[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-506447-105":59,"doc-detail-506447-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","adult-appendix-c-massive-hemorrhage-protocol-mhp-checklist","Adult Appendix C - Massive Hemorrhage Protocol (MHP) Checklist","","Adult Appendix C provides a Massive Hemorrhage Protocol (MHP) checklist for non-definitive inpatient care when no plasma is available on site. It specifies activation steps, communication with hospital locating to initiate CODE TRANSFUSION, patient identification and baseline blood work, TXA dosing, hypothermia prevention, staged MHP packs, laboratory targets, and anticoagulant reversal options. It also covers transfer to a tertiary centre, termination criteria, returning unused products, and an SBAR handover template including hemodynamic status and latest critical labs.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/adult-appendix-c-massive-hemorrhage-protocol-mhp-checklist/506447/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/adult-appendix-c-massive-hemorrhage-protocol-mhp-checklist/506447.png","ImageObject",300,407,{"name":92,"@type":93},"EvelynWrites","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-12","2026-10-05",true,{"@type":102,"interactionType":103,"userInteractionCount":8},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"When should the Massive Hemorrhage Protocol (MHP) be activated for adult patients without plasma on site?","Question",{"text":112,"@type":113},"Activate when massive hemorrhage management is required and plasma is not available on site, following the checklist’s activation and CODE TRANSFUSION steps, including calling hospital locating to activate the system.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What are the key actions during activation & Pack 1, including TXA and hypothermia prevention?",{"text":117,"@type":113},"Administer TXA as specified, ensure patient identification bands and obtain group and screen and baseline blood work. Implement hypothermia prevention by measuring temperature, obtaining a blood warmer for all infusions, and starting active warming if temperature is below 36°C.",{"name":119,"@type":110,"acceptedAnswer":120},"How does the checklist guide transfusion decisions and laboratory targets for Pack 2 and Pack 3?",{"text":121,"@type":113},"Use laboratory measures where feasible and review blood work to ensure targets are met (e.g., hemoglobin, INR, fibrinogen, and platelet thresholds). Continue staged MHP packs and reassess temperature, with active warming if below 36°C.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},506447,1791782368,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39},687212989558,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Adult Appendix C  \nADULT PATIENTS, NON-DEFINITIVE CARE AT HOSPITAL NO PLASMA AVAILABLE ON SITE  \nPATIENT TO BE TRANSFERRED TO TERTIARY CENTRE  \nMASSIVE HEMORRHAGE PROTOCOL (MHP) CHECKLIST  \nTo be repeated on each page  \n\n| TIME | ACTION | INITIALS |\n| --- | --- | --- |\n| ACTIVATION & PACK 1 (date _ _ / _ _ _ / _ _ time _ _ /_ _) |  |  |\n|  | MHP Lead RN:   |  |\n|  | Call to hospital locating (ext. - - - - ) to activate CODE TRANSFUSION |  |\n|  | Provide patient number, name, sex, age, location, and information regarding patient use of antiplatelet or anticoagulants to blood bank at ext. - - - -\u003Cbr>Antiplatelets 􀀀 Yes; Anticoagulant 􀀀 Yes, drug name:  |  |\n|  | 􀀀 Ensure identification band is affixed to patient |  |\n|  | 􀀀 Obtain group and screen sample |  |\n|  | 􀀀 Obtain baseline blood work |  |\n|  | Tranexamic acid: Administer 2 gram iv bolus in 100 mL over 20 minutes.