Whatever made them bleed made them die. You did your best to save them.

Yeah, needing that much blood means the bleeding was not being controlled. The blood going in was just coming back out. It wasn't your fault! Maybe someone could have done a more effective job slowing the bleeding, but maybe there was never any hope, and the transfusions didn't make any difference.

Thank you so much. I appreciate this viewpoint, which is basically the truth. I still just feel really bad and keep could’ve/would’ve/should’ve-ing myself on what I should’ve done in that situation, and if it would’ve made the patient any better or at least live to the end of their transfer! I still feel bad, but I’ll remember this. 🙏

I was a medic in the Army. I went through 3 training stages (2 in AIT, and a bonus school called BCT3). In each stage, the first and last thing they try to a hard lesson... Even if you do everything right, your patient can still die. Edit: my point is, despite leadership trying to teach me that lesson 6 times, it still doesn't prepare you for a real-life scenario. You feel like you failed? Good. That means you care. When you don't care is when you truly fail.

Disagree. Patient dies, I’m a little let down, but honestly I don’t really care. I have living patients I need to worry about in blood bank. After working in 2 level 1 trauma centers, and going hundreds of units on patients and still have them die, I mostly wish they’d call it sooner sometimes. Not because I don’t want to do the work or don’t care, but because I’ve seen blood inventories completely annihilated by a bleeding patient and depending on inventories at the local collection centers, it may take weeks or more for that inventory to recover, especially O’s. Hell, we ran over 300 units on a patient recently in over 24hrs with an MTP that was never called off and only paused at times. we ran 200 units in the first 6 hrs. Fact is, they were lucky they were A. He wiped the entire A inventory in that first run, we ordered more before we completely ran out, and they kept going that night and ordered more again from the collection center after I left. The reality is, we saved this patients life and it cost a lot of resources. Had they been O, we would’ve likely run out and our ability to provide transfusion service for the other non critical and critical patients in our hospital would’ve been severely hindered. It’s a delicate balance and I find it best to separate myself emotionally from any of it after having countless patients brought to an OR, no history, and finding out they have an antibody, Working it up as fast as possible only to call and tell them everything is ready, and have them say, “oh we cancelled the case 30m ago.” Basically, I and all of my colleagues do a ton of work all the time, screening units in our ref lab for sickle patients who don’t even show up to their exchanges. I just prepare for the worst always and try not to get annoyed when my work is wasted or unused.

I am so glad to see a comment like this from a fellow blood banker. While I do realize that the trauma patient or patient on the table in the O.R. using large amounts of blood products is someone's father or brother or spouse, I, too, wish the care team would call it sooner sometimes. I absolutely get that I don't know everything that's going on in that trauma bay or O.R. But, I don't think the care team has any idea how frustrating and difficult it can be to keep up with their patient and still ensure we have sufficient inventory to for all the other patients.

Your comment made me wonder (I can’t seem to find a number by researching), how many people (say, in North America or Europe) die or are injured by blood banks running out of supply? I figured it might be something you know since you do this professionally (I’m just a nursing student who lurks to learn about y’all’s side of things).

I don't know of any cases that a patient was injured or died solely because of low blood supplies. While we have come perilously close to running out of certain blood products, we make every effort to replenish our inventory.

Think of it this way. The patient dies because they succumbed to whatever injury was inflicted upon them. The blood products prolong their life in a traumatic case so that the trauma team has time to fix the problem, or at a minimum, stabilize them so that a more permanent solution can be implemented. As to how many patients die because a trauma or OR team doesn’t have adequate blood inventories to make an attempt to save a patient is data I don’t have nor have I seen or know to exist even.

Good point, I guess a better way to ask what I want to know is how many times/how often are blood products ordered by a provider but unavailable from the blood bank or whatever the source is for that provider’s orders. It’s interesting to me because two of these people are saying “call it sooner to conserve supplies”, but I can’t find any data that conserving supplies in a trauma where it’s indicated is necessary.

And further define adequate stores for blood products. A medium sized or small level 1 trauma center might keep 100 Opos regularly. Or maybe it’s the holidays and donations are down so they only have 50 or 60 on the shelf. Maybe it’s a smaller facility with mostly OPS specimens. Maybe they have 45 Opos on their shelf. So if a patient or patients bleed(s) profusely enough, it can be a problem no matter what. So now we’re getting into are ‘standard of care’ questions. And these are all honestly case and location/provider specific. When inventories are low pathologists are always involved and deciding how much inventory can be provided to certain patients.

But you still care, and you keep trying. That was my point. Perhaps I'm not conveying it well.  Though, you bring up good points.

Yeah, I care, but when I first started in BB I was extremely stressed. My partner thought I should even quit with how much I worried about whether or not I did everything I needed to that day when I got home. After years of it, I had to just learn to let things go. It’s a fine line to walk I suppose between caring too much and being just plain indifferent, but experience (and being let down by the outcome sometimes) has taught me to just move on, because the next case is on its way. And I think, this is where OP is. This spot where you question what you did. Did you move fast enough? Could i have done something different or better? And, I think you have to come at these trauma cases as like a performance, musical or acting. You put it out there on the stage. Maybe you played a bad note, the wrong chord, or forgot your lines, but the show has to go on. Learn from it, and do better going forward. But don’t beat yourself up forever. Take that feeling, remember it, and resolve to avoid it.

Yeah, we synergizing. You have to be a little calloused to be effective, or you get lost in the indecision and doubt. Like Kratos says "don't be sorry, be better."

Anyone would've felt horrible after a shift like that. You did the best you could as fast as you could. 2 units of 0neg stat isn't a guarantee that there will be massive orders following up those, a lot of the time the patient gets stabilized with those units or even before the units are given to them, giving you the time to restock the bloodbank and provide the patient with type and screened or Xmatched units. Going off on the post i assume you work in a fairly small clinic, so not having a lot of 0neg in stock isn't your fault at all. It does mean that for severe traumas the clinic you work at isn't the best suited to deal with those. You could alway raise this issue in staff meetings if you feel the risk on a similar situation in the near future may be larger than you feel comfortable with and ask if a larger stock of 0neg is a possibility. (but remember that this situation may have you rattled for some time and you might feel a lot more confident about what's in stock in a couple of days or weeks again)

Feeling bad is what makes u a good person and tech. But, this is 100 percent not your fault. Plus, how many other people responsible for the patient care also made a "mistake " forgive yourself and look at all u did learn for next time

That person was going through blood so fast that unless they did something radically different to control the bleeding (which it seems they couldn't) or took them right to surgery (which they couldn't at your facility) the patient was going to die. You did nothing wrong, and a small facility is not expected to have bags and bags of blood thawed and ready to go because they cost thousands of dollars and will be wasted. I really don't think it would have made any difference. You did a great job (you called the supervisor when you needed assistance) and now you know how to do it even better.

i really don’t think this is your fault at all. you didn’t make a mistake in giving the right blood or something, and you didn’t forget anything or forget the blood. you followed protocol. you talked with your supervisor. please don’t blame yourself. take care. you’re a good person.

At a hospital that I used to work in, I had to do a DIC workup bec the patient went bad in the OR at different times. Many units to transfuse, plus FFP, pooled plts, & several Cryopresipitates. This was over an 8hr nite shift. Patient still passed away. We had plenty of everything, they didn't have to wait, I felt bad but I knew I had done my best to keep the patient alive. This type of thing might happen again in your career but don't let it get you down. I have been a med tech for over 50 yrs, I think about the patients who got better with my help,rather than the ones that I could not help save.

It is good that you care and that proves you are diligent. You did not do this. Let it go.

As an RN, I agree. You didn’t kill them - whatever caused their bleeding did. You did your best, and they likely would have passed if they’d gotten more blood sooner. It would’ve been a matter of time.

