Following Las Vegas Mass Shooting, High Blood Transfusion Needs Were Met by Existing Supply at Local Hospitals and Blood Suppliers
Northwestern Memorial Hospital October 29, 2018
At 10:05 pm on October 1, 2017, a gunman opened fire from the 32nd floor of a Las Vegas hotel onto more than 22,000 concertgoers below. The incident, which would become the deadliest mass-shooting incident in modern United States history, overwhelmed Las Vegas hospitals with more than 600 injured patients arriving at emergency departments by both ambulance and private vehicle. More than 500 blood components were transfused in the first 24 hours following the incident in Las Vegas.
A new Northwestern Medicine study published in the Journal of Trauma and Acute Care Surgery analyzed the blood resource needs and blood donations in Las Vegas compared to other mass shooting incidents offering insight into medical needs following a mass shooting incident, which may help guide preparedness for future events.
“Blood component usage data from the Las Vegas shooting is a significant contribution to the limited data we have on blood component needs following mass shooting incidents,” said senior author Glenn Ramsey, MD, medical director of the blood bank at Northwestern Memorial Hospital and professor of pathology at Northwestern University Feinberg School of Medicine. “By analyzing this data and the data from other incidents, we can better predict what blood component needs may be following a mass casualty event to help hospitals, blood suppliers and emergency responders prepare.”
While the amount of blood components transfused per patient was similar in magnitude to other mass casualty events, the study data suggests that the total one-day blood component transfusions needed in Las Vegas were more than in any mass shooting on record, surpassing the 510 blood components transfused in Paris in November 2015.
“Even with the high volume of blood transfusions, in-hospital supplies and rapid supplementation from local blood suppliers met patient need in Las Vegas,” said Dr. Ramsey. “More than 700 blood components were rapidly shipped by United Blood Services and the American Red Cross to replenish blood supply at Las Vegas hospitals.”
Despite an adequate blood supply locally and nationally, local officials made a public plea for blood donations during a morning press conference on October 2. The resulting news stories led to hours-long donation lines across Las Vegas and a surge in blood donations across the country. The American Red Cross reported a 53% increase in blood and platelet donations appointments between October 2 and 4 nationwide. In Las Vegas, public citizens donated nearly 800 units immediately following the incident.
“The public call for blood donors was not necessary to meet immediate demand and led to outdated blood resources because of the limited shelf life of blood components,” said Dr. Ramsey. “This illustrates the delicate balance between the public’s altruistic desire to help during a mass casualty event and the need to appropriately manage resources and blood supply demand. Public officials should carefully consider initial statements and calls for donation should only occur when approved or requested by blood suppliers.”
Red blood cells have a shelf life of 42 days and platelets, only 5 days. That’s why it’s vital to continuously replenish the supply from blood donors who give regularly so there’s enough ready and waiting for patients when they need it. Beyond simply expiring, donated blood might go unused for many reasons such as units not meeting hemoglobin content standards, donor recall of information that affects the safety of the unit (like forgotten travel), abnormal test results and blood clots or other abnormalities seen during processing.
The authors suggest that one possible strategy for managing blood supply and demand following a mass casualty event is to develop a pre-planned response whereby blood donations would be scheduled on a rolling basis based on time-designated regional cohorts, such as zip codes by week. However, routine blood donation is the best means of supporting victims of mass casualty.
“A blood donation requires several days of processing before it can be transfused, so it is important to remember that ‘blood required for today’s disaster was donated yesterday,’” said Dr. Ramsey. “By routinely donating blood, we can all do our part to ensure blood supplies are adequate when a mass casualty event occurs.”
In addition to donating blood, the authors also suggest that public training in hemorrhage control and tourniquet use has the potential to save lives in a mass-shooting incident. In both Paris and Las Vegas, tourniquets were widely used. In Paris, most victims were triaged by emergency personnel supplied with hemorrhage kits containing tourniquets, hemostatic gauze and tranexamic acid.
In Las Vegas, medical supplies including tourniquets and pressure bandages were severely inadequate with first responders and on the scene. Many used makeshift tourniquets, which were less effective, and 60 percent of the injured were transferred to hospitals in private vehicles rather than ambulances.
“Public awareness in hemorrhage control and tourniquet training can save lives and potentially decrease blood need in mass shooting incidents,” said Dr. Ramsey. “Programs like the American College of Surgeons’ Stop the Bleed® can better prepare the general public and empower individuals to respond if they witness a mass casualty incident.”
Lozada MJ, Cai S, Li M, Davidson SL, Nix J, Ramsey G. The Las Vegas Mass Shooting: an analysis of blood component administration and blood bank donations. Journal of Trauma and Acute Care Surgery, online publication Oct 29, 2018.