TY - JOUR T1 - A regional massive hemorrhage protocol developed through a modified Delphi technique JF - CMAJ Open JO - CMAJ SP - E546 LP - E561 DO - 10.9778/cmajo.20190042 VL - 7 IS - 3 AU - Jeannie L. Callum AU - Calvin H. Yeh AU - Andrew Petrosoniak AU - Mark J. McVey AU - Stephanie Cope AU - Troy Thompson AU - Victoria Chin AU - Keyvan Karkouti AU - Avery B. Nathens AU - Kimmo Murto AU - Suzanne Beno AU - Jacob Pendergrast AU - Andrew McDonald AU - Russell MacDonald AU - Neill K.J. Adhikari AU - Asim Alam AU - Donald Arnold AU - Lee Barratt AU - Andrew Beckett AU - Sue Brenneman AU - Hina Razzaq Chaudhry AU - Allison Collins AU - Margaret Harvey AU - Jacinthe Lampron AU - Clarita Margarido AU - Amanda McFarlan AU - Barto Nascimento AU - Wendy Owens AU - Menaka Pai AU - Sandro Rizoli AU - Theodora Ruijs AU - Robert Skeate AU - Teresa Skelton AU - Michelle Sholzberg AU - Kelly Syer AU - Jami-Lynn Viveiros AU - Josee Theriault AU - Alan Tinmouth AU - Rardi Van Heest AU - Susan White AU - Michelle Zeller AU - Katerina Pavenski Y1 - 2019/07/01 UR - http://www.cmajopen.ca/content/7/3/E546.abstract N2 - 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. ER -