[
  {
    "i": 0,
    "s": 0,
    "e": 23175,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Core workflow. Recognize hemorrhagic shock or impending massive blood loss, activate the M T P workflow, call Blood Bank, send type and screen, assign the runner, verify every product, and discontinue deliberately. The most important safety point is this: activation starts the workflow. Blood product administration orders and documentation are follow-through steps."
  },
  {
    "i": 1,
    "s": 23535,
    "e": 54310,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ICU prebrief. Adult critical care GI bleed with hemorrhagic shock while anticoagulated. Before the case starts, listen for these priorities: The first threat is hemorrhagic shock, not the rhythm. Stop/hold heparin per provider direction and start the reversal conversation without letting it slow the room down. M T P activation is a team process: nurse, provider, charge, runner, supervisor, Blood Bank. Move fast, but keep identifiers, cooler temperature, and product routes clean."
  },
  {
    "i": 2,
    "s": 54670,
    "e": 91395,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ICU, phase 1: Recognition. A 68-year-old male admitted for new-onset A fib with rapid ventricular response has been on heparin for 6 hours. He now has sudden coffee-ground emesis with frank blood, abdominal distention, and altered mentation. The monitor still matters, but the room needs to pivot to hemorrhage. Current cues: blood pressure 88/54, heart rate 128 A fib, oxygen saturation 94% 4L, GCS 13. Your decision point: What is the emergency, and what are your first priorities?"
  },
  {
    "i": 3,
    "s": 91755,
    "e": 133530,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Recognition. Say the problem out loud first: \"This is hemorrhagic shock until proven otherwise.\" The key actions are: Say the emergency out loud: this is hemorrhagic shock until proven otherwise. Stop or hold the heparin per provider direction and document the time. Call for help, notify charge RN, and prepare to activate M T P. Assess access, oxygenation, mental status, and ongoing blood loss. Common miss: A common miss is getting distracted by A fib and treating the rhythm as the main problem. Detail to keep: GI notified: GI consultation should be notified urgently once the patient is stabilized enough for source-control planning."
  },
  {
    "i": 4,
    "s": 133890,
    "e": 153015,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ICU, phase 2: Activation. The provider confirms hemorrhagic shock. Two large-bore IVs are in place. The patient is still unstable, and the room needs clear roles before products start arriving. Your decision point: Walk through the activation sequence and the information Blood Bank needs."
  },
  {
    "i": 5,
    "s": 153375,
    "e": 202500,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Activation. Think parallel work: one person calls, one person prepares access/equipment, one runner goes to Blood Bank. The key actions are: Notify charge RN and assign a runner. A nurse can activate M T P through the policy/workflow and Blood Bank communication when hemorrhagic shock is assessed. Provider places needed blood product administration orders in eRecord and documents activation as required. Call Blood Bank extension 6 5 4 4 with patient identifiers, location, and unit phone. Common miss: The dangerous shortcut is thinking the order alone activates M T P or skipping the specimen safeguards. Detail to keep: Call Blood Bank at extension 6 5 4 4 with name, DOB, MRN, location, and unit phone number."
  },
  {
    "i": 6,
    "s": 202860,
    "e": 221010,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ICU, phase 3: Product Safety. The first cooler arrives. The room is moving quickly, and this is where the team has to slow down just enough to verify the right product, route, patient, paperwork, and temperature. Your decision point: What do you verify before and during administration?"
  },
  {
    "i": 7,
    "s": 221370,
    "e": 280245,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Product Safety. Use a product-by-product mental stop sign: packed red blood cells/fresh frozen plasma are not the same as platelets/cryo. The key actions are: Check cooler temperature: 1-10 degrees Celsius and not above 10 degrees Celsius. Verify expected contents and patient identifiers before each unit. Read the product label; do not identify platelets or plasma by appearance. packed red blood cells and fresh frozen plasma may use warmer or rapid infuser. Common miss: The classic safety trap is hanging platelets on the rapid infuser because everyone is moving fast. Detail to keep: Standard first release: 4 packed red blood cells in the cooler, fresh frozen plasma thawed at 37 degrees Celsius and released separately/as available often 2 at a time, and 1 dose platelets; cryoprecipitate AHF is thawed and issued after 4 fresh frozen plasma have been released."
