"… difficulty in obtaining blood quickly in major haemorrhage prior to start of case contacted blood bank to cross match 2 units - made aware would be 1 hour. At this time asked if type specific would be available if needed sooner. Surgery not started until after siting of Arterial line, GA, central line and urinary catheter. On opening bleeding noted unable to get through to blood bank engaged. Major haemorrhage call put out via 2222. Still difficulty contacting blood bank. major haemorrhage pack ordered. Further blood and products
requested as needed. Multiple rounds CPR with less than 2 min ROSC in between whilst waiting for blood”

This vignette serves as a useful reminder that any protocol is only as good as the systems that underpin it. Direct and clear communication with haematology laboratory staff and ‘if necessary’ medical staff is important. Regular stress testing of protocol activation can help identify problems.