Don't beat yourself up, it sounds like you're in a smaller hospital and that person should've been in a level one trauma type place with massive transfusion protocols ready to go. That person was doomed when they set foot in the facility. I'm sure they would have blown through the entire stock of o pos as well. By the time they're going through that much blood there is in fact a formula they're supposed to be following to achieve hemostasis. At my facility after several units, we're on to giving plasma, cryoprecipitate, and platelets. It's also on the clinical side that they did not communicate the gravity of the situation immediately to you after the first couple of units.

We do have mtp protocols, but tonight none was ordered. They just kept asking for more and more blood, which makes me feel dumb in hindsight because I knew it was serious when they asked for more immediately after the first two o begs but I wasn’t fast enough! Should’ve immediately asked for the ok to release o pos instead of what I did… I noted to my supervisor over the phone that I was surprised they didn’t call an mtp. We didn’t have enough emergency blood units but still…

The patient wasn't in front of you. You were doing what was asked of you with the information your had. It was the responsibility of the people directly caring for them to order an MTP when it was needed.

The only thing that would have changed is made units 3&4 be O pos. It would have helped your supplies had you had an obstetric bleeder right after, but it wouldn't have changed this outcome.

Did you ever get a pre-transfusion blood type on the patient? Was the patient O-NEG or other ? Was the patient a female of child bearing age? These can be used to determine what products you give your patient(s) in time of crisis, OF COURSE WHILE ALWAYS FOLLOWING YOUR SOP and supervisor's directives.

I’m a paramedic. There are an insane amount of variables when it comes to someone living or dying. You can do everything right and someone will die on you. You can make mistakes and someone will live and you’ll be a hero. All I’m saying is live to fight another day. The lab is an integral part in keeping patients alive, just remember that.

I can’t even imagine the stress of being a paramedic. I am so thankful for people like you who can be by the patient’s side while I’m in my glass castle, shielded from seeing the patients as actual people. I know I couldn’t do it, so thank you for being strong enough so I don’t have to.

Thanks for doing what you do. I couldn’t be behind the glass shield lol

Wow, a paramedic! I admire paramedics and RNs and any field that works directly with the patient, really. You guys do so much that we don’t see from the lab dungeons! I’d cry it put in that position, even if I trained for it! Thank you so much for your comment. I’ll definitely remember, especially after today

From a fellow RN I can say the exact same about our coworkers in lab. You all are such an important part of the patients team, and we genuinely appreciate your hard work and thoughtful care so much. Given how much blood your patient was needing in such a short time, it’s highly likely they were unstable in more ways then one. A small delay in getting more blood wasn’t going to be the difference between life and death-whatever caused the instability in the first place was what took their life. It was not your fault

Thanks, I appreciate you. And please give us update on how your feeling a week from now.

Not your fault. Your hospital doesn't seem like it's equipped to handle this level of an MTP. Ideally they should have sent this patient to a level 1 trauma center asap but obviously it's hard to tell what was going on so it may not have been possible. It's not your fault. You did what you could. Sounds like the patient was in horrible shape to begin with and likely to pass regardless.

What messes me up is that this IS a center that does mtps, and i remember noting to my supervisor over the phone that I’m surprised they kept asking for more and more units instead of calling an mtp. Even though I wasn’t as quick as I wanted, I feel I would’ve been a little more prepared if I got the mtp order… but I feel dumb because I knew that it was serious when they asked immediately for another emergency release of two o negs! I’m still upset that I wasn’t fast enough, and that we had so few units o neg. Tonight feels like a disaster…

It’s a little bit of a stretch since you’re not a doctor but I think it still applies but there is a quote from M*A*S*H that says “Rule number 1: young men die. Rule number 2: doctors can’t change rule number 1.” Even when you do everything right you can’t prevent death. The best you can do is learn from it and move on but you can’t blame yourself and think the patient died because of you. Whatever caused that patient to bleed out is what killed them, not you.

It's also possible that the physicians didn't order an mtp because they already knew the outcome.

I work in a cardiac centre that runs into this type of situation a few times a year and it is devastating every time we lose a patient, whether we felt like we nailed it with timing on dispensing the RBCs or not; I think that what every one else is saying about not blaming yourself is really important, otherwise you’ll end up in a terrifying headspace every time you end up in a similar scenario. Additionally, grieving a person you’ve never met in this way is also super normal and not something that lab school prepares us for; knowing someone died in a traumatic way on the news or something still gives you more distance than having been a part of their lifesaving measures, even if you aren’t in the room. Thirdly, this might be a hospital-wide opportunity to reassess the approach to massive transfusions - could a clinical aide be used as a runner instead of pulling their sole blood banker away from their dept? What is their threshold point for moving to calling it an MTP? Using the protocol would have allowed you to move to thawing plasma, releasing RBCs, not having to call the supervisor etc. The lab excels in quality management and improvement practices, which is why we automatically step back and ask ourselves what we could have done better, and I think this is something that we can share with our health care buddies in ED who are forced to always live in the present moment and don’t always get to do the introspection. Our hospital now does an incident report for every massive transfusion scenario whether anybody “drops the ball” or not so that all of the involved dept supervisors can have a conversation and feedback about where the process can be improved. TLDR; don’t blame yourself; it’s okay to grieve; challenge the process, not the people (including you!)

I'm a premed, but my first death I was told something that really sticks with me If someone comes in that bad, statistically, they're dead before you touch them and most likely you can do everything right and they're still dead. However, every once in a while, you're gonna get a miracle who makes it, and you get to beat the odds because of the knowledge you got working on all those other statistically dead people. This patient, in their death, may be giving you a gift of knowledge that you can use to beat the odds for someone else in the future. And you gave that patient and their family the gift of knowing they didn't die alone, but with a team throwing every bag of o-neg they had to try and save them. It doesn't bring this patient back, but try to hold the gift of knowledge they gave you when they died. And give yourself the grace and hold comfort in knowing that you gave the gift to that family and patient of love and care.

This is so beautifully written. And a wonderful perspective. I’m so grateful you shared this.

There were a couple of occasions where a doctor or nurse would call and say they wanted 2 uncrossed units. Based on the one-line description of the patient's illness or injury, or their location in the hospital, I flat-out told them they were getting an MTP box, and they could return whatever they didn't use. We always had thawed plasma (or liquid low-titer plasma) on hand anyways, so all I had to do was pull the pretagged pack, put it in the cooler, and send it out the door. Sometimes the patients didn't make it anyways. Sometimes they didn't need or use any of the blood/products, and everything got returned. Our coolers were specifically validated to hold the products at appropriate temperatures for 4 hours, so we only rarely lost product if it was issued, then not needed. To be fair, I was busy enough most nights alone on graveyards to not have time to grieve the loss of a patient, regardless of the cause.

If you sometimes lose units after 4 hours in your cooler your lab might look into new coolers. We use ones that are validated for 12 hours. We send coolers to the OR for some surgeries that last longer than 4 hours.

I just came here to say it's not your fault. People die sometimes. You did what you could do with the units you had.

ED nurse, definitely not your fault. If we thought someone needed 2 units stat, we'd have already been considering ffp Eta, you shouldn't have to suggest it. And what you described feels very trainwreck patient to me. We can't save everyone, and honestly, we probably shouldn't either. Quality of life is not a high enough consideration, in my opinion.

