Aims, Objectives and Background The Scottish Transfusion and Laboratory Support in Trauma Group (TLSTG) have previously audited National Code Red activations to optimise the transfusion support given to patients following major trauma in Scotland. This report is for all patients in Scotland for whom a Code Red was activated between 1st January 2018 and 31st December 2019 and also compares findings to previous audits since 1 June 2013.

Method and Design A clinical and transfusion lead for each centre entered anonymised data onto a secure electronic database (REDCap).

Results and Conclusion There were 96 Code Red activations. Mean age was 43 (SD 18) years, and 66 (69%) were male. Median ISS was 29 (IQR 19–41, n=76, mean ISS 31, SD 17) with 71 (74%) blunt trauma. 87 (90%) received blood components with 73 (76%) receiving pre-hospital transfusion. 67 of 73 (92%) who received pre-hospital transfusion, received further hospital transfusion. Median time from 999 call to Code Red activation was 80 (IQR 56–106, n=47) minutes and 77 (93%, n=93) patients received pre-hospital TXA. Median time after ED arrival to transfusion was 4 minutes (IQR 0–17, n=50) for Concentrated Red Cells (CRC) and 16 minutes (IQR 5–28, n=49) for Fresh Frozen Plasma (FFP). Median time from ED arrival to Full Blood Count (FBC) result was 70 mins (IQR 50–109, n=61) and for clotting was 74 mins (IQR 54–100, n=83). 65 (68%) patients survived to hospital discharge. Activations have increased over the audit periods (audit 1=56, audit 2=66, audit 3=96), with an increased in female% noted this audit. Injury Severity Score (ISS) has increased (26,28,31) as has pre-hospital transfusions (16,48,73), pre-hospital tranexamic acid% (70,78,93), Rotational Thromboelastometry use (0,12,13) and massive transfusion (7,5,24). Time to CRC, FFP, FBC, and clotting results are maintained or improved. CRC (16,9,17 units) and FFP (37 vs 14 units) wastage has increased. Survival% is maintained (63,66, 65)