A California colleague wonders what others do in the event that a donor is discharged from a mobile blood collection site after a successful blood donation and subsequently exhibits a reaction, such as fainting. The inquiring colleague wonders at what point does the obligation of the collection staff to respond for medical assistance end. For example, should the donor collection staff respond to a call for help if a high school or college student returns to class and faints in the classroom, and the school requests assistance? The inquiring colleague reports that her blood donor center has a policy that details actions to take when a blood donor reaction occurs within the walls of the blood center or at the collection site of a blood drive. If a donor experiences a reaction within the blood center or at a blood drive collection site, the donor collection personnel provide basic emergency care, apply cold cloths, elevate the donor's feet, monitor vital signs and offer liquids to drink, if appropriate. They do NOT have a policy for intravenous fluid replacement or the use of any emergency drugs. If a donor does not respond to the first aid, or if a donor is physically injured due to a fall, 911 is called for emergency assistance. If a donor has left the collection site to return to a nearby location, such as their work area or classroom, an informal policy permits donor collection personnel to respond to the nearby work area or classroom, provided the blood drive is still ongoing. The responder was usually a RN. One concern is liability to the blood center and/or to the responding RN should a serious problem develop for the donor during the time that first aid is being administered in an emergency that is occurring in a location remote from the blood collection site. Additionally, there may only be one RN at a blood drive, and if that RN responds to a location removed from the actual blood drive, that presents another problem. The inquiring colleague's institution is considering updating their guidelines for dealing with donor reactions, and she wonders what other institutions are doing in situations similar to those described above.

The following comments were received.

ADDENDA Dec. 12, 2003

1. A Texas blood banker reports that at his donor center an occasional donor may experience a reaction after leaving the donation area. They do not have specific written policies to address this exact scenario, but they certainly have common practices that address such an occurrence. Basically, they will always respond to a donor who is suffering an apparent complication of donation, provided they are aware the reaction is occurring and the donor is close enough to the donation site for the donor staff to have access to provide care. At a blood drive (mobile site), if staffing permits, donor staff will go to the affected individual if they are nearby (e.g. within the building where the blood drive is occurring), provided this is alright with the sponsoring donor group. The donor staff prefer to guide followup care, but they are somewhat at the mercy of the donor group or building management. Not infrequently, the donor group or building management call 911 for emergency aid despite reassurances from donor staff that transport to a medical facility is unnecessary. In occasional cases the donor staff do recommend transport of the donor to a hospital or emergency room. The donor staff does not include any nurses on blood drives and IV fluids or medications are never given by donor staff to whole blood donors. In the event that resuscitative measures are needed, the donor staff are not trained to proceed beyond basic CPR (which they have not ever needed, by the way!) Rather, they would call 911 themselves for donors injured by trauma (e.g falling) or with chest pain or with intractable vomiting. The blood center medical staff is immediately notified after 911 is called in any instance. Donors who feel bad and cannot return to school or work are helped to find a ride home and advised about supportive care by their family with follow-up by the donor center staff.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator