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042 Scottish code red audit report 2015–2017
  1. Matt Reed1,
  2. Claire Cooke2,
  3. Niall McMahon3,
  4. Katie Hands4,
  5. Susan Henderson5,
  6. Eleanor Knight4,
  7. Munsor Latif6,
  8. Nicola Littlewood7,
  9. Naomi Todd6,
  10. Margaret McGarvey6,
  11. Neil Hughes8,
  12. Michael Donald9,
  13. Megan Rowley10,
  14. Catherine Innes10,
  15. Symon Lockhart10
  1. 1Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
  2. 2Department of Emergency Medicine, Royal Infirmary of Edinburgh, NHS Lothian
  3. 3Department of Emergency Medicine, Royal Alexandra Hospital, EMRS, Emergency Medical Retrieval Service, ScotSTAR, Hangar B
  4. 4Department of Transfusion Medicine
  5. 5Department of Emergency Medicine, Ninewells Hospital
  6. 6Department of Emergency Medicine, Queen Elizabeth University Hospital
  7. 7Department of Emergency Medicine, Queen Elizabeth University Hospita, Emergency Medical Retrieval Service, ScotSTAR
  8. 8Department of Emergency Medicine, Monklands Hospital, EMRS, Emergency Medical Retrieval Service, ScotSTAR
  9. 9Department of Emergency Medicine, Ninewells Hospital, EMRS, Emergency Medical Retrieval Service, ScotSTAR
  10. 10Department of Transfusion Medicine, Royal Infirmary of Edinburgh


The Scottish Transfusion and Laboratory Support in Trauma (TLST) group previously audited all National Code Red activations between June 1st 2013 and October 31st 2015, generating a number of recommendations to be adopted to optimise the transfusion support given to patients following major trauma in Scotland. A repeat audit was undertaken for all patients for whom a Code Red was activated between 1st November 2015 and 31st December 2017.

A clinical and transfusion lead for each centre entered anonymised data onto a secure electronic database (REDCAP; the server of which is held within the University of Edinburgh. This database was maintained by the Edinburgh study team. Each of Scotland’s pre-hospital trauma teams who take patients to hospitals where Code Red Policy is in place, and the receiving hospitals, agreed to enter data into the National Code Red audit for all patients for whom a Code Red was activated during the study period. The project was deemed a service evaluation by the South East Scotland Research Ethics committee (Ref: NR/1408AB11) and therefore did not require full ethics submission. The project was also registered with each hospital’s clinical effectiveness/governance teams where available, and a favourable Caldicott opinion was obtained.

Abstract 042 Figure 1

Flow chart showing transfusion events and outcomes of code red patients

Abstract 042 Figure 2

Ratio of the mean number of concentrated red cells (CRC) and fresh frozen plasma (FFP) transfused to code red patients at 30 minute intervals

Abstract 042 Table 1

66 activations (24 South-East of Scotland, 32 West, 10 East). Mean age 45 years, 88% male patients. 93% of Code Red patients received blood components with a 300% increase in pre-hospital transfusion (48 patients; 73%); median time from 999 call to Code Red activation reduced to 37 minutes from 70 minutes; 78% patients received pre-hospital TXA (improved from 70%). CRC:FFP ratios improved in comparison to 2013–15. Survival to discharge increased (63% to 66%) despite increased ISS.

Code Red practice has improved since our last audit. There are still improvements to be made in TXA administration and time to blood products.

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