A Protocol to Implement and Evaluate a Community Walking Blood Bank for Hemorrhagic Shock When Banked Blood is Unavailable - The Local Initiative For Emergency Blood (LIFE-Blood) Study, Phase 2

Abstract

ABSTRACT Introduction Trauma, obstetric hemorrhage, and severe anemia lead to millions of deaths every year. The majority of these deaths occur in regions known as “blood deserts” where there is virtually no access to blood transfusions. Currently, these blood deserts have minimal resources to improve access to this life-saving medicine. A community walking blood bank (CWBB) is a low-resource strategy that can provide just-in-time, point-of-care tested, blood transfusions in blood deserts when banked blood is not readily available and the alternative is almost-certain death. This protocol is designed to evaluate the effectiveness and implementation of a CWBB at Lodwar County Referral Hospital (LCRH) located in a blood desert in rural northwest Kenya. Methods We will use a mixed methods approach relying on an implementation science design to evaluate effectiveness, acceptability, applicability, and impact of a CWBB. First, a previously developed emergency transfusion protocol will be validated and finalized by key hospital stakeholders. Effectiveness will be assessed 1) quantitatively, using prospective laboratory-based data collection before and after protocol initiation to measure changes in blood ordering practices and 2) qualitatively, through key informant interviews of hospital staff and the community focusing on clinical blood demand and general understanding and perceptions about blood donation and transfusion. Lastly, we will determine the adaptability and scalability of a CWBB to other low-resource settings with in-depth interviews, and a modified Delphi approach to achieve consensus regarding key components of a CWBB and its transferability to other settings. Discussion The global shortage of blood products represents one of the most pressing challenges in healthcare delivery. This study represents the first structured implementation and evaluation of a community walking blood bank, addressing an urgent need for innovative solutions to chronic blood shortages in remote settings. We will prospectively quantify blood demand, understand the impact of a walking blood bank on healthcare providers’ practices, and lastly, explore how it can be adapted to a variety of settings. Through this implementation-effectiveness approach, we hope to provide evidence for a sustainable solution to otherwise preventable deaths due to chronic blood shortages in remote settings. Trial Registration Not applicable