Page 40 - Journal of Special Operations Medicine - Fall 2014

6. Fund the development and fielding of a platelet- collected in deployed medical treatment facilities to
sparing leukoreduction filter for collecting whole achieve FDA compliance.
blood for transfusion.
7. Explore pathogen reduction technologies that can
be used with blood products to increase transfusion Acknowledgments
safety and reduce the screening burden currently The authors gratefully acknowledge the research as-
needed to ensure freedom from transfusion- sistance provided by Mrs Danielle Davis of the Joint
transmitted pathogens. Trauma System. The authors also thank the Department
8. Although blood products are the preferred fluid of Defense Trauma Registry for providing much of the
resuscitation option for casualties in hemorrhagic casualty data discussed here.
shock, logistical constraints may require that Hex-
tend, LR, or Plasma-Lyte A be used in the prehos-
pital phase of battlefield trauma care. Research Disclaimers
should be carried out to determine which of these The opinions or assertions contained herein are the pri-
three fluids produces the best outcomes for civilian vate views of the authors and are not to be construed as
patients in hemorrhagic shock in trauma systems official or as reflecting the views of the US Department
where prehospital blood and plasma are not used. of the Army or the Department of Defense. This recom-
9. Develop methodology, training, and equipment to mendation is intended to be a guideline only and is not
improve the ability of far-forward medical person- a substitute for clinical judgment.
nel to transfuse whole blood where possible.
10. Explore ways to expand the use of liquid (never- Disclosures
frozen) plasma as a way to enhance the availabil- Dr Weiskopf, in 2012, was part of a group that reviewed
ity of 1:1 plasma:RBC resuscitation on TACEVAC all tetrastarches use in surgery, resulting in the Van Der
flights without delaying the missions in order to Linden review that is cited. The project was funded by
thaw frozen plasma. Fresenius-Kabi. Dr Schreiber is funded by the NIH and
11. Develop rapid transition programs to accelerate the DoD to study resuscitation of hemorrhagic shock.
the fielding of newly developed fluid resuscitation He directed the clinical hemostasis research program at
products and technology to combat units. Novo Nordisk A/S 2005-07, and now consults for vari-
12. Fund the continued development and expedited ous governmental agencies and corporate entities in the
fielding of technologies that enable prehospital fields of transfusion and hemostasis. Dr Champion is
combat medical personnel to better evaluate the the president/CEO of SimQuest, LLC.
need for and the adequacy of fluid resuscitation.
Examples of candidate technologies include the tis- Release
sue oxygen saturation monitor and the cardiovas-
cular reserve index. This document was reviewed by the Director of the Joint
13. A longer-term research goal to improve survival in Trauma System and by the Public Affairs Office and the
hemorrhagic shock is the identification of pharma- Operational Security Office at the US Army Institute of Sur-
cologic agents that reduce metabolic demand until gical Research. It is approved for unlimited public release.
oxygen delivery capacity can be reestablished for
casualties in shock. 38 References
14. Establish a Military Use Panel as a shared effort 1. Apodaca A, Olson C, Bailey J, et al. Performance improve-
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DoD-FDA Military Use Panel would be to evaluate shock. Crit Care Clin. 1993;9:313–333.
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15. Develop blood-banking methods and technologies 6. Bickell WH, Wall MJ, Pepe PE, et al. Immediate versus
that will enable whole blood and apheresis platelets delayed fluid resuscitation for hypotensive patients with

32 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014