Nov 30, 2023

Questions in Transfusion: When disaster strikes

At a glance

  • How to classify events
  • Keys to strong disaster plans
  • Post-disaster analysis

When things go wrong, either on a local level or a more widespread level, your facility should have plans in place so everyone knows the next steps. A business continuity plan (BCP) addresses what’s needed to ensure that business operations and processes continue in an emergency with potential for disruption.1 It is a preemptive assessment of threats, key operations units needed to remain functional, and mitigation strategies.

A continuity of operations plan (COOP), on the other hand, refines the BCP and documents how critical divisions or departments will maintain essential operations, how long they can be maintained, and critical needs for returning to normal. Finally, disaster management plans (DMPs) provide directions for how to respond to specific events.

This Questions in Transfusion, and the article it summarizes, aim to prompt organizations to consider their preparedness, as well as their need for BCPs, COOPS, or DMPs.

Question: How do you classify events that disrupt operations?

  • Major incident. An event that presents a serious threat to the health of the community, disruption to service, or causes (or may cause) such numbers and types of casualties as to require special arrangements.
  • Mass casualty incidents or events. An incident or event (or series thereof) that causes casualties on a scale beyond the ability of normal resources of emergency and healthcare services.
  • Business continuity incident. An event that disrupts, or may disrupt, normal service to below acceptable predefined levels, requiring special arrangements.

Question: What’s key to a strong BCP?

  1. Risk assessment of anything that could negatively impact an organization
  2. Business impact analysis1

Representation both from organizational management (CFO/CEO/COO, HR, logistics) and the key management representatives who oversee critical operational divisions and infrastructure is essential. Once the assessment is complete, the workgroups should move on to develop a COOP.

Question: What happens after the emergency is resolved?

A root cause analysis should be carried out to see if something specific was missed in the BCP/COOP. Careful dissection of the event could lead to significate changes in the BCP, which means the organization will be better prepared in the future.


Laboratories should ensure they have a BCP and, as necessary, COOPs and DMPs, in place. Hospital-based labs should coordinate with the larger organization to ensure it understands the lab’s role in patient care, as well as advocate for their unique needs in the face of a disaster. Independent labs will be responsible for their own emergency plans. In either case, collaboration and support is key.

Further Reading

Doughty H, Chowdhury F, on behalf of the National Blood Transfusion Committee Emergency Planning Working Group. Emergency preparedness, resilience and response guidance for UK hospital transfusion teams. Trans Med. 2020;30:177-185. 

Business continuity plan. Techopedia. Updated March 24, 2022. Accessed May 1, 2022. 

Continuity of Operations plan (COOP). Techopedia. Accessed May 1, 2022. 

CLSI. GP36-A:2014. Planning for Laboratory Operations During a Disaster; approved guideline. Clinical and Laboratory Standards Institute; 2014. 

R3 report issue 34: new and revised standards in emergency management. The Joint Commission. Accessed May 24, 2022. 

NFPA® 1600: Standard on Continuity, Emergency, and Crisis Management, 2019 edition. 

Standards for Blood Banks and Transfusion Services. 32nd ed. AABB; 2018. 

2021 CAP Checklist. College of American Pathologists. 

Morgan SJ, Rackham RA, Penny S, Lawson JR, Walsh RJ, Ismay SL. Business continuity in blood services: two case studies from events with potentially catastrophic effect on the national provision of blood components. Vox Sang. 2015;108:151-159. 

Gomez AT, Quinn JG, Doiron DJ, Watson S, Crocker BD, Cheng CK. Implementation of a novel real-time platelet inventory management system at a multi-site transfusion service. Transfusion. 2015;55:2070-2075. 

Virk MS, Lancaster D, Quach T, et al. Optimizing O-negative RBC utilization using a data-driven approach. Transfusion. 2020;60:739-746. 

O’Brien KL, Uhl L. Management of a hospital transfusion services during a nationwide blood product shortage. Arch Pathol Lab Med. 2018;142:779-781. 

AHA, AMA, ANA joint statement urges blood donation. AABB. January 28, 2022. Accessed May 1, 2022. 

Prokopchuk-Gauk O, Petraszko T, Nahirniak S, Doncaster C, Levy I. Blood shortages planning in Canada: The National Emergency Blood Management Committee experience during the first 6 months of the COVID-19 pandemic. Transfusion. 2021;61:3258-3266. 

Extending the blood supply – tips for hospitals. Updated December 17, 2021. Accessed May 24, 2022. 

Pollack R. Perspective: doing our part to shore up America’s blood supply. American Hospital Association. February 11, 2022. Accessed May 2, 2022. 

Cohn CS, Pagano MB, Allen ES, et al. How do I manage long-term blood component shortages in a hospital transfusion service? Transfusion. 2020;60:1897-1904. 


  1. Redmond, MC. Mastering Business Continuity Management., Inc.; 2018.