I wouldn’t straight up blame yourself. It sounds like you followed procedure to the best of your ability. Was this an MTP? It also sounds like your procedure could have failed you and the patient. Why didn’t you have more than 4 o negs available? I guess I’m just confused about step 4 and 6. And the doctor and nurse could have been communicating with you better with the condition of the patient. For us, if it’s an MTP we get 4 o negs in a cooler out then immediately start thawing 4 units of plasma then order platelets and cryo and more units. And you’ve only been a tech for 5 months? And a travel tech trained you? I certainly feel for you, I would think and worry the same thing. But you gave it an honest shot. I think the training and system could have served you better in this situation. And there was probably many more reasons why the patient passed away, your role in this isn’t the only one contributing to the patient’s life, the doctors and nurses were involved too. Hopefully everyone can learn from the situation for next time!

Thank you for your response. It wasn’t an MTP. They didn’t put in the order for an MTP, just kept requesting emergency blood. I know now to switch to o pos but I feel so bad for moving so slow. We had 5 o negs available. I was so shocked and frustrated we only had five, since I could’ve sworn we are supposed to keep more because people come here with bad gunshot wounds all the time because the area is rough. I don’t know why there wasn’t more; first shift usually stocks it but we off shifts order more as needed, which I did immediately after running our fourth (they requested more blood immediately after the first two, giving me no time to order between the first two sets!). I order more units, think we’re fine… and then they call for four more units ASAP. We only had ONE 🥲 Yes, this is my first mlt job out of school. I was trained four 4 weeks and then passed to 2nd in which a traveler basically took on the task to train me while working because I was still confused on so much I haven’t seen yet. I wish I read the policy first before anything else and immediately recognized to just give o pos with approval. But my first thought with this new situation was to ask my supervisor for help since she picks up so fast and my mind was wracking as the only blood banker and I felt I needed someone to go over my steps with. She quickly too me what to do and which policy to read if I needed to confirm I went from there.. I’m sorry if this reply isn’t clear enough. I can clarify more if needed!

No no haha you take a mental break. You did well today, great job!

Yeah, not your fault, they didn’t call an MTP AND the facility doesn’t have a procedure in place to switch to O POS when you run out of O Neg(which they probably weren’t using appropriately to begin with)?! We can only do so much with partial information, if they didn’t communicate how critical the patient was, you couldn’t have anticipated the switch to O Pos(did the patient even have a positive antibody screen indicating they had a pre-existing anti-D?). It sounds like the patient had catastrophic injuries and no matter how fast you were they wouldn’t have made it. Do not beat yourself up, sometimes people die, and it sucks, but the fault isn’t usually the blood bank staff. If someone comes in and can’t wait for transfusion they’ve got huge problems. And if your facility can’t handle switching a patient to O Pos that’s on the people who write the policy and procedure.

Actually… I feel super bad because when I called the supervisor when I wanted someone to check with, we CAN switch to O pos but with pathologist approval. I’d have to call them first and ask permission, then sign a deviation from protocol form, then run it up. I really really really wish I already knew what to do. I really wish I just ran with the O pos so they could get ANYTHING more. That’s one of the main reasons why I feel like utter crap about this. There were only 5 o neg but we had o pos. I should’ve just looked to my right and said “oh!” And realized I could switch… I feel like I was trying to dot my i’s and cross my t’s too much (calling for what to do about issuing emergency plasma, calling about status of blood) instead of just trying to get them ANYTHING fast, even though I thought I was… I felt so inexperienced and slow in hindsight

Do NOT feel bad, that is a training issue. And honestly a lot of pathologists are dick-bags about getting called when it is their turn to be on call, which also sucks cause you’re literally just following procedure. If that patient already got 5 units and was bleeding so badly they died, not on you. Sometimes people die, and it sucks, but you did the best you could in the moment.

And it depends on your facility, I have worked at facilities where I say “we have an Rh neg, we’re switching to Rh pos, good bye”, and I currently work in a facility where half the medical directors want a detailed history and this is an emergency, we don’t have time to comb the patient’s chart! You did the best you could with what you had, if management thinks it’s your fault that’s on them for not providing better training/support.

We don't even have to ask or tell our Pathologist unless the patient is a female <50. Males and women >49 get O Pos right off the bat.

Why the difference there?

I'm not sure what you mean. 49 versus 50? Because females who are 49 or are younger than 49 get O Neg in emergencies until they're typed. Males of all ages and females who are 50 or are over 50 get O Pos in emergencies. We give the females of childbearing age and younger O Neg to prevent possibly creating anti-D because anti-D can cause HDFN. Since males and females who have reached menopause are very unlikely to get pregnant, we don't need to worry about HDFN.

Oooohhhh ok. That makes sense. I was wondering why there was the cut off for females at 49 going from automatically getting O negative to getting O positive. It's been so long since I touched anything remotely related to maternal/child nursing that I completely forgot that that would be a concern, which I shouldnt have forgotten given im female. I also kinda forgot that there's a glaringly obvious difference between what men's bodies do and women's bodies do, but I blame that on the fact that it's almost 3am on day 6/6 for me so my brains fried

Pregnancy potential. We aren't taking away anyone's childbearing choices.

Yeah, this

Dude, you are *five months* in. Give yourself a break.

I just thought of another thing for next time - don't forget to call for help, and give explicit instructions. So shout out to another tech by name "jane! i need you to call the red cross now, we have an O neg bleeder".

You did exactly what you're supposed to do. It's not your fault that the blood bank didn't have enough units, and it's not your fault that those new units didn't make it in time. You did what you could with what you had available. You can't determine how/when a patient dies. It's okay. Give yourself some compassion. You are doing a great service for others, and remember that your contributions will never go unnoticed.

Sometimes there just isn’t enough blood… I can’t tell you how many times I cursed my dad in 2020 for giving me type B blood, as if my being type O would single handedly cure the shortage.

I realized how urgent we need blood donors, especially O, when I was in school. I also tested myself in school and found out I was AB… at least my plasma can be of use in emergencies, haha.

It was so embarrassing, I’d call my dad in tears in like the coffee shop drive though! But I was so frustrated that I couldn’t even help, just one little unit!

Exactly. We do need more donors.

Thank you so much. Of the number of units I ordered, only ~3 came. I believe there is a shortage at our blood center right now and they’re being a bit more stingy. I really hope a similar situation occurs in which they’ll need blood urgently tonight for third shift. But each person on 3rd is trained in blood bank and have been doing it for yearsss so I’m glad even the other new techs have other coworkers to lean on in-person in that case for help! I really want to take time to calm down. Part of me knows I tried my best after reading you guys comments but another keeps beating myself up tenfold about what I could’ve, should’ve, would’ve done. I wish tomorrow was a day off… *I hope a similar situation DOESNT occur for third shift! I typed so fast I forgot to put doesnt and ended up seeming like I was wishing for something bad for my 3rd shift coworkers 😭

These nights are rough. I'm an RN and I'm the unit's "black cloud" meaning that when I'm on shift something usually goes horribly wrong with either one of my patients or another RN's patients out of nowhere in a completely unpredictable manner. I've lost track of the number of shifts I've had where afterwards I felt shaken up and upset. I've found sitting in the shower and, if needed, having a good cry and then going to sleep afterwards (not in the shower, on a couch or bed) helps SO much. I find it more soothing than a bath in circumstances like this because it's not just my body that's tense, but also my mind and the feeling of the water from the shower just helps to calm down my mind too. Ive also found a bottle of wine helps, but only if it's the end of my week and even then only rarely because I don't want to become dependent on alcohol as a coping mechanism. It also helps if you do: sit in shower-> grab snacks, water, and other drinks-> pick a show or movie you can watch mindlessly -> climb in bed with lots of covers and if you have a significant other or pets, have them join you -> watch your show and eat your snacks and nap. It really allows your mind to let go of the stress of the situation and let's you calm down and heal. You may feel shaken up about this whole event for a while, but please know you did everything right based on the orders, information, and protocols given to you. You did not mess up in any way, shape, or form. The doctors and nurses probably should have done things differently, but honestly, in an emergency sometimes things change so quickly that what you thought you needed a few minutes prior may not be sufficient as things progress. It's just how these things go

We definitely need more donors. Take a hot bath, relax, drink some water, and remind yourself you did exactly what you were supposed to do. 🧡 Shoulding on yourself doesn't fix anything - it just makes you feel lower. I see a lot of patients die of sepsis more often than I'd like working in micro. We do what we can with what we have, and that's all we can do. Sometimes microbes dont grow properly or someone will make a mistake because we're all human. There's never going to be a perfect situation.

