Background:

Mass casualty events (MCEs) are increasing in frequency and severity, with recent large-scale incidents resulting in casualty loads of up to 337 patients. An MCE in Los Angeles (LA) could significantly strain the trauma system’s blood supply, especially given LA’s large population and diverse geography makes large MCEs possible and restocking blood supplies difficult.

Objective:

This study aimed to assess the MCE preparedness of trauma centers in LA by evaluating on-site blood product levels and estimating institutional capacity based on Association for the Advancement of Blood & Biotherapies (AABB) guidelines.

Methods:

A cross-sectional needs assessment survey was distributed to 15 LA trauma centers. Data on on-site quantities of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and whole blood (WB) and blood utilization during Massive Transfusion Protocols (MTPs) was collected. Descriptive analysis reported medians and interquartile ranges (IQRs). Patient capacity was evaluated with AABB disaster guidelines.

Results:

Ten trauma centers (Three Level 1 and Seven Level 2) responded. Median on-site PRBC stock was 280 units (IQR 181, 444), supporting an estimated 93 admissions per institution (IQR 60, 148). Median FFP stock was 248 units (IQR 142, 382), but only 5.5% (13.5 units) were thawed, limiting immediate capacity to 13 patients (IQR 10,18). Additional FFP required a median preparation time of 30 minutes (IQR 25, 30).

Institutions maintained a median 7 units of platelets (IQR 4, 12), supporting 28 patients (IQR 17, 50). WB was used in trauma care at 4 (40%) institutions, who stored a median of 16 units (IQR 12, 20). These institutions initiated MTPs with a median 2 units of WB, for a capacity of 8 patients (IQR 6,10).

Conclusions:

Capacity for immediate large-scale MCE response in LA may be limited, particularly due to the low availability of thawed FFP and platelets, highlighting the need for enhanced regional disaster preparedness.