The Edinburgh ED Blood Project group is leading this national audit on behalf of the Scottish Transfusion and Laboratory Support in Trauma Group (TLSTG) which was established in March 2014 to provide a forum focused upon optimising the transfusion support given to patients following major trauma in Scotland. Over the last 6 years, three of Scotland’s four pre-hospital services, Emergency Medical Retrieval Service (EMRS) based in the West of Scotland, Tayside Trauma Team (TTT) based in the East and Medic 1 based in the South East, have worked together through the TLSTG to introduce a unified national pre-hospital Code Red protocol.  This is activated prior to a patient with major or massive haemorrhage arriving in the Emergency Department (ED), allowing time for blood components such as Fresh Frozen Plasma (FFP) to be thawed.

Previous work

Reed MJ, Cooke C, McMahon N, Hands K, Henderson S, Knight E, Littlewood N, Latif M, Tod N, McGarvey M, Hughes N, Donald M, Rowley M, Innes C, Lockhart S on behalf of the Scottish Transfusion and Laboratory Support in Trauma Group. Improvements in National Code Red Transfusion practice in Scotland after adoption of recommendations from the Scottish National Code Red 2015 review. Injury 2020; 51: 913–918. PMID: 32093938

Reed MJ, Glover A, Byrne L, Donald M, McMahon N, Hughes N, Littlewood NK, Garrett J, Innes C, McGarvey M, E Hazra E, Rawlinson PSM on behalf of the Scottish Transfusion and Laboratory Support in Trauma Group. Experience of implementing a National Code Red bleeding protocol in Scotland. Injury Int. J. Care Injured 2017; 48: 41–46. PMID: 27641222

What?

The aim of this audit is to monitor and optimise the transfusion support given to patients following major trauma in Scotland.

Aims for National Code Red 2018-2019 audit

1. To audit the use of Code Red across Scotland and including the extension of the protocol to the North of Scotland in 2018-19.
2. To audit the current Code Red activation criteria in 2018-19 ensuring they continue to predict the need for blood components.
3. To audit the improvement in administration of pre-hospital Tranexamic Acid in 2018-19 aiming for 100% pre-hospital administering within 3 hours to bleeding trauma patients (78% of Code Red patients received pre-hospital TXA in 2015-17, compared to 70% of Code Red patients in 2013-15.
4. To audit pre-hospital transfusion usage in 2018-19.
5. To audit median time to ED FFP and ED emergency O negative CRC administration in 2018-19.
6. To audit the median time from 999 call to Code Red activation in 2018-19 (halved in the 2015-17 period compared to 2013-15).
7. To audit the survival to discharge in 2018-19.
8. To audit the CRC:FFP ratio in 2018-19.
9. To audit the mean time for the treating clinician to receive the first FBC result.
10. To audit use of Point-of-Care coagulation testing or Viscoelastic testing across Scotland for Code Red patients in 2018-19.
11. To audit performance of the current ROTEM protocol where possible for Code Red patients in 2018-19.
12. To compare Scottish Code Red data with other Code Red practices around the world or in the remainder of the UK
13. To analyse data from 2013 to 2019 using iterative QI techniques including e.g. control/SPC charts to look for improvements over time and improvements related to specific intervention.