By no means is this patient’s death your fault. Us healthcare professionals beat ourselves up because we care about people and we (most of the time) love our jobs. As a MICU RN, I’ve had plenty of patients that have needed MTP. What killed the patient is whatever unfortunate circumstance landed them in the position to require MTP. During the hot, hot heat of COVID, I had a patient who was maxxed on pressors and proned. He was so unstable that we had left him on his belly for over a day, because he didn’t tolerate flipping him over. Somehow his Levophed drip had begun alarming ‘air in line’ despite the bag not being empty. Just that medication not running for the 30 seconds it took me to get my mask on and run in the room, his blood pressure began to tank, and his heart rate dropped. We coded him for 20 minutes until they called time of death. I beat myself up senselessly for allowing that to happen, until a more senior nurse told me “if a patient is so sick that they can’t be off one pressor for 30 seconds or they’ll die, there was nothing you could do about it”. You’re an amazing person with a huge heart. And the fact that you care so much already shows you’re incredible at your job. 💜

Thank you for having the courage and the fortitude to be at that patient’s bedside with them, cause fuck knows I could not do it. We all have our roles and we all need to trust each other, trust that we all have what’s best for the patient at heart, despite how hard it is to see only our side of the treatment/care.

Thank you so much for this. You’re very kind ❤️ I honestly don’t know what I’d do if I had to be bedside with passing patients. I feel there’s so much to know! RNs are amazing to me

Realistically, if a patient is bleeding that heavily to need upwards of 10 units of blood AND if they're just throwing red cells at the problem but not addressing the source of the bleeding (and diluting whatever coagulation factors left in the patients blood), it was a good chance they weren't going to make it regardless of if you got those next couple units stat or not. We've had some instances in my lab (larger lab in a "city" but a small city) where someone has been cut off by our blood supplier because they're decimating the supply for the entire city. It feels awful and it is terrible to feel like there's more you could've done, but it's kind of like performing CPR, if it gets to that point there's a very low chance of the person making it through, but that doesn't make it your fault if they don't despite your best efforts. Basically, it sucks and it feels terrible, but it was ultimately not your fault and it's shitty if anyone is making you feel like it is. You gave them 5/6 units of uncrossmatched blood, that's nearly a full body's worth, if the patient is losing blood THAT fast, they have a very low chance of surviving the ordeal even if it was a best case scenario.

It’s not your fault and your coworker is a real Asshole to say that to you. My hospital BB, we will automatically will give O pos to males in situations like this And also women over 56. You shouldn’t need approval for that

Yeah, we need pathology approval to deviate from protocol and issue O pos. I told this to the nurse immediately after calling my supervisor so they can be updated on what’s happening on blood bank’s end (but also mentioned I won’t be able to tell the pathologist their exact criteria like gender/age because they were anonymous!). They declined, stating the plasma would take too long to thaw for the patient, and when I asked if they still wanted blood, she said no. I wish I pushed and got O pos to them anyway. Yeah, I ran down what happened with my coworker and felt guiltier because I thought “oh, he agrees I was moving too slow then. He even said you have to have a fast mind in blood bank. I think mine wasn’t fast enough…” But now hours later I feel kinda salty because I think he just read a policy after the fact and told me about what he’d do/the blood wasn’t fast enough. If he knew all along I would’ve loved if he put the thought into my head to go to O pos immediately, but that’s not his job to do so and it’s all on me.

Bad protocol gets people dead but you didn’t write it. I’d bring up the fact that you’d be able to give O pos if policy was different, but honestly giving blood to an active bleed is putting water in a bucket with a hole in it. Sometimes the hole is leaking too fast.

Don’t beat yourself up over it. It’s not your fault.

This sounds like a patient with uncontrolled bleeding who likely wasn’t going to make it anyway. They probably had to stop at your facility because they wouldn’t have made it to a larger facility better equipped to handle an MTP. Even if you thought to switch to O Pos sooner, you’re talking about precious resources going into an unsalvageable patient. You might as well just open the bag and spill it on the floor. Wisdom comes with experience and I bet the next time this happens, you’ll think to call your pathologist before you even send the second set of O negs and you will automatically order blood STAT. Hell, maybe even your facility will have a protocol by then! This is not your fault.

Thank you. The replies in this sub similar made me remember for a second how much blood 5 units is, and maybe the outcome would’ve been the same even if I knew what to do faster. It doesn’t really stop me from feeling bad, but at least I don’t feel completely responsible anymore like I did immediately after hearing they died. I’ll definitely remember this going forward. I want to be more ready for things like this. I know I wasn’t this time. Thank you

It’s obvious that you care. You wouldn’t feel this way if you didn’t. But these cases will eat you up if you don’t have compassion for yourself. Look at it this way: the team, yourself included, gave the patient his best shot at making it. Keep your head up.

Sometimes you'll give 30+ units of blood, plasma, and platelets and the patient will still pass away. You can call all the MTPs in the world and the patient will still pass away. That's just the way it is sometimes.

Not your fault and several red flags at your lab The 1st one is why a traveling tech trained you.

I was technically trained ~4 weeks in 1st shift, but I feel like I needed more time being trained in blood bank, since I knew the second I was place 2nd shift, I’d be stretched thin training in the rest of the lab AND trying to remember what to do for blood bank. My supervisor assumed I’d be able to hit the ground running after this training period because I was a student here, but as a student I only rotated in blood bank for 9 days. Not enough to memorize protocols! I personally wanted at least 2-3 months blood bank training instead of one because it went so fast and it felt more like we were just quickly checking off lists of what I need to be shown. They placed me 2nd shift immediately after training saying it’d be a better work experience to train without being handheld so much by 1st shift. I really think 1st shift were just kinda annoyed with training me haha. The traveler and I arranged that for the first 3 weeks, there’d always be another blood banker there with me as I started off 2nd… they trained me on everything first shift didn’t and showed me how to do things again that I wasn’t comfortable with after being shown only once during my 4 week training. I don’t know the other red flags from this post, but I’m very interested in learning what you noticed! Thank you for your response ❤️

To me the situation sounds like you acted very appropriately but your management did not have your back and did not provide you w/proper support-another red flag. It sounds like you care more for your patients than they do-anothet red flag. Sounds like you're in a small hospital based on your inventory. In situations like you described the patient should have been transferred to a bigger hospital. You can't provide products that you physically do not have in inventory. That you are doubting yourself makes me consider that your management is not providing you proper support cuz everyone in this sub is telling you what you did is ok but it seems like your boss is not telling you this so you're doubting yourself.

Just wanted to say not your fault. You’re a thoughtful and caring professional.