\u003Cbr>Hold if: more than 3 hours from injury/onset of hemorrhage or given pre-hospital or pre-activation or patient has a gastrointestinal hemorrhage |  |\n|  | Hypothermia prevention:\u003Cbr>􀀀 Measure and document patient temperature\u003Cbr>􀀀 Obtain blood warmer for all infusions\u003Cbr>􀀀 If patient temperature less than 36⁰C start active warming |  |\n|  | Initiate transfer out: Notify if required:\u003Cbr>􀀀 CritiCall -1-800-668-4357 􀀀 EMS 􀀀 Ornge |  |\n|  | Obtain 1st MHP pack (if not obtained before activation):\u003Cbr>Pack arrival time (_ _/_ _)\u003Cbr>􀀀 􀀀 􀀀 􀀀 4 units Red Cells (RBCs)\u003Cbr>Use Rh-negative blood only for females under 45 years\u003Cbr>Avoid additional boluses or infusions of crystalloid except on physician order |  |\n|  | 􀀀 Platelets (if available): If platelet count below 50 x109/L or patient on an antiplatelet drug, transfuse 1 pool of platelets |  |\n|  | 􀀀 Fibrinogen: if fibrinogen less than 1.5 g/L, 4 grams of fibrinogen concentrate over 5 min by iv push; |  |\n|  | 􀀀 Calcium: 1g Calcium Chloride or 3g Calcium Gluconate iv push after pack 1 |  |\n|  | Anticoagulant reversal:\u003Cbr>􀀀 If Warfarin: PCC 2000 IU iv over 10 minutes AND 􀀀 Vitamin K 10 mg iv\u003Cbr>􀀀 If Xa inhibitors (e.g., apixaban, rivaroxaban): PCC 2000 IU iv over 10 minutes\u003Cbr>􀀀 If Dabigatran: Idarucizumab 5 grams iv over 10 minutes\u003Cbr>􀀀 If Heparins: consult Pharmacy for protamine dosing |  |\n| PACK 2 (time _ _ /_ _) |  |  |\n|  | 􀀀 Obtain hour one blood work |  |\n|  | 􀀀 Review last set of blood work to ensure at target: Hemoglobin greater than 80 g/L, INR less than 1.8, fibrinogen greater than 1.5 g/L, platelets greater than 50x109/L |  |\n|  | 􀀀 Measure and document patient temperature\u003Cbr>􀀀 If patient temperature less than 36⁰C start active warming |  |\n\nADULT PATIENTS, NON-DEFINITIVE CARE AT HOSPITAL NO PLASMA AVAILABLE ON SITE  \nPATIENT TO BE TRANSFERRED TO TERTIARY CENTRE  \n\n|  | Obtain 2nd MHP pack (if needed):\u003Cbr>Transfusions based on laboratory measures where feasible\u003Cbr>􀀀 􀀀 􀀀 􀀀 4 units Red Blood Cells\u003Cbr>􀀀 2000 IU of Prothrombin Complex Concentrates\u003Cbr>􀀀 4 grams of fibrinogen concentrate over 5 min by iv push |  |\n| --- | --- | --- |\n|  | 􀀀 Platelets (if available): if platelet count below 50 x109/L, 1 pool of platelets |  |\n|  | Anticoagulant reversal (only if ongoing hemorrhage):\u003Cbr>􀀀 If Xa inhibitors (second dose): PCC 2000 IU iv over 10 minutes |  |\n|  | 􀀀 Calcium: 1g Calcium Chloride or 3g Calcium Gluconate iv push after pack 2 |  |\n| PACK 3 (time _ _ /_ _) |  |  |\n|  | 􀀀 Obtain hour 2 blood work |  |\n|  | 􀀀 Review last set of blood work to ensure at target |  |\n|  | 􀀀 Measure and document patient temperature\u003Cbr>􀀀 If patient temperature less than 36⁰C start active warming |  |\n|  | Obtain 3rd MHP pack (if needed)\u003Cbr>Transfusions based on laboratory measures where feasible\u003Cbr>􀀀 􀀀 􀀀 􀀀 4 Units Red Blood Cells\u003Cbr>􀀀 2000 IU of Prothrombin Complex Concentrate\u003Cbr>􀀀 4 grams of fibrinogen concentrate over 5 min |  |\n|  | 􀀀 Platelets (if available):  if platelet count below 50 x109/L, 1 pool of platelets |  |\n|  | 􀀀 Calcium: 1g Calcium Chloride or 3g Calcium Gluconate iv push after pack 3 |  |\n| TERMINATION (time _ _ ","cbCaiofgJkrvNYJ3","https://ap.wps.com/l/cbCaiofgJkrvNYJ3","pdf",144475,"English","# Massive Hemorrhage Protocol (MHP) Checklist\n## Activation & Pack 1\n## Pack 2 and Pack 3\n## Termination and Return of Unused Products\n## HANDOVER SBAR Tool","[{\"question\":\"When should the Massive Hemorrhage Protocol (MHP) be activated for adult patients without plasma on site?\",\"answer\":\"Activate when massive hemorrhage management is required and plasma is not available on site, following the checklist’s activation and CODE TRANSFUSION steps, including calling hospital locating to activate the system.\"},{\"question\":\"What are the key actions during activation \\u0026 Pack 1, including TXA and hypothermia prevention?\",\"answer\":\"Administer TXA as specified, ensure patient identification bands and obtain group and screen and baseline blood work. Implement hypothermia prevention by measuring temperature, obtaining a blood warmer for all infusions, and starting active warming if temperature is below 36°C.\"},{\"question\":\"How does the checklist guide transfusion decisions and laboratory targets for Pack 2 and Pack 3?\",\"answer\":\"Use laboratory measures where feasible and review blood work to ensure targets are met (e.g., hemoglobin, INR, fibrinogen, and platelet thresholds). Continue staged MHP packs and reassess temperature, with active warming if below 36°C.\"}]","Adult Appendix C - Massive Hemorrhage Protocol (MHP) Checklist | PDF",1791165411]