Page 32 - JSOM Winter 2024

Blood

The Liquid Will to Fight

Jesspal S. Bachhal, MBA *; Arturo P. Diaz, MS ; F. Y. Bowling, BHSc, NRP 3
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Introduction
Mortality risk increases by 5% for every minute blood is de- is then sent to a central repository center called the Armed
layed for an exsanguinated trauma patient.¹ Blood is type- Services Whole Blood Processing Laboratory (ASWBPL). The
specific, temperature-sensitive, and quick to expire, (42 days ASWBPL maintains both blood and blood products for con-
shelf life when stored appropriately), making it difficult to tingencies/wartime. CL VIII(B) required in theater is sent to a
plan for and use without appropriate training and equipment. central shipment point within that theater.
The Joint Staff Surgeon has recommended the following plan-
ning factors: 20% of wounded in action (WIA) will require This central point is known as the Expeditionary Blood Trans-
blood; each WIA requiring blood will need 8 units. 2 shipment Center (EBTC) and is responsible for issuing blood
to Blood Supply Units (BSUs).
Universal whole blood transfusion for U.S. Forces was first
performed in 1917 by U.S. Army Captain Oswald Robertson Current doctrine states that the BSU is responsible for the lo-
in World War I. His first blood bank consisted of 22 bottles of gistical movement of blood from the EBTC to the Blood Prod-
universal whole blood, which helped resuscitate 20 Soldiers. uct Depot (BPD). BSUs can go as far forward as the Role 2,
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By World War II, the U.S. Military was able to provision over depending on what is designated in the operation plan based
340,000 pints of whole blood, which played a vital role in on their capabilities.
treating the wounded in the European theater of operations. 4
The BSU role is normally assigned to a fixed Military Treat-
The Vietnam War presented the first opportunity for the U.S. ment Facility (MTF), a casualty receiving ship, or a Role 3. 6
Military’s blood program to use type-specific blood groups
on a large scale; of the 100,419 universal donor transfusions, The EBTCs, BSUs, and BPDs are all managed by the Joint
there were zero reported deaths from transfusion incompat- Blood Program Officer (JBPO). The JBPO is typically a Lab-
ibility. However, there were 9 reported deaths attributed to oratory Officer and, if assigned to a Joint Task Force, should
hemolytic transfusion reactions, even after extensive cross- be appointed to serve as the single integrated medical logis-
matched blood compatibility testing. 5 tics manager for joint blood operations. The JBPO advises the
Geographic Combatant Command Surgeon on all matters con-
These historical records are provided to show that blood cerning theater blood operations and exercises responsibility
transfusion and banking are not new concepts, and although for managing the Geographic Combatant Commander’s (GCC)
risk is present, this commodity is vital for sustaining combat blood program. Figure 1 outlines the flow of this process.
power and preventing death.
For GCCs without an assigned JBPO, the Command Surgeon
The aim of this article is to create shared understanding to must designate a blood program officer that can provide sup-
help future practitioners quickly become familiar with today’s port for theater blood operations. 6
current information, and empower them with tactical, opera-
tional, and strategic planning considerations so that they can Depending on geographic size of the military operation, or
formulate blood supply into their sustainment plan with con- based on mission requirements, the GCC may designate one
fidence in tomorrow’s fight. or more Area Joint Blood Program Officers (AJBPO) who can
plan, coordinate, and communicate the same way as the JBPO
does, but within a more defined geographical area.
Blood Support Standard Operating Procedures
Whole blood and blood products, or CL VIII(B), are managed These officers need to be knowledgeable enough to coordinate
by a joint effort through the Armed Services Blood Program. deliveries of blood products to area facilities and then report
Due to Title 10 of the United States Code, any blood products to the JBPO as well as their respective command element. The
collected and stored must meet the FDA-approved standard AJBPO is responsible for making sure the blood distribution pro-
for collection. gram for their assigned geographic area’s operation is working. 6

Blood product collection typically takes place in an Armed Medical providers requesting or holding CL VIII(B) are re-
Services Blood Donor Center (BDC). Collected blood product quired to use two standardized message formats set by the
*Correspondence to jesspal.s.bachhal.mil@socom.mil
1 CPT Jesspal S. Bachhal is a 70K8X, currently serving as the Chief of Medical Acquisitions and Logistics within USSOCOM Surgeon’s Office
in Tampa, FL. MAJ Arturo P. Diaz is a 70K8X, currently serving as the Military Deputy for Logistics & Technical Support Directorate (LTSD),
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within Army Medical Logistics Command (AMLC) at Fort Detrick, MD. SGM (Ret.) F. Y. Bowling is a prior service 18D and 18Z, currently
serving as the Biomedical Lead within the USSOCOM SOF AT&L-ST Directorate in Tampa, FL.
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