Emergency support in surgical units: dealing with haemorrhage

This Rapid Response Report makes recommendations to ensure that surgery is not commissioned or delivered in facilities lacking the systems and equipment to manage emergencies safely.

Routine elective surgery has serious risks such as severe haemorrhage. All units must have in place systems and equipment which can respond immediately to these emergencies. These systems need regular review, testing and updating and must ensure adequate supply of blood, resuscitation equipment and the necessary surgical equipment in case of recognised complications such as haemorrhage.

In one incident a patient died following routine laparoscopic surgery exacerbated by no blood being available, a lack of critical resuscitation devices such as central venous catheters and an absence of surgical equipment such as abdominal packs and vascular sutures. Poor communication and a lack of surgical assistance aggravated the situation.

The alert recommends that managers of surgery should advise surgeons, nursing staff, operating department practitioners and other healthcare professionals of these issues.

They should also:

• establish and maintain a system for the urgent supply of blood products; 
• ensure that all units have access to emergency equipment that may be required in the event of haemorrhage; and 
• establish a system for surgeons and anaesthetists to summon help in emergency situations.

Healthcare organisations should ensure that they use the WHO Surgical Safety Checklist.