Transfusion medicine handbook

6. Special Circumstances

6.4 Code Crimson/ Code Red/ Trauma Pathway

Code Crimson/ Code Red/ Trauma are different names for the same process. These refer to established trauma activation systems that tie together key services (such as appropriate clinical skill and experience, blood bank, operating theatres and interventional radiology) with the goal of rapid decision making and reducing delays to definitive damage control management.

Often transfusion of the stat pack, reassessment and definitive treatment to stop the bleeding may mean activation of the MHP is not required.

The ABC score AND senior clinician approval is used to guide activation of the MHP Code Crimson/Code Red/Trauma. One point scored for each:

• Positive FAST (Focused Assessment with Sonography for Trauma, to assess intra-abdominal free-fluid on ultrasound)
• Penetrating mechanism
• Systolic BP ≤90 in ED
• HR ≥120 in ED

ABC scores <2 are unlikely to require massive transfusion.

While the score can aid decision-making, senior clinician judgement should always be used before activating the MHP. The score tends to over-triage towards massive transfusion. The need to terminate the MHP should be constantly reassessed and immediately relayed to blood bank.