PT  - JOURNAL ARTICLE
AU  - Callum, Jeannie L.
AU  - Yeh, Calvin H.
AU  - Petrosoniak, Andrew
AU  - McVey, Mark J.
AU  - Cope, Stephanie
AU  - Thompson, Troy
AU  - Chin, Victoria
AU  - Karkouti, Keyvan
AU  - Nathens, Avery B.
AU  - Murto, Kimmo
AU  - Beno, Suzanne
AU  - Pendergrast, Jacob
AU  - McDonald, Andrew
AU  - MacDonald, Russell
AU  - Adhikari, Neill K.J.
AU  - Alam, Asim
AU  - Arnold, Donald
AU  - Barratt, Lee
AU  - Beckett, Andrew
AU  - Brenneman, Sue
AU  - Chaudhry, Hina Razzaq
AU  - Collins, Allison
AU  - Harvey, Margaret
AU  - Lampron, Jacinthe
AU  - Margarido, Clarita
AU  - McFarlan, Amanda
AU  - Nascimento, Barto
AU  - Owens, Wendy
AU  - Pai, Menaka
AU  - Rizoli, Sandro
AU  - Ruijs, Theodora
AU  - Skeate, Robert
AU  - Skelton, Teresa
AU  - Sholzberg, Michelle
AU  - Syer, Kelly
AU  - Viveiros, Jami-Lynn
AU  - Theriault, Josee
AU  - Tinmouth, Alan
AU  - Van Heest, Rardi
AU  - White, Susan
AU  - Zeller, Michelle
AU  - Pavenski, Katerina
TI  - A regional massive hemorrhage protocol developed through a modified Delphi technique
AID  - 10.9778/cmajo.20190042
DP  - 2019 Jul 01
TA  - CMAJ Open
PG  - E546--E561
VI  - 7
IP  - 3
4099  - http://www.cmajopen.ca/content/7/3/E546.short
4100  - http://www.cmajopen.ca/content/7/3/E546.full
SO  - CMAJ2019 Jul 01; 7
AB  - Background: A massive hemorrhage protocol (MHP) enables rapid delivery of blood components in a patient who is exsanguinating pending definitive hemorrhage control, but there is variability in MHP implementation rates, content and compliance owing to challenges presented by infrequent activation, variable team performance and patient acuity. The goal of this project was to identify the key evidence-based principles and quality indicators required to develop a standardized regional MHP.Methods: A modified Delphi consensus technique was performed in the spring and summer of 2018. Panellists used survey links to independently review and rate (on a 7-point Likert scale) 43 statements and 8 quality indicators drafted by a steering committee composed of transfusion medicine specialists and technologists, and trauma physicians. External stakeholder input from all hospitals in Ontario was sought.Results: Three rounds were held with 36 experts from diverse clinical backgrounds. Consensus was reached for 42 statements and 8 quality indicators. Additional modifications from external stakeholders were incorporated to form the foundation for the proposed MHP.Interpretation: This MHP template will provide the basis for the design of an MHP toolkit, including specific recommendations for pediatric and obstetrical patients, and for hospitals with limited availability of blood components or means to achieve definitive hemorrhage control. We believe that harmonization of MHPs in our region will simplify training, increase uptake of evidence-based interventions, enhance communication, improve patient comfort and safety, and, ultimately, improve patient outcomes.