If an individual with haemophilia presents at an Emergency Department with a bleeding episode which requires treatment with factor concentrate, a number of delays can occur. Firstly, the triage nurse may not be familiar with haemophilia and may not be aware of the fact that factor concentrates should be given without delay. The doctor seen at the Emergency Department may be similarly unfamiliar with haemophilia and may order tests, x-rays or scans to confirm a bleeding episode is present before ordering factor concentrate. There may be a delay in locating the factor concentrate which is stored in the hospital. There may be a delay if a consultant haematologist in the hospital has to sign off before the factor concentrate is to be used.
In a normal scenario in an Emergency Department when a person without haemophilia attends, the person is triaged, seen by a doctor, diagnosed and then treated. The difference with a person with haemophilia is that it is necessary to treat the bleeding episode with factor concentrate without delay and then follow up with diagnostic scans or other tests required after giving treatment. The healthcare workers in the Emergency Department may be reluctant to do this and we have recorded a number of cases where people with haemophilia have been subjected to long delays in emergency departments before receiving factor concentrate because of some of the above-mentioned scenarios. This is despite the fact the person would have asked the Emergency Department to contact their Comprehensive Treatment Centre for advice and information.
The three Comprehensive Treatment Centres offer 24-hour advice to all other hospitals on appropriate treatment. It is vital that if a person with haemophilia attends at an Emergency Department that the triage nurse or doctor contacts the persons Comprehensive Treatment Centre, and that appropriate factor concentrate is given within thirty minutes.
This is the rationale behind the Severe Bleeding Disorder Alert Cards that the Irish Haemophilia Society have produced in conjunction with the National Haemophilia Council. The cards are distributed by the Comprehensive Care Centres to all patients with severe haemophilia. The cards ask the health care worker in the relevant Emergency Department to immediately contact the Comprehensive Treatment Centre and provide the telephone numbers for use during the day and at nights and weekends. The National Haemophilia Council are progressing the awareness of the Severe Bleeding Disorder Alert Cards via the entire health system across the hospital network, the ambulance service, nursing units and all other relevant HSE healthcare workers and staff.
For the person with haemophilia, the most important piece of equipment in a non-specialist centre is the telephone and the instruction to the Emergency Department staff to call the relevant centre will save lives. Please also remember to carry your Severe Bleeding Disorder Alert Card with you at all times.