  },
  {
    "i": 8,
    "s": 280605,
    "e": 311730,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ICU, phase 4: Platelet Route. Four packed red blood cells and two fresh frozen plasma have been administered. blood pressure improves to 96/60, but the patient remains in A fib with heart rate 110. The attending orders the first platelet dose through the rapid infuser. The room also has a separate blood warmer available. Current cues: blood pressure 96/60, heart rate 110 A fib. Your decision point: What needs to be stopped before the platelets reach the patient?"
  },
  {
    "i": 9,
    "s": 312090,
    "e": 360940,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Platelet Route. Stop the unsafe route without stopping the whole resuscitation. The key actions are: Stop both unsafe routes before administration: platelets should not go through a rapid infuser or any blood warmer. Clarify with the provider: the rapid infuser has a warmer built in, and a separate warmer is also unsafe for platelets. Switch to standard blood tubing with a blood product filter, without pressure. Read the label, not the appearance. Cold-stored platelets can look like plasma/fresh frozen plasma and should have a bright yellow warning label. Common miss: The common miss is letting the platelet order ride because the room is moving fast. Detail to keep: If the team misses it, pause on why heat and pressure damage platelets and why plain IV tubing is not the same as blood tubing with a filter."
  },
  {
    "i": 10,
    "s": 361300,
    "e": 382250,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ICU, phase 5: Cooler Temperature. The platelet issue is corrected. The next two fresh frozen plasma are ready after thawing and arrive separately. The cooler holding cold products reads 12 degrees Celsius. Current cues: Cooler 12 degrees Celsius. Your decision point: What do you do before using products from this cooler?"
  },
  {
    "i": 11,
    "s": 382610,
    "e": 432660,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Cooler Temperature. Temperature safety is part of transfusion safety, even during M T P. The key actions are: Do not transfuse products from that cooler until Blood Bank gives direction. State the problem clearly: the cooler should be 1-10 degrees Celsius, so 12 degrees Celsius is out of range. Tell charge RN and call Blood Bank extension 6 5 4 4; return the cooler/products as directed. Request replacement products if the patient still needs them. If handled correctly, replacement products return in a cooler reading 6 degrees Celsius. Common miss: Treating 12 degrees Celsius as close enough during an emergency. Detail to keep: If not communicated, the next cooler arrives at 13 degrees Celsius and products are discarded. Debrief the time loss and patient-safety risk."
  },
  {
    "i": 12,
    "s": 433020,
    "e": 458145,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ICU, phase 6: Close the Loop. After multiple products, the patient stabilizes. The provider decides to discontinue M T P. The emergency feels quieter, but Blood Bank and documentation are not finished yet. Current cues: blood pressure 108/66, heart rate 96 A fib, GCS 15. Your decision point: Bleeding appears controlled and vital signs have stabilized. What happens next?"
  },
  {
    "i": 13,
    "s": 458505,
    "e": 507005,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Close the Loop. The end of M T P is an active process, not simply \"the patient is stable.\" The key actions are: Provider or designee calls Blood Bank extension 6 5 4 4 immediately to discontinue M T P. Provider closes related blood product orders/documentation in eRecord as appropriate. Return all remaining products and the cooler to Blood Bank. Document total units by product type, M T P start/end time, vital signs, and reactions or complications. Common miss: A frequent waste and safety issue is failing to notify Blood Bank, so they keep preparing products. Detail to keep: If 1 unit fresh frozen plasma is currently infusing at discontinuation, confirm with the provider whether it should be completed."
  },
  {
    "i": 14,
    "s": 507365,
    "e": 537765,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ICU recap. Name hemorrhagic shock early, activate the M T P workflow, call Blood Bank, and assign a runner with a patient label. Do not let atrial fibrillation, heparin, or reversal discussions delay product replacement and source control. packed red blood cells and fresh frozen plasma may use a warmer or rapid infuser. Platelets and cryoprecipitate do not. Check the cooler before using products, and close the loop with Blood Bank as soon as M T P is stopped."
