The Massive Transfusion Protocol (MTP) is one of the key life-saving tools that trauma professionals can utilize in their trauma centers. These are complex processes with specific triggers and logistics that vary by trauma center level, location, and volume. Because of this complexity, it is impossible to create a cookbook for designing your protocol.

However, there is one constant across all trauma centers regarding their MTP. I call it MTP cooler etiquette. This cooler is the center focus of the entire protocol, and the patient relies on good manners in its use for their life. Here are my thoughts about how to properly handle the MTP cooler.

• Decide who carries it to and from the trauma bay / OR  ICU. At a few centers, blood bank personnel are responsible for bringing the coolers to the required location. However, the majority do not have enough spare lab techs to run coolers all around the hospital. Each center will need to decide who is best suited. Frequently, this falls to personnel from the ED or OR. However, in large medical complexes, it may be preferable to have security personnel handle this, as they are very familiar with the hospital layout.
• Ensure the cooler is visible in the area it is used at all times. It is critically important that the cooler not be hidden in a corner or behind other equipment. This can lead to it being forgotten and to the wastage of the blood products inside. In the trauma bay, it should be located next to the team leader. In the operating room, it should be adjacent to anesthesia personnel. In the ICU, it should be located just inside the patient room door. This guarantees that everybody who enters and leaves the area can see it and will not forget to send it back when it’s no longer needed.
• Place clear signage on the cooler to remind all personnel to call the blood bank when the MTP is over.
• When moving the patient from area to area, place the cooler on the bed next to them. Placing it under the bed is a recipe for forgetfulness.
• Empower everyone in the room to bring up the question of whether the cooler is no longer needed. Don’t wait until there are cobwebs on it and the blood products are at room temperature. Once the question is asked, call the blood bank immediately and let them know it is being deactivated.
• Finally, decide who has the task of taking it back to the blood bank. Typically, this is someone from the area where it was last used. Anyone assigned to this task should recognize the importance of a timely return to the blood bank. Blood is a precious product and should be handled accordingly.

If you have some good suggestions on blood bank etiquette, please leave them in the comments below.