Objectives: The care of exsanguinating trauma patients has changed over the last decade-and-a-half following the description and rapid adoption of damage control resuscitation. Immediately available balanced blood products (IABB) or whole blood (WB) have replaced large volume crystalloid and red blood cell (RBC)-based resuscitation. Most trauma systems (TS), including ours, require access to RBCs, but not IABB. We aimed to identify gaps in access to IABB across our state TS.
Methods: All trauma centers (TC) were surveyed. IABB was defined as 1) at least 2 units (U) of thawed or never frozen plasma (ToNFP), 4 U RBC, 2 U fresh frozen plasma (FFP), and 1 U platelet or 2) at least 2 U of WB. The percentage of the state population within specific travel time thresholds was calculated using service areas in ArcGIS Pro and US Census data.
Results: All TC (n=64) in our TS completed the survey. All Level 1-3 TC (n=29) have RBC, FFP, and platelets, but only half of the Level 2 and 16% of the Level 3 TC have ToNFP. A third of Level 4 TC have only RBC, while only 1 has platelets, and none have ToNFP. Within 30 min drive time, 85% of the population has access to RBC, 81% to FFP, and 65% to platelets, but only a third are within 30 min of IABB. Almost everyone in the state is within an hour’s drive of RBC (100%) and FFP (99%), but only 61% are that drive time from IABB. Because of a lack of ToNFP, 15% of the population do not have access to IABB within a 90 min drive. The median drive time to any TC in the TS is 19 min, while it is 59 min to a TC with IABB. Only one TC (Level 3) maintains WB.
Conclusion: Only 17% of the TC in our state TS can provide IABB. Increasing the availability of WB would reduce the time to immediately available balanced blood products.