  },
  {
    "i": 15,
    "s": 538125,
    "e": 566725,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OB prebrief. Postpartum hemorrhage with instability and escalation to M T P. Before the case starts, listen for these priorities: Use quantified blood loss plus perfusion signs, not reassurance. M T P may be initiated after the second packed red blood cells in OB with continued hemorrhage. Role clarity prevents chaos: primary RN, provider, charge, runner, supervisor. Transfer to OR requires a structured handoff and clear infusion responsibility."
  },
  {
    "i": 16,
    "s": 567085,
    "e": 592010,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OB, phase 1: Recognition. A postpartum patient has quantified blood loss over 2000 mL, ongoing bleeding, pallor, diaphoresis, tachycardia, and decreasing blood pressure despite standard uterotonic management. Current cues: quantified blood loss > 2000 mL, blood pressure falling, heart rate rising. Your decision point: What tells you this is more than routine postpartum bleeding?"
  },
  {
    "i": 17,
    "s": 592370,
    "e": 644945,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Recognition. quantified blood loss matters, but the patient matters more. Pair blood loss with perfusion signs. The key actions are: Recognize postpartum hemorrhage with hemorrhagic shock. Escalate beyond routine uterotonic management. Call for help and prepare for M T P activation. Name the risk out loud so the team aligns around hemorrhage. Common miss: The miss is waiting for one more intervention while perfusion is already failing. Detail to keep: The patient is a 28-year-old G1P1, 2 hours after a normal spontaneous vaginal delivery. quantified blood loss is 2,000 mL and rising despite standard uterotonics, TXA, and JADA placement. Two large-bore IVs are in place, the patient is on non rebreather oxygen, and 2 units packed red blood cells have already been administered."
  },
  {
    "i": 18,
    "s": 645305,
    "e": 659480,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OB, phase 2: Activation. The patient has received packed red blood cells and continues to bleed. The team needs to activate the OB M T P workflow. Your decision point: Who does what in the first few minutes?"
  },
  {
    "i": 19,
    "s": 659840,
    "e": 701490,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Activation. Closed-loop communication is the intervention: name the person and task. The key actions are: Nurse or attending can initiate per OB criteria when met. Provider places needed blood product orders in eRecord and documents activation as required. Call Blood Bank extension 6 5 4 4 with identifiers, location, and OB phone. Charge RN assigns runner/designee and notifies supervisor. Common miss: The miss is everybody assuming someone else called Blood Bank. Detail to keep: Call Blood Bank extension 6 5 4 4 with patient name, DOB, MRN, OB location, and OB unit phone."
  },
  {
    "i": 20,
    "s": 701850,
    "e": 714825,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OB, phase 3: Product Safety. M T P products arrive while the patient is being prepared for possible transfer to OR. Your decision point: What product handling rules cannot be skipped?"
  },
  {
    "i": 21,
    "s": 715185,
    "e": 756235,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Product Safety. Do not let transfer pressure erase product rules. The key actions are: Check cooler temperature before use. Use two-person verification for each unit. packed red blood cells and fresh frozen plasma may use warmer/rapid infuser. cold stored platelets platelets use standard blood tubing with a blood product filter and not pressure. Common miss: The miss is putting newly thawed fresh frozen plasma into a cooler or running platelets under pressure. Detail to keep: Cooler temperature must be 1-10 degrees Celsius and cannot exceed 10 degrees Celsius; if above 10 degrees Celsius, do not use products and return the entire cooler to Blood Bank."
  },
  {
    "i": 22,
    "s": 756595,
    "e": 769520,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OB, phase 4: Transfer and Stop. The patient is transferred to OR for source control, then stabilizes after intervention. Your decision point: What handoff and discontinuation steps close the loop?"
  },
  {
    "i": 23,
    "s": 769880,
    "e": 810705,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Transfer and Stop. The receiving team needs the story, the numbers, and what is still active. The key actions are: Use SBAR: situation, delivery/quantified blood loss, products given, hemodynamics, active infusions. Clarify who manages infusions during OR transfer. Do not discontinue M T P until surgical control is confirmed. Provider or designee calls Blood Bank to stop M T P. Common miss: The miss is transfer without a shared product count and M T P status. Detail to keep: During OR transfer, anesthesia manages infusions and documents on the anesthesia record."
