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Moreover, at the Bufalini Hospital a hemophilia center and a thrombosis and hemostasis center inside the transfusion medicine ward are present in order to guarantee consultation on congenital and acquired bleeding disorders. In the regional healthcare plan was published, and for the accreditation of the emergency department, a specific protocol and standard operative procedure for the management of major blood loss were required.

A multidisciplinary team for the implementation of the transfusion policy was created involving traumatologists, emergency physicians, and transfusion medicine specialists with expertise in hemostasis.

A first formula-driven protocol for the management of trauma-induced coagulopathy was adopted for the prompt release of the blood component therapy. The instrument was located in the intensive care unit ICU , and an intensive training course was started.

Practical Issues in Anesthesia and Intensive Care | Biagio Allaria | Springer

All the anesthetists and transfusion medicine specialists were trained by classroom lessons with a ratio of one tutor to three students. Every year a refresh course is organized. Before introducing the device in the clinical practice, a verification of ROTEM reference ranges was conducted performing assays on blood samples from 20 healthy blood donors with normal coagulation, and results were compared with the reference ranges provided by the manufacturer.

A specific algorithm was defined for the coagulation support to the trauma bleeding patients, and a laminated poster with the algorithm is present in the ICU and in the blood bank. In the emergency department are available 6 units of zero negative red blood cells, 3, units of prothrombin complex concentrates, and 2 g of fibrinogen. Cardiothoracic Surgery.

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