Page 13 - JSOM Spring 2026

Perceived Performance Traits of Blood Warming Devices

Among Special Warfare Medics

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Seth Williams, DO, MC ; Wayne Papalski, NREMT-P, HMCS ; Matthew A. Tovar, MD, MC *;
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Lorie Gower ; Christopher Treager, MD, MC ; Eric J. Koch, DO, MC ;
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Eric Sulava, MD, MC ; Emily Friedrich, PhD ; Brittany Dellinger, MS, MBA 9
ABSTRACT
Background: Hypothermia is a major driver of trauma-induced Introduction
coagulopathy on the battlefield. Several portable blood warm-
ers have been developed for use in forward-deployed prehos- Hemorrhage remains the leading cause of preventable death in
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pital environments; however, end-user preferences for device military trauma patients. Beyond direct blood loss, a critical
use have not previously been investigated. Methods: A con- contributing factor to mortality in severely injured patients is
venience sample of Naval Special Warfare (NSW) Corpsmen the “trauma diamond of death”: hypothermia, coagulopathy,
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(HMs, n=35) were surveyed regarding their perceived usabil- acidosis, and hypocalcemia. Even mild hypothermia exacer-
ity of five blood warmer devices: the QinFlow , M Warmer, bates coagulopathy, impairs platelet function, and contributes
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Buddy Lite , Thermal Angel , and the North American Rescue to metabolic acidosis, creating a vicious cycle that significantly
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(NAR) Quantum . The Likert-based survey was built around increases the risk of mortality. Seminal studies by Jurkovich et
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evaluating three domains: ease of use, device ruggedness, and al. and Luna et al.have long highlighted the devastating impact
perceived device efficacy. Responses were quantified and com- of hypothermia on trauma outcomes, underscoring the urgent
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pared using the Kruskal-Wallis test and the chi-square test, need for effective warming strategies in prehospital settings.
as appropriate. Statistical significance was defined as P<.05.
Qualitative responses were summarized into major themes. The American Association for the Surgery of Trauma and the
Results: The M Warmer received the highest overall scores in American College of Surgeons Committee on Trauma recom-
all three domains with statistically significant differences iden- mend active rewarming for any trauma patient with a core
tified across most comparisons to other warmers. Qualitative temperature below 37°C, emphasizing that hypothermia is in-
analysis reinforced these findings, emphasizing the importance dependently associated with increased blood product require-
of compactness, intuitive deployment, and device reliability ments and mortality, and that aggressive correction mitigates
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in austere environments. The M Warmer was the most fre- this risk. Effective blood and fluid warming devices are cru-
quently preferred device (45%, P=.0067), with users citing cial tools towards achieving this resuscitation goal, particu-
portability, rapid setup, and compatibility with existing gear larly in austere prehospital environments where maintaining
as key advantages. Conclusion: In this cohort of NSW HMs, core body temperature is challenging yet integral in ensuring
user-centered evaluation of field blood warmers identified the patient survival.
M Warmer as the most operationally favorable device. Prefer-
ences were shaped not only by perceived effectiveness but by A review of the current blood warmers market identified five
factors directly relevant to forward-deployed settings: portabil- portable blood and fluid warmers in routine or emerging pre-
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ity, intuitive operation, and logistical simplicity. These findings hospital use: the QinFlow Warrior/Warrior Lite, MEQU M
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underscore the importance of integrating end-user feedback Warmer , Buddy Lite , Thermal Angel , and North American
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into medical equipment acquisition. Rescue (NAR) Quantum . Within the military medical system,
the primary goal of these devices is to rapidly deliver resus-
Keywords: blood transfusion; trauma; resuscitation; prehospital citation fluids at or near physiologic temperature (approx-
emergency care; military medicine imately 37°C) to prevent transfusion-induced hypothermia
*Correspondence to Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708, or matthew.a.tovar2.mil@health.mil
1 LT Seth Williams is a resident physician affiliated with the Combat Trauma Research Group within the Department of Emergency Medicine
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at the Naval Medical Center Portsmouth, Portsmouth, VA. Wayne Papalski is affiliated with the Naval Special Warfare GROUP2 TACMED,
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Virginia Beach, VA. LT Matthew A. Tovar is a resident physician affiliated with the Combat Trauma Research Group at the Naval Medical
Center Portsmouth, Portsmouth, VA. Lorie Gower is a clinical research coordinator affiliated with the Combat Trauma Research Group at the
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Naval Medical Center Portsmouth, Portsmouth, VA. LCDR Christopher Treager is a staff physician affiliated with the Combat Trauma Re-
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search Group at the Naval Medical Center Portsmouth, Portsmouth, VA. CDR Eric Koch is a staff physician affiliated with the Combat Trauma
Research Group at the Naval Medical Center Portsmouth, Portsmouth, VA. LCDR Eric Sulava is a staff physician affiliated with the Combat
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Trauma Research Group at the Naval Medical Center Portsmouth, Portsmouth, VA. Emily Friedrich is a biomedical engineering consultant at
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Exponent, Philadelphia, PA, and was previously affiliated with the Combat Trauma Research Group at the Naval Medical Center Portsmouth,
Portsmouth, VA. Brittany Dellinger is affiliated with Culmen International, Alexandria, VA, and is the Combat Trauma Research Group program
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manager at the Naval Medical Center Portsmouth, Portsmouth, VA.
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