  },
  {
    "i": 24,
    "s": 811065,
    "e": 837765,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OB recap. In postpartum hemorrhage, call early and assign roles out loud. Hand off quantified blood loss, interventions, products already given, active infusions, and M T P status when the patient moves. Platelets do not go through a warmer or rapid infuser. Thawed fresh frozen plasma is released separately and should not go into the cooler. At the end, call Blood Bank, return products, document totals, and send the paper record where it belongs."
  },
  {
    "i": 25,
    "s": 838125,
    "e": 872000,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OR prebrief. Perioperative M T P after OB transfer with intraoperative product management. Before the case starts, listen for these priorities: The OR inherits both the patient and the M T P process. Anesthesia and circulating RN verification must be explicit. Cooler contents and thawed fresh frozen plasma are handled separately. Documentation may shift to anesthesia/code documentation during active rapid transfusion. ICU transfer requires handoff from both circulating RN and anesthesia."
  },
  {
    "i": 26,
    "s": 872360,
    "e": 891335,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OR, phase 1: Receiving the Patient. A patient arrives from OB with active hemorrhage and M T P in progress. Products have already been given and the OR team is taking over. Current cues: Active hemorrhage, M T P active. Your decision point: What must the OR team confirm immediately?"
  },
  {
    "i": 27,
    "s": 891695,
    "e": 934970,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Receiving the Patient. Inherited emergencies need a deliberate reset before the next action. The key actions are: Receive SBAR from OB nurse. Confirm M T P is active, products given, quantified blood loss, IV access, and current status. Anesthesia takes over hemodynamic management and product administration. Circulating RN confirms activation/documentation, blood product orders, and Type and Screen status. Common miss: The miss is starting the case without knowing what products already went in. Detail to keep: The OR inherits both the patient and the M T P process; do not assume prior-unit verification covers the OR phase."
  },
  {
    "i": 28,
    "s": 935330,
    "e": 952005,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OR, phase 2: OR Activation and Verification. Anesthesia may need to continue the active M T P workflow or activate it from the OR while products are arriving. Your decision point: What verification and communication steps protect the patient?"
  },
  {
    "i": 29,
    "s": 952365,
    "e": 993890,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for OR Activation and Verification. Every receiving area owns its part of verification. The key actions are: Anesthesia provider documents activation/continuation and places needed blood product orders in eRecord. Call Blood Bank extension 6 5 4 4 with identifiers and OR location/phone. Assign a perioperative aide runner with patient label. Verify each unit with anesthesia and circulating RN using two identifiers and tags. Common miss: The miss is assuming ED/OB verification covers the OR phase. Detail to keep: Call Blood Bank with patient name, DOB, MRN, OR location, and OR phone number."
  },
  {
    "i": 30,
    "s": 994250,
    "e": 1016500,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OR, phase 3: No Type and Screen in OR. A patient is already in surgery without a preoperative Type and Screen. An artery is nicked, and anesthesia wants to initiate M T P and have 2 units of blood sent. Current cues: No pre-op type and screen, Unexpected arterial bleeding. Your decision point: What must happen so emergency blood can be issued safely?"
  },
  {
    "i": 31,
    "s": 1016860,
    "e": 1083035,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for No Type and Screen in OR. This is a speed-and-identity problem. Move fast, but keep the labels and specimens clean. The key actions are: Activate through the OR workflow/Blood Bank call; anesthesia/provider places blood product and Type and Screen orders and documents follow-through. Circulating RN checks chart for Type and Screen status, calls lab/Blood Bank extension 6 5 4 4, states M T P is being activated, and confirms patient information. Charge RN assigns a perioperative aide runner and anesthesia tech support. Circulating RN labels the pink-top tube with patient sticker plus handwritten date, time, and collector initials. Common miss: The miss is getting emergency blood moving but losing the Type and Screen, confirmatory specimen, label, or emergency-release paperwork loop. Detail to keep: Crossmatched units are better for the patient and preserve limited O-negative blood. That depends on getting both the initial and confirmatory Type and Screen specimens safely collected."
