Trauma Injuries: Is Non-blood Management Care
an Option?
Fall 2003
Trauma is the fourth leading cause of death
for people of all ages in the United States.
Trauma-related injuries account for 5.1 million
deaths per year or 15% of deaths worldwide. Most
trauma victims are a challenge to clinicians
because bleeding can threaten survival and result
in permanent disability or death.
Trauma patients who refuse blood transfusions
prove to be an even greater challenge. Patients
who decline blood transfusion because of their
beliefs must be well prepared to cope with this
situation. If the trauma center is not familiar
with the alternatives to blood transfusion, it
is important that a transfer to an institution
that is well versed in non-blood management takes
place quickly. Please keep the following in mind
when requesting a transfer to the Center for
Bloodless Medicine & Surgery (CBMS) at Pennsylvania
Hospital:
Document your right to refuse. This can
be extended to patients who once had, but no
longer have the capacity to make decisions on
their own. Such patients indicate their wishes
through an advance medical directive (either
oral or written). In anticipation of such situations,
many Jehovah's Witnesses sign and carry a specially
prepared, wallet-size advance medical directive/release
card indicating their wishes not to receive blood.
In general, such an advance medical directive
will be honored unless there is clear evidence
that the patient revoked the advance medical
directive or completed it when coerced or inadequately
informed.
Inform the attending physician of your
desire to transfer to the Center for Bloodless
Medicine & Surgery at Pennsylvania Hospital.
A transfer can only take place once the patient
is stable and deemed capable of transport. Your
attending physician will then notify the CBMS
on-call coordinator who will coordinate with
the Medical Director for CBMS to determine if
a transfer is appropriate.
Remain calm. An appropriate bed will
need to be located, surgeons may have to be notified
and many other events must take place before
the transfer can occur. All of these arrangements
will be handled by Pennsylvania Hospital. During
this time period the best thing you can do is
remain calm.
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