Massive Transfusion Protocol Activation Note

Massive Transfusion Protocol (MTP) Activation Note

Date/Time of Note: [documentation date and time] (Use 24-hour format.)

Event Time Window: [activation time] to [termination time or "ongoing"] (Use 24-hour format.)

Author/Role: [author name and clinical role]

Patient/Location: [patient identifier] — [current location and service]

Event Summary

"MTP activated for [indication and suspected source]; [key intervention status]; [current hemodynamic status]." (Write a single concise sentence in this format.)

Activation & Context

Time Activated: [activation time]; activated by [role]; communicated to [recipients] (Use 24-hour format. Include who activated and to whom communicated.)

Trigger Criteria Met: [specific institutional trigger criteria met] (Document only applicable trigger elements; do not restate the full protocol.)

Clinical Indication: [hemorrhagic shock / uncontrolled bleeding / anticipated massive hemorrhage] — [objective supporting data] (Include vitals, shock index, bleeding descriptor, or mechanism.)

Suspected Bleeding Source: [suspected / confirmed] — [anatomic source] (Note if confirmed intraoperatively or by imaging.)

Relevant Modifiers: [anticoagulant or antiplatelet exposure with last dose timing; coagulopathy risk factors; special transfusion requirements] (Omit this field entirely if none apply.)

Cancellation: [cancellation time] — [rationale] (Only include if activation was canceled.)

Resuscitation Record

Products Administered: (Summarize totals during MTP window. Reference flowsheets or anesthesia record for unit-by-unit timestamps.)

• RBC: [units total]; [uncrossmatched / emergency-release / type-specific / crossmatched]
• Plasma: [units total]
• Platelets: [units total]; [single donor / pooled] (Include if applicable.)
• Cryoprecipitate: [units or pools total]
• Whole blood: [units total] (Only include if used.)
• Factor concentrates: [agent and total dose] (Only include if used.)
• Plasma-to-RBC ratio: [ratio at key decision points] (Include if tracked institutionally.)

Adjuncts: (Only list those administered.)

• TXA: [dose] at [time]; [time from injury or bleeding onset]
• Calcium: [agent, dose, time]
• Reversal agents: [agent, dose, indication, time]

Hemorrhage Control Interventions: (List chronologically with times. Use 24-hour format.)

• [time] — [intervention]
• [time] — [departure for definitive control] (Include destination.)
• [time] — [hemostasis achieved] (Only include if known.)

Response & Status

Vitals: (Report worst and most recent values during MTP window.)

• HR: [worst value at time] → [most recent value at time]
• BP or MAP: [worst value at time] → [most recent value at time]
• Temperature: [lowest value at time] → [most recent value at time]

Labs/POC: (Include timestamps. Note pending tests and reassessment interval.)

• Hgb: [value at time]; Platelets: [value at time]
• INR: [value at time]; aPTT: [value at time] (Include if obtained.)
• Fibrinogen: [value at time]
• Lactate or Base Deficit: [value at time]
• Ionized Calcium: [value at time]
• Viscoelastic testing: [key parameters]; [how results guided therapy] (Only include if TEG/ROTEM performed.)
• Pending: [tests pending] — reassess at [interval]

Hemostasis Status: [ongoing / temporized / achieved] — [mechanism of control or temporization]

Resuscitation Adequacy: [objective indicators of adequate resuscitation] (Include BP trend, HR trend, urine output, vasopressor trajectory, lactate or base deficit trend.)

Plan & Termination

Source Control Plan: [planned or completed intervention]; [timing]; [responsible service]

Transfusion Plan: [continue MTP / transition to goal-directed component therapy]; reassess at [interval]

Disposition: [destination]; handoff to [recipient and service]

MTP Termination: [termination time / "MTP ongoing"]; [rationale]; blood bank notified: [yes / no]; product reconciliation: [transfused / returned / pending] (If MTP remains active, state "MTP ongoing.")

Adverse Events/Safety: [concern type] — [details and actions taken] (Only include if applicable. Omit entirely if no concerns.)