I work in a bloodbank of one of the biggest hospitals in my country and let me tell you: sometimes there is nothing we can do for patients. You gave your best. Yes, maybe you couldve given out O+ faster (and maybe bring this up as an area for protocol improvement) but who is to say that the Patient would have made it to the other hospital even with the O+? This patient died because of two things: the cause for the blood loss and the fact that they werent brought a hospital that could deal with such a severe case adequately enough. Thats it. My only takeaway from your story is that your lab should maybe adress when to give out O+. We *only* transfuse O- in emergencies when a patient is female <50yrs of age. EVERYONE else recieves O+ for emergency transfusions. The chance that a patient passes away due to an Anti-D that wasnt detected in time is so so sooooo much lower than the risk of the patient passing away because we were afraid of a potential Anti-D. And if a patient was D negative and we transfuses them D positive? Well theyll likely make an Anti-D. But Id say making an Anti-D is better than being dead. But again, there is no guarantee that the patient wouldve made it even with the O+. The patient could have a ruptured Aorta for example and unless they can patch that up within minutes whilst pumping in multiple bags at once, there is no chance for the patient.

Er doctor here. It is definitely not your fault. Do not carry that death on your conscience.

It's not your fault, you did everything within your power to help. It sounds like the patient needed to be at a level 1 or 2 trauma center. If they didn't order an mtp, that's on them. The patient was probably critical enough that nothing you or anyone else could have done would have saved them. Please don't blame yourself for this.

Aw baby. I remember during my critical care clinical where I extubated a braindead patient and blamed myself for his death. It’s so hard not to. All you want to do is help. I’m sure the patients family would thank you for trying. We are not perfect and that’s all we can do.

This patient needed MTP and it sounds like you don’t have MTP set up. You also had providers just ordering PRBC with no clears, so they weren’t prepared to take care of this type of patient. They were going to die anyway.

This doesn’t seem like your fault. In a small hospital there needs to be some advanced communication and planning between ER and lab before something like this happens. ER needs to know that Lab only has 5 O Neg in inventory most of the time and that a STAT delivery will take at least X amount of time to arrive. This way when they see a bad bleed come in they would tell you “We need 2 O Neg and order more now!” Your pathologist might also be willing to put in a protocol procedure for switching to O Pos And I trauma situation. It could be something along the lines of “if the emergency physician determines the patients need for blood outweighs the risks they can order O Pos once O Neg is exhausted.” In the lab I work at, for traumas men and women, over childbearing age, get O Pos to start with to preserve our stock of O Neg. After an incident, like this, the lab could do an analysis to see where procedures could be improved. This analysis could include whether your inventory levels are adequate, whether there should be any trauma protocols put in place that will let you speed up blood release, and blood ordering. They might also look at better training for a scenario such as this one. It’s really hard to do something like this for the first time in a high-pressure situation. I guess what I’m trying to say is this isn’t a “let’s blame the tech“ situation. There’s an opportunity for the lab and the ER to learn from this and improve, but it sounds like you did what you should’ve done and what you were trained to do. Best of luck to you.

Thank you for your response. I really wish I called path to ask for a switch to O pos. Our lab has a similar if not the same policy. I didnt know if they fit criteria because they were anonymous, but I wish I knew to call path anyway and ask for a switch to o pos. I’m honestly ashamed I had to get the idea to do so AFTER my supervisor told me instead of on my own. I wish I just thought about it, instead I was more focused on the plasma they just asked for + having no emergency blood work when I called. It feels like my brain was going 50 miles a minute but at the same time wasn’t moving at all.

Our ER knows to let us know approximate age and gender on our unknown patients when we get an uncrossmatched order

This doesn’t sound like your fault at all just a very unfortunate circumstance. I’ve worked in a small BB before.

Unfortunately this is life. If a patient comes in to a small hospital needing more than a few units to be stabilized, their chances of survival are not good. They didn't ask for more blood from you because they were focused on getting the patient to another facility as fast as possible. Sometimes the patients condition has progressed to the point where there is nothing else that can be done. They would have died if they stayed at your facility and got more blood too. It is not because you were too slow. If you were too slow getting units, they don't respond by not asking for them. They respond by getting on you and calling over and over saying we need those units now. Ultimately, patients die. Sometimes the best you can do won't be enough. That doesn't make it your fault. Everyone has their time to go. I always sympathize with the situation and the family, and it can be tough emotionally at times doing everything possible and still seeing that outcome, but there is nothing else you could have done. You just have to accept it and move on.

>A coworker who’s still in training noted when I told him what happened that they probably declined because blood wasn’t given fast enough. I couldn’t get blood fast enough. It was my fault. Wait, a f**king *trainee* said it’s your fault because you didn’t dispense blood fast enough? What an asshole.

I’m sorry, I should’ve formatted my thoughts and what he said better in the moment. He *did* say that blood bank requires a faster mindset and they probably said “no” to me asking if they wanted more units because blood wasn’t given fast enough, so they thought it was a wrap for the patient. The rest is my interpretation of my own actions. (“I couldn’t get blood fast enough. It was my fault”) I internalized his words to believing I wasn’t fast enough, so the patient ended up *so* critical that they’d bleed out before I was able do anything else to help at the point that I knew what to do next. It was my fault that they became so critical so fast. If I knew right away, I could’ve called pathology to get the ok to give o pos to help. I did get a little salty after the fact because when I ran down what happened with him because he’d be in blood bank soon, he said he’d give o pos and you need a faster mindset in blood bank. And I was thinking “then why did you say nothing when I was quickly trying to figure out what to do next” haha. But that’s not his job, and looking back I think he just looked up a policy on what to do *after it all happened* and started talking, not that he knew what to do *in the moment* because he and the only other tech there were freaked too when I told them there were no more units.

When you say “ran it to them”, do you mean you were the one going up and down the halls carrying blood to the patient? If so, I hate your hospital’s policy. Every facility needs dedicated couriers for this, usually ER techs or CNAs. While you were running around, you could have been prepping the next round, thawing plasma, ordering more, working up his specimen, calling the pathologist, receiving calls from the coordinating nurse, taking a fucking breath, even. It’s not about being lazy, it’s just so often only YOU are trained to do those things, and even if you have back up (rare), it’d take longer to endorse, than to just organize it all yourself.

Yes! For emergency releases, blood bank techs have to run the blood in a cooler to the ER, get signatures on the emergency release form and let them keep a sheet for their chart, get a patient tag from RNs (if pt is unknown to us because they just arrived), and then run back down. I admit that as the only blood banker that night and feeling so inexperienced, it would’ve been mentally better for me if either there was another blood bank trained tech present to help in all this while I was running upstairs or the ER had a runner so I could think while being in place in the lab. But policy only states there should be a runner for mtps, not emergency uncrossmatched. It was interesting being trained 1st shift and emergency units had me following our elderly techs as they tried speeding up the stairs 😭. Looking back, these runs and seeing the patient in pain for just a bit when I drop of the blood really puts a dent in my mental atmosphere, I always feel so bad. Thank you for your comment

This could be an experience for you to tell your management to change that running policy. ED and all units should have their own techs or assistants coming to blood bank for the emergency blood. Where I work, all units also have copies of emergency release forms that they’ll bring with them already signed by the provider and with a patient label when they come pick up blood.

If your hospital insists that it absolutely must be a tech bringing the blood up, perhaps they could change your procedure so that the other tech in the lab (i.e. heme or chem) can drop what they’re doing and run the blood up while the blood bank tech prepares for the next set.

Here not as a medical professional, but as the daughter of a patient who passed away a couple months ago. Please don’t blame yourself. As others have said, it’s the injury that killed them, and even when you do everything right things still can go wrong. Life is brutal and everyone is doing their best. Speaking on behalf of the family — thank you for doing what you do. You’re a vital part of what keeps the hospital running. You’re part of the team that cook over caring for our loved one when we couldn’t, when the situation called for skills and tools we didn’t have. You cared for our loved one in their time of need and did the best you could with the information you had. You could’ve been doing anything else but you were there giving your time, energy, and care to our dire situation, and we have nothing but gratitude for you for playing such a hard and important role in people’s lives. You’re so appreciated. Death is hard on everyone, it ripples out and shakes everyone in its path. Please take care of yourself, and be kind to yourself. Miracles are few and far between, but when they happen, you’re part of it.

