Transfusion Medicine Service Trauma Activated Transfusion Algorithm (TATA)

• Life threatening trauma presenting to the Emergency Room or OR
• Used only for trauma patients to provide early and appropriate hemotherapy support primarily during the first 90 minutes post trauma
• Activated only by trauma attending by calling the Transfusion Medicine Service (TMS)/Blood Bank at 5-7207
• The identification of candidates is made by the responsible Trauma Attending
  

Notification of Transfusion Service

The trauma attending physician responsible for the potential TATA candidate shall notify the Transfusion Service (5-7207) that TATA is indicated. The Lab will contact the Pathologist who will review the situation. (Circulating RN in the OR may need to call on behalf of the trauma surgeon if surgeon is scrubbed)

Activation of Tier 2 and Tier 3 must be communicated to the TMS physician or the TMS/Blood Bank (5-7207) by the surgeon, anesthesiologist, trauma MD, or TMS physician when they are ready to proceed to the next Tier (Circulating RN may place the call on behalf of the surgeon or anesthesia provider)

Transportation

Transportation of blood components is coordinated by the Transfusion Service (Blood Bank). Runners are available (24/7) and will be coordinated by the Transfusion Service (Blood Bank) to hand carry blood components during a TATA.

The Transfusion Service Pathologist shall proceed to the involved patient's location, notify the clinical staff in person, and supervise the transfusion needs of the patient from that point forward until, by agreement with the patient's physician, the TATA emergency is declared to be at an end. The TATA provides a coordinated hematologic resuscitation effort, including the use of frozen plasma, cryoprecipitate, platelets, and red blood cells

Specified 3 tier algorithm includes:

• Tier 1 – 6 units RBC, 1 dose FFP
• Tier 2 – 3 units RBCs, 1 dose FFP, 1 pack platelets
• Tier 3 – 3 units RBCs, 1 dose FFP, cryoprecipitate
• Blood components (by Tier) may be requested from the Blood Bank via the DH1 system in the OR after the algorithm is activated by using the following DH1 entries:
  • Trauma—Tier 1 (TATA)
  • Trauma—Tier 2 (TATA)
  • Trauma—Tier 3 (TATA)

Note:  O Rh negative or O Rh positive units may be sent based upon patient status, gender, and age.

Goals

The goals of the TATA are:

1. To focus responsibility for blood resuscitation on the Transfusion Service Pathologist
2. To provide optimal blood component therapy for critically ill patients 
   (Typically blood components are provided using a ratio of 1:1:1 – Fresh Frozen Plasma (FFP): Platelets (PLT): Red Blood Cells (RBC) for the first 3 Tiers.)
   

Specific Protocol Guidelines

1. Role of ED or Surgical Team
   1. TATA Protocol must be discontinued by the trauma physician, anesthesiologist, or TMS physician
   2. Once Tier 3 is completed, a discussion with trauma or anesthesia and the TMS physician is required to continue transfusion with specific, agreed upon components
   3. Obtain tests as indicated by the case
2. Role of the Transfusion Medicine Service Pathologist acting as TATA Manager:
1. Manage hematologic replacement therapy
2. Direct Clinical Laboratory Sections to obtain top priority for tests in support of the patient
3. Collaborate with anesthesia service to collect and follow laboratory test results as needed in order to drive blood component replacement

Trauma Activated Transfusion Algorithm (TATA)