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NHS Tayside ED Guidance
Major trauma
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Roles and responsibilities of the trauma team
Paediatric major haemorrhage protocol (children under 50kg)

Update your RDS mobile app to v4.7.2 to download toolkits even when website is down.

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. You will see that each toolkit has a small QR code icon in the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively update to the latest release - RDS app version 4.7.1 - to see this improvement.

Updating to this latest version of the RDS app is also strongly recommended to get the full benefits of the new resilience arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Paediatric major haemorrhage protocol (children under 50kg)

NHS Tayside ED Guidance

Call 2222 state "Paediatric massive haemorrhage ward X":
- Switchboard will voice page duty bleep holder, transfusion lab BMS, duty porter, transfusion practitioner, haematology registrar.
- Out of hours: also page operational coordinator and hospital at night coordinator.
Call blood bank ext 33394 state "paediatric massive haemorrhage": give patient name, CHI, location, your name and contact details.
Call for additional support and nominate: team lead and communication lead to hand all calls.
Send urgent blood samples:
- FBC
- Coagulation screen
- Fibrinogen
- Cross match
- U & E
- Calcium
Request blood components:
- red cells
- FFP
- platelets
- note: all paedipacks contain SAG-M
Resuscitate patient "ABCDE" approach:
- Use emergency O RhD negative blood if required immediately
- Red cell transfusion 5ml/kg alternating with FFP 5ml/kg
- Trauma less than 3 hours - consider tranexamic acid 15mg/kg IV
- Aim to control haemorrhage
- Use blood warmer
Ongoing bleeding while awaiting blood results:
- Transfuse further RBC in 5ml/kg aliquots
- FFP in 5ml/kg aliquots
When blood results available maintain:
- Hb over 80g/L
- APTT and PT ration under 1.5
- Platelets over 75 x 10⁹/L
- Fibrinogen over 1.5g/L
Bleeding controlled:
- Communication lead to notify blood bank to "stand down"
- Complete massive haemorrhage activation record proforma

Contact numbers:

Ninewells Transfusion lab 32953
PRI transfusion lab 13338 (bleep 5122 out of hours)