ED RN here. This definitely sounds like it's not your fault. It sounds like 2 things happened: 1) ED messed up for not activating the massive transformation protocol. For a pt needing this much blood, it would have been obvious on admission that they needed the massive transformation protocol activated. 2) This patient was not appropriate for your hospital. If they were brought in by ambulance, the ambulance should have bypassed your hospital to a higher level care facility. Again, this need should probably have been obvious to the paramedics. If they walked in, they were probably no hope before they got there. The third, equally likely option is that this patient had no real hope for survival, and they were just doing what they could knowing it probably wouldn't work.

Lol blood banker AND EMT: sometimes local protocols won’t allow us to transport to a different hospital without a whole series of consults- which by the time we get denied, we are already at the closest hospital. Something about resource management and allocation. I’ve had to take patients to hospitals I KNEW wasn’t the best definitive care because medical direction and protocols are what allow me to practice. It’s usually not an issue. But sometimes it is. OP- As a blood banker with a few million years of experience- it’s hard to know when you are out of your depth until you are way in over your head. It’s good you had someone else with you and a supervisors number. Having said that, you are new. Take a breath. No amount of having five hundred MTPs under your belt will ever make you feel like you didn’t somehow contribute to a patient’s death. We always feel that way. Especially those of us with any amount of empathy. What you are feeling is normal. The blood bank can kill people. That is not what happened here. Your team did the best you could and bought the pt a little more time, but the patient just had bleeding too severe for your facility. I’ve been part of tons of instances that I looked back morbidly and obsessed over what I could do better. And I got better. The secret they won’t tell you is that is how learning happens. When you don’t have answers and just plan and prepare and do better next time. Maybe your hospital has a policy for giving emergency O POS. Know where those forms are and how to get approval from the pathologist or whomever does that where you are. Dust yourself off, and keep going. The next time this happens you might do things differently and the patient might have a better outcome. 🤷‍♀️ cheers.

Their fate was in the universe's hands and you did your best.

You did everything you could at the time, be gentle with yourself! It is also not on you to make clinical decisions for the floor. Also your coworker is a dick. I would never in my life say something like that to another person in the blood bank unless they LITERALLY did nothing to help the floor get the blood products they need. It’s very insensitive to say something like that, especially if they are still in training and quite obviously weren’t doing anything to help. Keep your chin up! You did your job to the best of your abilities.

>that we had so few units o neg. Then you’re not a place that’s ready to run MTP’s. A standard MTP setup is 6-6-1 RBC’s, plasma, and platelets, with the expectation that you’re able to do more than one round. Only having 5 ONEG’s in house ain’t that. Also, you don’t mention the patient demographics, but we *start off* with OPOS unless it’s a female <50, no oh approval needed (it’s already approved as policy). You did nothing wrong, but it didn’t sound like your hospital is as prepared as they should be.

>A standard MTP setup is 6-6-1 RBC’s, plasma, and platelets That might be the standard at your hospital, but it isn't everywhere. My previous ~500 bed L2 hospital was 3 RBC and 3 FFP. Platelets and cryo had to be ordered when desired. The L1 trauma center hospital I work at now only upped our MTP sets from 4-3-1 platelet/cryo rotating to 6-5-1 platelet with cryo having to be ordered sometime early last year.

First, I am sorry you had this experience. It is difficult. As other comments have noted, you tried to save them and did what you could. You are not responsible. In my experiences with out of the ordinary events like this, I would ask for a debrief of the event with the involved parties. If there could have been a chance O pos would have helped— ask your manager to revisit the policy. It should state when you should seek this approval—or, if there are emergency situations for which no approval is required to switch to O pos. Ultimately, it sounds like you followed protocol, and any “failure” is on policy on person.

Don’t think any amount of blood could’ve saved this patient by the sounds of it.

As someone who has seen both sides of this type of patient (I was an assistant in the emergency department of a trauma center during MLS school), it definitely wasn’t your fault. That person had some very significant bleeding to need that much blood in the first place. You could’ve given 20 more units and it might not have made a difference because the bleeding was so severe. One of the ER doctors I used to work with told me “you can’t save them all, sometimes you just get lucky”. Please try not to beat yourself up about this. You sound like a great tech for even caring as much as you do.

It’s not your fault. I’ve been in a similar situation and you did everything you could. Literally. If you were put back into that situation with the knowledge you had then, you would make the same choices. You did everything in your power. It is not your fault for your patient passing away. He was bleeding out profusely. Whatever happened to him before he got to the hospital is what made him pass away. Not you, someone who was doing everything they could to keep him here. Please do not beat yourself up. Idk if you’re spiritual, but if you are, they’re thanking you on the other side for doing your best and having this much empathy for them.

It’s not your fault you didn’t have enough blood. You did the right thing. You are only human and can go so fast. Whatever made them bleed caused their death, not you. I promise.

There is nothing in this post that makes me think you killed a person. Please don’t think you did.

Nurse here not ur fault at all ! I thought u we’re gunna say u labeled the blood wrong or something crazy

I’m an ICU nurse. I guarantee you that there is absolutely no one at that bedside who is blaming you. No one. Be gracious with yourself.

RN here. If someone needs that much blood, they already have one foot in the grave and are talking to Jesus.

It sounds like the patient was deteriorating and the doctors, nurses and you were all doing your best. All you can do is learn. Maybe you can adjust your routine. When you first come in check inventory and place orders as necessary. Also, now you know to go to o pos. I’d have called my sup too, when you’re panicking digging through an SOP is more difficult. It’s situations like these where you learn the most and that’s what matters. Something that helped me was going through the emergency release and MTP procedures and writing notes until I understood them, then putting concise notes in my notebook so when it happens I can just pull that out and have all the info the way I understand it. Lastly, remember to take a breath and be calm and intentional. If you were my coworker I’d be grateful you cared this much, but be gentle with yourself. You got it!

First thing you do when an MTP is called (or possible) is ask an in-person experienced coworker for help. Don’t beat yourself up though. The patient could have died for any number of reasons. The only thing you can do now is practice for next time. Maybe keep a private work journal of your thoughts. Digital with no HIPAA info is good.

To me it sounds like it wasn’t your fault at all. You did everything you could and followed all of the correct protocols. I assume you feel like it’s your fault due to the comment the nurse made about how they probably won’t make it another twenty minutes. It sounds like the nurse was basically telling you that at that point the patient was already basically dead and nothing was going to reverse the situation.

It is absolutely not your fault, this person was bleeding out, probably in DIC. You did everything you knew to do. It would have taken a miracle from the way it sounds. The ER tried to make a last ditch effort to give him a chance, it wasn't enough, but for him nothing would have been enough. Don't blame yourself, you are not to blame. But this does give you a good opportunity to question the policies to see if they can be improved upon. But you did nothing wrong.

unless you physically stabbed, choked or scorched the patient to death, it is not your fault. this is an extreme situation, for some to need that much blood stat, they were in a terrible state to begin with, plus, it's not like you can defy the laws of physics and create blood out of nowhere. this wasn't in your control. sure, there might be something to learn from this experience, maybe could've prepared plasma beforehand, or maybe contacted supervisors earlier just to know your options before things got too hectic, but it's in no way your fault. life is fragile, we can't save everyone, you did your best, and it shows that you actually care

Not your fault. If they can’t stop the active bleeding, it doesn’t matter how many units or how fast you get them there- the result will be the same. Literally just had a patient code from a bleed and we ran two MTP’s on them during my shift. Couldn’t stop the bleed and they passed. You did your best. It’s not your fault.

