Page 19 - Journal of Special Operations Medicine - Summer 2016

Early, Prehospital Activation of the Walking Blood Bank
Based on Mechanism of Injury Improves Time to
Fresh Whole Blood Transfusion

Aaron K. Bassett, DO; Jonathan D. Auten, DO;
Tara J. Zieber, MD; Nicole L. Lunceford, DO

ABSTRACT

Balanced component therapy (BCT) remains the main- blood (FWB) transfusion. FWB has been found to im-
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stay in trauma resuscitation of the critically battle in- prove survival among battlefield casualties presenting to
jured. In austere medical environments, access to packed surgical care facilities that have limited ability to store
red blood cells, apheresis platelets, and fresh frozen and deliver apheresis platelets. 5
plasma is often limited. Transfusion of warm, fresh
whole blood (FWB) has been used to augment limited Finite resources and fluid operational demands make
access to full BCT in these settings. The main limitation FWB an important part of remote damage control re-
of FWB is that it is not readily available for transfusion suscitation (rDCR) strategies. The walking blood bank
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on casualty arrival. This small case series evaluates the (WBB) comprises a group of healthy volunteers who
impact early, mechanism-of-injury (MOI)-based, preac- are available to donate FWB when a casualty arrives.
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tivation of the walking blood bank has on time to trans- Blood-borne pathogens, transfusion reactions, and in-
fusion. We report an average time of 18 minutes to FWB creased time to delivery have been historically cited de-
transfusion from patient arrival. Early activation of the tractors to FWB use. The introduction of a prescreened
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walking blood bank based on prehospital MOI may fur- FWB donor pool has decreased the potential for transfu-
ther reduce the time to FWB transfusion. sion reactions, transfer of blood-borne pathogens, and
time to delivery of blood products. Historic time to
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Keywords: blood bank, walking; blood, fresh whole; ther- transfusion of FWB is between 25 and 42 minutes from
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apy, blood component patient arrival. Prior to the development of a robust
prescreening process, the average time to deliver the first
unit of FWB was 50–60 minutes. Activation in the pre-
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hospital setting based on mechanism of injury (MOI)
Introduction
has the potential to reduce the time to FWB availability.
Hemorrhage remains the leading cause of preventable
death on the modern battlefield. Balanced component A process improvement (PI) project was initiated in
1,2
therapy (BCT) with packed red blood cells (pRBCs), March 2012 through the Central Command Joint Com-
fresh frozen plasma (FFP), and platelets has been found bat Casualty Research Team. The PI project evaluated
to provide a survival benefit among critically injured the impact of prehospital, MOI-based activation of the
civilian trauma patients. Large military medical treat- WBB between 1 April 2012 and 1 June 2012 at a single
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ment facilities (role 3 MTFs) have the ability to provide Role 2 MTF in the Helmand Province, Afghanistan.
full BCT to patients. However, forward deployed MTFs Combat Trauma Registry and local blood bank forms
with surgical capability (role 2 MTFs) are limited in the were used to extract data from the role 2 facility. To-
ability to consistently deliver BCT. Despite this, the tal blood use, complications, and 30-day mortality data
4,5
forward resuscitative surgical system (FRSS) concept were obtained from the Department of Defense (DoD)
has shown benefit in providing effective trauma surgical Trauma Registry. A total of seven WBB activations re-
care to the critically injured combat casualty. Current sulted in FWB donation and transfusion: three activa-
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US military clinical practice guidelines (CPG) recom- tions occurred after patient arrival, one occurred during
mend BCT for all casualties undergoing massive trans- air medical evacuation (medevac), and three occurred
fusion (greater than 10 units of pRBCs in 24 hours). If upon receipt of the initial prehospital information. This
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BCT is not available, the Joint Theater Trauma System case series reviews the four cases in which the WBB was
(JTTS) CPG recommends consideration of fresh whole activated prior to patient arrival.

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