  },
  {
    "i": 32,
    "s": 1083395,
    "e": 1096770,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OR, phase 4: ICU Transfer. Bleeding is controlled and the patient will transfer to ICU with ongoing monitoring needs. Your decision point: What makes this handoff complete?"
  },
  {
    "i": 33,
    "s": 1097130,
    "e": 1144505,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for ICU Transfer. Handoff the M T P as its own active problem. The key actions are: Coordinate ICU bed, monitors, transfer team, and respiratory/anesthesia support as needed. Handoff by circulating RN and anesthesia to ICU RN. Include total products, M T P status, procedure, hemodynamics, active infusions, and documentation location. Provider or designee calls Blood Bank to discontinue when appropriate. Common miss: The miss is handing off the surgery but not the transfusion episode. Detail to keep: Transfer team may include RN circulator, anesthesia provider, anesthesia tech, perioperative aide or other available personnel, and respiratory."
  },
  {
    "i": 34,
    "s": 1144865,
    "e": 1173190,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "OR recap. The OR team owns verification from the moment the patient enters the room. Confirm active M T P status, products already given, Type and Screen, emergency release paperwork, and who is documenting. fresh frozen plasma is thawed at 37 degrees Celsius and stays separate from the cooler. ICU handoff must include the procedure, hemodynamics, active infusions, product totals, documentation location, and whether M T P is still active."
  },
  {
    "i": 35,
    "s": 1173550,
    "e": 1225500,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ED prebrief. Trauma arrival with massive chest bleeding, chest tube insertion, ED M T P workflow, and transfer to Strong. Before the case starts, listen for these priorities: Prepare for traumatic hemothorax with chest tube placement, extensive bloody output, and possible ED M T P activation. Prioritize ED hemorrhage workflow: trauma bay setup, Level 1 rapid infuser plugged in/warming, Blood Bank communication, Type and Screen, emergency release products, cooler paperwork, and transfer planning. ED providers do not place a chart order called \"M T P.\" The activation workflow is separate from the transfusion/blood product orders they place after the fact. The cooler paperwork is an ED safety task: the ED physician completes it and it returns to Blood Bank with the cooler."
  },
  {
    "i": 36,
    "s": 1225860,
    "e": 1255810,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ED, phase 1: Pre-arrival. EMS reports a 64-year-old male with a tractor crush injury to the chest. He is alert, has absent breath sounds on the left, and had left chest needle decompression in the field. They are 20 minutes out. Current cues: blood pressure 89/62, heart rate 125, respiratory rate 24, oxygen saturation 96% non rebreather, Pain 10/10. Your decision point: What should the ED prepare before the patient arrives?"
  },
  {
    "i": 37,
    "s": 1256170,
    "e": 1314620,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Pre-arrival. Keep the priority clear: chest trauma, chest tube, extensive blood output, emergency release products, transfer to Strong. The key actions are: Anticipate massive chest bleeding from traumatic hemothorax and possible M T P. Prepare trauma bay, blood warmer, Level 1 rapid infuser plugged in/warming, large-bore IV supplies, and chest tube tray. Notify trauma team, respiratory therapy, provider, charge RN, and Blood Bank of a possible M T P. Prioritize ED hemorrhage workflow and transfer planning once chest tube output confirms major bleeding. Common miss: The miss is treating this as a routine trauma setup instead of preparing the ED hemorrhage/M T P workflow and transfer plan. Detail to keep: Charge RN can give Blood Bank a heads-up that a patient possibly requiring M T P is inbound, but product release is confirmed after patient arrival assessment."
  },
  {
    "i": 38,
    "s": 1314980,
    "e": 1347755,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ED, phase 2: Arrival and Activation. The patient arrives pale and diaphoretic but maintaining oxygenation. A left chest tube is inserted and immediately returns a large amount of blood. The ED team identifies massive bleeding from the chest/lung and activates the ED M T P process. Current cues: blood pressure 82/50, heart rate 132, oxygen saturation 96% non rebreather, Extensive chest tube output. Your decision point: How do you activate and obtain first products?"
