Management of blood system in disasters.

Managing the blood system in disasters is one of the main challenges for any blood transfusion service exposed to natural hazards such as earthquakes, floods and tsunamis, biological threats such as pandemic influenza as well as manmade disruptions and terrorism. Sri Lanka had to face contrasting types of situations. The most unexpected and dreadful one was the 2004 December 26 tsunami catastrophe which cost >30,000 human lives, leaving more than 23,000 injured. Health services were over-burdened with influx of dead bodies and injured people, most due to drowning. Injuries varied from small lacerations to deeper wounds, broken arms, legs, ribs, damaged organs and head injuries. The National Blood Transfusion Service, had to coordinate its blood supply effectively and to manage large number of blood donors during the first few days following tsunami. In contrast to the acute destruction of tsunami, Sri Lanka also faced a "chronic disaster" of 3 decades due to the separatist war waged by the Tamil Tigers, until it was completely terminated in 2009. There were large scale terrorist attacks using suicide bombers, land mines and claymore mines resulting in frequent influxes of dead bodies and injured patients to hospitals. The experiences of Sri Lanka blood system in the face of two contrasting types of disastrous situations are presented.