Composition, Quality and Delivery of Major Haemorrhage Protocols (MHP) and critical bleeding clinical practice guidelines in hospitals across Queensland Health

Grant ID: EMLE-221R37-2022-FORBES

Project Summary

Major bleeding is a leading cause of death in trauma patients. Blood product replacement is a key component of damage control resuscitation aimed at limiting coagulopathy until definitive control of bleeding is achieved. Although Major Haemorrhage Protocols (MHP) are now widely used in the initial resuscitation of traumatically injured patients (1), protocols can vary based upon individual institutions' capabilities and processes.

Within Australia, the National Blood Authority 2011 Patient Blood Management Guideline Module 1: Critical Care/ Massive Transfusion (2) recommended institutions develop standardized MHP to guide clinicians regarding the dose, timing and ratio of blood component therapy for bleeding trauma patients. However, it is currently unknown if these guidelines are implemented and if so, what institutional variations occur. While the guidelines provide a robust review of the evidence base for MHP, there is little information about the logistics of MHP implementation.

Our project aims are firstly to compare the available trauma bleeding protocols across Queensland for content and quality. Secondly, we wish to understand the institution's capabilities of delivering an MHP in terms of the structure and processes available to them. Thirdly we want to explore the experiences of clinicians involved in delivering an MHP for trauma patients in both tertiary, rural and remote hospitals within Queensland.

Expected benefits are to identify potential disparity of care for trauma patients in terms of MHP content, availability of resources and access to blood products. This information can help guide improvements in education, blood products availability and cost-effective care across Queensland.



- Forbes, J., Composition, Quality and Delivery of Major Haemorrhage Protocols (MHP) and critical bleeding practice guidelines in hospitals across Queensland Health. Australia New Zealand Trauma Society (ANZTS) Trauma 2023 Conference, October 2023, Melbourne, Australia


Amount Awarded


Grant Scheme


Principal Investigator:
Dr Jessica Forbes

Co Investigators:
Ms Elizabeth Wake
A/Prof Shane George
Ms Tash Adams
Dr Caitlin Brandenburg
Dr Clinton Gibbs
Dr Don Campbell OAM
Dr Alistair Hamilton
Dr James Winearls

Associate Investigators:
Dr John Casey
Dr Jack Righton
Ms Michelle Jeffress
Ms Paressa Cresswell
Dr Daniel Bodnar


Collaborating Institutions

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