  },
  {
    "i": 39,
    "s": 1348115,
    "e": 1410115,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Arrival and Activation. The faster the room moves, the more important identifiers become. The key actions are: Activate the ED M T P workflow by calling Blood Bank extension 6 5 4 4 with patient identifiers, ED location, and unit phone. Do not look for a chart order named M T P in the ED; providers place transfusion and blood product orders after the fact and document activation in a provider note as required. Send runner/designee with patient sticker to Blood Bank for emergency-release blood and cooler pickup. Draw Type and Screen immediately with correct pink-top tube, label, and collection information. Common miss: The miss is documenting this like an inpatient M T P order set. ED workflow is activation plus after-the-fact transfusion/product orders, not a chart M T P order. Detail to keep: The cooler comes with paperwork the ED physician must complete; that paperwork must return to Blood Bank with the cooler."
  },
  {
    "i": 40,
    "s": 1410475,
    "e": 1425375,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ED, phase 3: Products and Paper Trail. Initial emergency-release products arrive in a cooler while Type and Screen is still en route to Blood Bank. Your decision point: What must the ED team remember about product handling?"
  },
  {
    "i": 41,
    "s": 1425735,
    "e": 1473560,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Products and Paper Trail. Emergency release changes the paperwork burden; it does not remove verification. The key actions are: Use emergency uncrossmatched blood until Type and Screen reaches Blood Bank. Female patient: O-negative blood. Male patient: O-positive or O-negative blood depending on Blood Bank supply/process. ED physician completes the cooler paperwork; cooler and paperwork return to Blood Bank. packed red blood cells and fresh frozen plasma may use warmer/rapid infuser; platelets and cryo do not. Common miss: The miss is assuming usual inpatient product ordering and scanning workflow applies cleanly in ED emergency release. Detail to keep: The cooler paperwork is part of the safety process, not optional cleanup."
  },
  {
    "i": 42,
    "s": 1473920,
    "e": 1489270,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ED, phase 4: Transfer to Strong. The chest tube continues to put out a large amount of blood. The patient is not being sent to CT; trauma transfer to Strong is initiated. Your decision point: What must travel with the patient and handoff?"
  },
  {
    "i": 43,
    "s": 1489630,
    "e": 1539055,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Transfer to Strong. Transfer is not just transport. It is the moment to close M T P locally and hand off the product story. The key actions are: SBAR handoff to the transfer/receiving team: mechanism, chest tube placement, chest tube output, products given, hemodynamics, and active infusions. Expect transfer to Strong for trauma care rather than CT scanning at Thompson. Discontinue M T P at transfer so Blood Bank does not continue preparing products for a patient leaving the facility. Return the cooler and ED physician-completed paperwork to Blood Bank. Common miss: The miss is transferring the patient while Blood Bank continues preparing products or while cooler paperwork remains incomplete. Detail to keep: The endpoint is transfer to Strong, not ED-to-OR at Thompson."
  },
  {
    "i": 44,
    "s": 1539415,
    "e": 1564690,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "ED recap. Prepare for massive chest bleeding before the patient arrives, but confirm the need for products after assessment. Draw Type and Screen, use the correct emergency uncrossmatched blood workflow, keep cooler paperwork with the ED physician process, and set up the rapid infuser correctly. At transfer, give the receiving team the product story and call Blood Bank so products do not keep being prepared after the patient leaves."
  },
  {
    "i": 45,
    "s": 1565050,
    "e": 1597275,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Observation / Med-Surg prebrief. Floor patient with hemorrhagic shock, Rapid Response Team activation, and escalation to OR for source control. Before the case starts, listen for these priorities: On a floor unit, the key move is early recognition plus escalation. Rapid Response Team and M T P thinking can happen in parallel. For adult patients, the nurse or attending may activate M T P when criteria are met per policy. Transfer requires SBAR plus active product and documentation status."
  },
  {
    "i": 46,
    "s": 1597635,
    "e": 1620035,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Observation / Med-Surg, phase 1: Recognition on the Floor. A post-surgical Med-Surg patient becomes pale, diaphoretic, increasingly confused, tachycardic, and hypotensive with new abdominal distention. Current cues: blood pressure 82/48, heart rate 132, Confused. Your decision point: What do you recognize, and what help do you call?"
