Blood product availability in the Washington state trauma system.

BACKGROUND: Early transfusion can prolong life in injured patients awaiting definitive hemorrhage control. We conducted a community resources assessment of blood product availability at hospitals within the Washington State (WA) Regional Trauma System, with the expectation that a minority of Level IV and V centers would have blood products routinely available for use in resuscitation. METHODS: We designed a questionnaire soliciting information on routinely available unit quantities of red blood cells (RBC), plasma, platelets, cryoprecipitate, and/or whole blood and submitted this questionnaire electronically to the 82 WA designated trauma centers (Levels I-V). Non-responders were contacted directly by telephone. The study was conducted in September and October 2021. US 2020 census data were used to correlate results with local population densities. RESULTS: First-round contact netted responses from 57 (70%) centers; the remaining centers provided information via telephone, for a 100% final response. Packed RBC were available in 79 of the 82 centers (96%; range 6-220 units); plasma, 62 centers (76%, range 1-100 units); platelets, 40 centers (49%, range 1-8 units); cryoprecipitate, 45 centers (55%, range 1-20 units). Whole blood was only available at the Level I center. Three Level V centers, located in 2 of the 8 WA state trauma regions, reported no routine blood availability. The two trauma regions affected represent 12% of the state's population and more than a third of its geographic area. CONCLUSIONS: Within the WA regional trauma system, blood products are wide, if unevenly, available. Large urban/rural disparities in availability exist that should be explored.

Evolution and functional significance of tendon ossification in woodcreepers (Aves: Passeriformes: Dendrocolaptinae).

The woodcreepers, a clade of scansorial, neotropical birds, are distinctive among passerines in having extensive tendon ossification. Dissection of 42 of the 50 species indicates that such ossification in the hindlimb is limited almost entirely to tendons of insertion of the crural muscles. Most crural muscles have ossifications, and in all but one the ossified tendons are long and thin. Preliminary dissection revealed a similar pattern among ossified wing tendons. Phylogenetic analysis suggests that extensive tendon ossification is a synapomorphy of the woodcreepers. The species of Dendrocincla, which form a clade, show secondary reduction of ossification in some tendons, which may be correlated with increased intraspecific variation and with an expansion of foraging habits and postures to include nonscansorial behaviors. In contrast, the larger woodcreepers, other than Drymornis bridgesii and Nasica longirostris, form a clade with virtually no loss in ossification or evidence of intraspecific variation, even in large series of two species. Phylogenetic losses do not occur for the primary flexor of the ankle (M. tibialis cranialis), whereas two extensors (Mm. fibularis longus and gastrocnemius pars lateralis) show a complex pattern of derivation and loss. Previous biomechanical studies demonstrate that ossification increases the stiffness of tendons, making them stretch less under a given force. These structural and phylogenetic patterns are consistent with the view that hindlimb tendon ossification in woodcreepers is an adaptation to resist increased forces that act to extend the limb during vertical climbing. © 1993 Wiley-Liss, Inc.