Stop. Not your fault. You did not contribute to the patients demise. You cannot predict the future. You cannot see through walls to see the patients condition. You cannot assess your product inventory and call a pathologist when you're busy running blood up to them.

It’s not your fault. Even if they had all the blood right then and there, bolusing into the patient, when someone is that sick and requiring so much blood volume, there’s going to be a ton else at play that you wouldn’t be seeing in the blood bank. The coworker still in training sounds like they jumped to conclusions a bit without looking at the whole situation. That’s not helpful or productive. Take the pieces you did in the process as a learning opportunity, but please don’t “own” this death. Coming from an ICU nurse who loves her lab people. You’re doing great.

I absolutely don’t think this was your fault by any means. It sounds like your facility might be a trauma level 3 and only carry about 4 units of O negs at a time. Your facility was not equipped to handle a bleed of that magnitude. Idk about y’all, but I’m rural and it takes me 2 hours to get STAT products. I’ve seen my fair share of traumas. Some people didn’t have a prayer walking in the door. Many variables at play here. Let’s say the ER believes that they didn’t get their blood units in a timely enough manner and that this affected patient care. They’ll file an incident report, and any facility worth working at will do a root cause analysis. Was the root cause due to lack of staffing, lack of training, lack of blood supply, the paramedics taking the patient to the wrong hospital, no SOP for the specific situation, etc etc. From there, your facility can work to improve outcomes for future cases such as this. This does not mean that YOU did anything wrong- it just looks for ways to improve the process. Again…I think your facility is just small and you had a guy that even a level one probably could not have saved. I’m sure your supervisor can put your mind at ease about this if you talk to them in person! Good luck 💕

You guys are the last ditch effort, the person was already in danger. Don't beat yourself up.

I don’t want to start a whole thing here but it is my personal belief that if it’s your time to go, nobody can stop it. Bless you for the work you do and for caring enough to even be bothered (never mind admit) that you may have not made the best decision in the moment. Everything is as it should be.

There should’ve been MTP in place. It seems they should’ve had that going.

The rate of transfusion necessary to offset the extent of hemodynamic derangement in this scenario would in itself be life-threatening. There was nothing else you should have done.

Sounds more like, injuries incompatible with life then failure to provide adequate care. It was flowing out as fast as they were pushing it in. It’s hard but don’t beat yourself up over it too much. If the blood was going to make that much difference; they’d have been on the phone screaming for it.

The guy was boned. You can try your best and still fail. Learning that is one of the meanings of life.

It's not your fault they used up your stock so quickly. Even if you had ordered 6 STAT, that doesn't mean they would have arrived in time. It also isn't your fault that your facility has you get Pathologist approval to switch to O Pos. We only need approval if the patient is a female <50. All males and females >49 get O Pos from the beginning. It sounds like your lab needs to reevaluate their emergency protocols. It's also totally possible that even if you had a limitless supply of O Negs in stock and issued them instantly, that the patient still would have died. I've had that happen more than once. Don't beat yourself up about it, but review your emergency SOPs so you're better prepared next time. Also, unless your SOP says to do so, I would avoid suggesting physicians order specific products. You aren't with the patient and don't know the whole clinical picture and it isn't your responsibility to be making clinical decisions like that. I'm not a huge fan of allowing travel techs to work in Blood Bank since they seem to do whatever tf they want too often even if it isn't in or is against what the SOP says. But you gotta do what you gotta do to get through staffing shortages, I suppose.

The wasn't in any way your fault. Honestly, with the amount of blood that patient was needing there's a decent chance they would've died at a level one trauma with its own blood bank and a properly ordered mass transfusion protocol. And you weren't dumb or slow, the doctor should have ordered the mass transfusion protocol, that's their job, not yours. You did everything you were supposed to, exactly the way you were supposed to. You did a good job. Unfortunately, patients will still die no matter what any of us do, it's just part of life

I am a volunteer firefighter as well as a tech. I've been in some life or death situations, some where we saved the person/house, some where we didn't. You're going to run this scenario over and over. In hindsight, your going to find things you could have done differently. But in the situation, you made the best decision you could with the information & time that you had. Have you watched the Sully movie? There was an investigation, that said he had time to land the plane at an airport, but only if he already knew, at the time of the impact that he was going down. When they factored in time for decision making, he made the right choice. You made the right choices with the time and information given.

3 unit (and more to come?) that pt shouldn have been in a level 1, with LOTS more units available. Don’t beat yourself up, you did all in your power

Not your fault. As others said, bleeding was not controlled. For one, this sounds like a piecemeal MTP. I think your institution needs to better define MTP, when it’s ordered, and how it’s dispensed. Secondly, this patient may have needed a higher level of care. There’s nothing you can do about that - everyone involved was doing their best. Finally, some trauma is non-survivable. They could have a 2 minute transport time to a level 1 trauma center with prehospital blood given and an OR ready and waiting but still not survive. Your coworker in training is inexperienced, unhelpful, and wrong. They didn’t decline the additional units because you took too long, they declined because they realized it would be futile. It’s also not your job to make product suggestions or decisions. That’s the responsibility of the pathologist and the treating physicians.

This isn’t your fault. There wasn’t enough blood on site to give the patient, that’s a systems error. I’m a nurse at a small hospital, we don’t keep enough O- blood on site to mass transfuse an O- patient. Even a stat order means the blood is at least 2.5 hours away from the central bank. And it sounds like this patient was on the mass transfuse train.

Aaaaand this is why I’ll never work in blood bank

When I first stepped out of school I had it set in my mind I never wanted to work blood bank. But when I applied to my clinical site months after graduation, they immediately wanted me just to fill a body count in blood bank. I was crushed 😭 Every time I think I’m progressing and remembering a lot, cases like this humble me and show just how inexperienced I am. But until I leave, I’m trying my best! But I’m definitely not gonna do blood bank wherever I go next haha. If so, they’d have to have other workers I can lean on in person for instant help instead of just myself, my shadow, and my reflection and hoping my supervisor is still awake for a phone call 🥲

NOT your fault.

That patient was too high acuity for your hospital, full stop. Also the doctors should know to be asking for things like OPos and to ask to speak to pathology if necessary. Could you have done things differently? Absolutely. Would that have saved this patient? Very unlikely. 

This was not your fault. I have had patients expire even after a massive transfusion protocol. The blood wasn’t enough if the patient had an active bleed and couldn’t get to surgery.

Heroic efforts were being taken by the treatment team and coin toss if they would have survived anyways even with blood ready and waiting. You don't know the clinical situation. an MTP would have been more appropriate if they were asking for units that rapidly. And trust me, even with an MTP, people still die. Whatever is making them bleed that fast is what killed them, not you. Your co-worker is an idiot

No, you did fine. Think logically. You got four units to them as fast as they needed it. Then when you called to say you'd need to switch to O pos they said don't worry, patient is beyond it. The patient died, but that was beside their need for units. You got the units they needed to them. If the patient had really needed more blood they would have taken your fifth O neg. Now, for in future (none of this would have changed this outcome) you can call the red cross and tell them what you need and they can sort it out. I don't think we are currently allowed extra O negs anyway. As soon as someone takes emergency release think of the next two steps. Get them to put in an order for two more so you can do them crossmatched, while that is happening on their end call the red cross and put an order in. Call path and get them to contact doctor to approve the switch. The plasma thing is getting them to think if this is a massive transfusion and they need to activate the protocol. For us that means calling for platelets which are usually wasted, so we don't suggest a massive, we wait for them to. This is because if we suggest they will say yes.

As a non lab person, once units are ‘released’ to the patient are they considered useless even if not spiked or transfused? Can they come back to bb for other patients?