  },
  {
    "i": 47,
    "s": 1620395,
    "e": 1665595,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Recognition on the Floor. Rapid Response Team brings help; it does not replace your recognition. The key actions are: Recognize hemorrhagic shock from possible post-surgical bleeding. Call Rapid Response extension 6 6 6 6 and state unit/room twice. Notify provider/covering hospitalist immediately. Begin bedside support: oxygen, IV access, positioning, vital signs, and focused assessment. Common miss: The miss is waiting for the Rapid Response Team to arrive before thinking about M T P. Detail to keep: This is a post-surgical floor patient with signs of possible hemorrhage: pallor, diaphoresis, confusion, tachycardia, hypotension, and new abdominal distention."
  },
  {
    "i": 48,
    "s": 1665955,
    "e": 1683330,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Observation / Med-Surg, phase 2: Activation with Rapid Response Team. Rapid Response Team arrives. The clinical picture supports hemorrhagic shock and active bleeding. Your decision point: How does the floor team activate M T P without losing role clarity?"
  },
  {
    "i": 49,
    "s": 1683690,
    "e": 1734440,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Activation with Rapid Response Team. If the criteria are clear, do not let hierarchy slow activation. The key actions are: For adult patients, the nurse or attending may activate M T P per policy when criteria are met. Provider places needed blood product orders in eRecord and documents activation as required. Call Blood Bank extension 6 5 4 4 with identifiers, location, and unit phone. Charge RN assigns runner/designee and notifies supervisor. Common miss: The miss is assuming only the Rapid Response Team leader can start the M T P process. Detail to keep: Notify covering provider or hospitalist immediately; they may also activate M T P, but the nurse does not need to wait if criteria are clear and policy allows activation."
  },
  {
    "i": 50,
    "s": 1734800,
    "e": 1749300,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Observation / Med-Surg, phase 3: Support Products Safely. Blood products arrive to a unit that does not handle M T P every day. Your decision point: What safety checks need extra attention on the floor?"
  },
  {
    "i": 51,
    "s": 1749660,
    "e": 1796310,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Support Products Safely. When the process is rare, slow down at product boundaries. The key actions are: Check cooler temperature before product use. Use two-RN verification with patient identifiers and tags. packed red blood cells and fresh frozen plasma may use warmer/rapid infuser if available and appropriate. Platelets and cryo must not go through warmer or rapid infuser. Common miss: The miss is unfamiliarity: assuming all products use the same line setup. Detail to keep: Floor units may handle M T P less often, so use the checklist deliberately: cooler temperature, product match, two identifiers, provider-signed emergency release paperwork, product tag signature, vital signs, unit number, and start/stop times."
  },
  {
    "i": 52,
    "s": 1796670,
    "e": 1813495,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Observation / Med-Surg, phase 4: Transfer to OR. The surgeon is heading to OR. The patient is moving for emergency surgical re-exploration, then likely ICU post-op. Your decision point: What does OR/anesthesia need in the handoff?"
  },
  {
    "i": 53,
    "s": 1813855,
    "e": 1867305,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Facilitator takeaway for Transfer to OR. M T P handoff is not optional detail. It is patient safety information. The key actions are: SBAR with trigger, Rapid Response Team course, suspected surgical source, products given, and response. State that M T P is active and should not be deactivated until source control is confirmed. Send product documentation, emergency release forms, and tags per process. Clarify remaining products, cooler status, and who called Blood Bank. Common miss: The miss is giving a general transfer report without the M T P operational details. Detail to keep: OR/anesthesia handoff should include whether Rapid Response Team was called, who activated M T P, Blood Bank notification status, product totals, current hemodynamics, active infusions, remaining products, cooler status, surgical history, and outstanding documentation."
  },
  {
    "i": 54,
    "s": 1867665,
    "e": 1893340,
    "a": null,
    "v": "A",
    "speaker": "Alex",
    "voice": "am_adam",
    "t": "Observation and Med Surg recap. Escalate early. Call Rapid Response, state the unit and room clearly, and organize the bedside while help is coming. M T P can be activated before ICU arrival when the bleeding emergency is clear. Use SBAR, send the Type and Screen, assign the runner, verify products carefully, and hand off M T P status and product totals when the patient moves."
  }
]