experience in blood supply that would stand up in a court of law should a patient sue because of alleged damage resulting from a transfusion? Transfusion medicine is becoming more and more complicated. As this is one area where a simple mistake can easily lead to the death of a patient, it is essential at the outset to take all possible preventative measures to ensure all the consequences which flow from such an event are avoided.

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