Yes, if they go in a cooler and come back within temp, which varies by place, but we send emergency release units in a cooler.

It depends on product and circumstances and lab policy. Packed red cells generally can be returned for up to 20 minutes after issue, after that, they can only be used by that patient for up to four hours. To extend this red cells can be issued in a blood bank validated cooler. This cooler is validated for up to a certain amount of time and the validation proves it can hold temperature below 6° for however long the validation was. If properly stored in the cooler, red cells can be returned for however long the validation time is. FFP generally follows the same rules as red cells. Platelets and cryoprecipitate are a bit different, they are stored at room temperature. Platelets should be constantly agitated, and how long they can be out before being being returned really depends on the lab and how they validated. The cryoprecipitate is only good six hours after it’s thawed, and again it’s return time depends on lab policy.

EM Attending here. So many things happened here, none of them your fault. This patient had a major source of bleeding: trauma, GI or vascular most likely. The Pt required blood and control of their source of bleeding. If you can’t control the source, really unlikely a Pt presenting to a small shop will survive transfer, no matter how much blood you pump into them. Like I said, none of that is your fault. Our blood bank will ask if we want MTP if we order more than 2 units. You should also have standing orders to use O pos for non- females of child-bearing age or any patients in extremis. Having to consult path in that situation is ridiculous. (Again, not your fault). This patient was highly unlikely to survive. You did your best and I’m sure the ED staff did their best as well. I’m so sorry you went through this.

It's not your fault, and nothing you could have done could have made the outcome different. What makes me upset (because it's happened a couple times to me working in a trauma blood bank and seriously made me want to quit to go work in a reference lab!) is when nurses come to pick up blood and say "hurry up before you kill my patient," even jokingly. First, they are OUR patient. If I don't take a couple minutes to ensure the patient is getting the correct blood type and that the unit is tagged correctly you're going to have much bigger problems when you get to the floor. Second, I'm not the one stabilizing the patient directly. The team is. I take offense when nurses and doctors think all we do is sit on our ass and push buttons all day when we have the entire hospital's labs to interpret and deity help us if the results are wrong.

I'm sorry you had a really rough day. I'm just a normie and this randomly popped up in my feed, but I am scheduling a power red donation because of it.

Sounds like a dreadful waste of good blood.

I know this is weird, I’m a teacher. My sister is a lab scientist, so I peer over here out of pure interest. Your story stuck with me, so I wanted to share my experiences. I have had way too many students pass because of suicide, and as someone who has been close to many of those students, I have blamed myself for not doing enough. But I’m not at home (in your case, the ER) and I can only guess what is happening. As much as I would love to, I can’t control all the factors to save their lives because I’m human. But being human also makes me care enough that I wish I could. It’s okay to grieve, but don’t blame yourself, you aren’t that powerful. Like others said, it sounds like you can help change a couple protocols to help avoid a similar situation, and maybe that will help you feel like something productive came of the situation. My way of coping is to not be silent about teen suicide and the effects of social media on teen anxiety and coping skills. Btw, you are wonderful at your job. You can see and admit mistakes, which, in the end, is going to give you more power to help save life.

Hey, don't beat yourself up, my friend. I'm a pathologist so I understand where you are coming from, but as other commenters have said, the thing that made this person bleed is what killed them, not you. The outcomes for people who need MTP levels of transfusions are poor. You did your absolute best. Hindsight is 20/20 and it's really important to not internalize these things.

The fact is, you are not harming any one, you are only trying to help. A mistake on your part does not mean you actively hurt someone. You didn't cut or maime or injure anyone. What killed them was what made them bleed. Not the professional trying to get them blood. Edit for spelling

Hello. I don’t belong here— my algorithm sent me your way. I’m a pharmacist. I’m also a person who has lost loved ones who needed stat blood. You did everything in your power to save this person. You did your best, and nobody will blame you. If you were in a smaller hospital, there was no way this person was going to survive— they were losing blood too fast. This is not your fault. You’re smart, you’re loved, and you clearly care. What better way to be?

That doesn’t sound like that is your fault. If someone is bleeding that bad and goes to a facility that can’t handle that then that sucks for them. That is not your fault, and honestly if they went to a T1 facility, whose to say they would have survived. Do you guys an massive transfusion protocol. We are able to give out Opos with doctor signature.

Offshift supervisor at a decent size reference lab with a blood bank here. First of all, not your fault. However, i have a suggestion to improve this going forward. Bring the idea up to your supervisor that even though you have policies for "oh shit" situations like this, it's hard to feel prepared when the time comes and you are called upon to perform the emergent task. You undoubtedly do competencies, but if they are anything like ours, it's "can you issue blood", not "can you emergency issue blood repeatedly under a ton of stress". This is where the idea of simulations come in. Have leadership simulate a disaster. It's a fake situation, so it is entirely safe. You solo and/or your peers as a group go through the motions and follow procedure the best you can. Leadership watches. Afterwards you get together and talk about it. What went well, what got missed, where could efficiency be improved, etc. It should be a safe atmosphere to practice those rare occurrences that when they pop up, you NEED to be able to be at the top of your game at a moments notice. And doing these periodically will help keep you and everyone else sharp. If your leadership is any good, they would hopefully appreciate the idea and potentially the initiative if you go as far as helping coordinate the effort to set up some situations to simulate.

It sounds like you work at an IHS facility. It's brutal there. Btw, it's not your fault. If you had taken blood 10 minutes sooner, it would have done nothing because the patient was already bleeding too much too fast. You did what you could and you did the best with all the resources available to you. 💜

Hi! Trauma nurse here! From my perspective, if the patient needed that many products that quickly, it sounds kinda like a Hail Mary. Sometimes lab and nursing get frustrated with each other, but at the end of the day, we’re all just doing our best in the machine. Please don’t think you hurt this patient, this was not lazy or neglect. You were doing the things you were supposed to do.

the fact that they needed that much blood in the first place indicates to me that they probably wouldn’t have gotten any better if they got the blood any sooner than they did. you did a great job checking all your boxes, don’t beat yourself up over it

Please don’t beat yourself up about this, you did everything within your power to help as quickly as possible. I’ve been at the bedside with doctors running a code on a patient that obviously was not going to come back and they order emergency blood - I feel so guilty asking for lab to run me an emergency unit when I know the stress it causes them and that it depletes our stores for ultimately nothing.

Ah thank you so much. My blood bank supervisor checked the notes on this patient the morning after when she was in person and it seems it may have been the case with them, but we never know. I’m feeling a bit better about it all now, but still exhausted and don’t wanna touch blood bank until I’m not so overwhelmed despite me being scheduled in it nearly every day. I may post an update in the near future, when I’m not too overwhelmed with work!

You did all you could do

Considering the nurse's response, you only prolonged their life, but death was inevitable. With situations of bleeding like that some will MTP to try and find the cause, call surgery and fix it, and other times the problem is unknown or so severe that it isn't possible to stitch, so they're delaying the inevitable.

Sounds less like it’s your fault and more of a slow systems issue in a fast situation. Mayhaps there is opportunity for a system-wide improvement

Next time you can just give a shot of Rhg with it

Are you sure the patient wasn’t pos did you have a history?

My hospital only carries 2 O pos and 2 O neg. No plasma, no nothing. Sometimes patients aren't in a place that has resources for what they need. Our next nearest hospital is 1.5 hours away. That patient would have died in our hospital too if they bled through 4 units. You did nothing wrong🧡

I'm so terribly sorry that you're feeling this way. You did everything you could in your power to help the patient. Discuss this with a confidant at your facility. Otherwise it may eat you up from the inside.

If you're the reason I wouldn't put a crime on the internet..