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The CPG provides specific guidance and recommended References
methods of prescreening and collection of FWB, in a 1. Cotton B, Podbielski J, Camp E, et al. A randomized control
detailed format. The CPG recommendations include pilot trial of modified whole blood versus component therapy
prescreening of potential donors, use of preapproved in severely injured patients requiring large volume transfu-
DoD collection and screening forms. Documentation is sions. Ann Surg. 2013;258:527–532, discussion 532–533.
standardized across all services and provides a consis- 2. Spinella P, et al. Warm fresh whole blood is independently
7
tent method for obtaining warm FWB for transfusion. associated with improved survival for patients with combat-
related traumatic injuries. The Journal of Trauma. 2009;66(4).
The Norwegian Naval Special Operation Commando, 3. Jones AR, Frazier SK. Increased mortality in adult patients
in conjunction with the Department of Immunology with trauma transfused with blood components compared
and Transfusion Medicine at Haukeland University with whole blood. J Trauma Nursing. 2014;21(1).
Hospital, has also developed a “Blood Far Forward” 4. Nessen SC, et al. Fresh whole blood use by forward surgi-
program. The goal of using a protocol for the collec- cal teams in Afghanistan is associated with improved survival
10
compared to component therapy without platelets. Transfu-
tion and administration process is to provide FWB to sion. 2013;53(suppl).
Special Operations Soldiers operating in forward posi- 5. Perkins JG, et al. Comparison of platelet transfusion as fresh
10
tions. Despite these advances, a consistent limitation in whole blood versus apheresis platelets for massively trans-
the FWB program has been the time required to collect fused combat trauma patients. Transfusion. 2011;51.
the blood product. 6. Chambers LW, et al. The experience of the US Marine Corps’
Surgical Shock Trauma Platoon with 417 operative combat
casualties during a 12 month period of Operation Iraqi Free-
Historical data suggested an average time to transfusion dom. J Trauma. 2006;60(6).
9
from patient arrival to be approximately 42 minutes. 7. Joint Theater Trauma System Clinical Practice Guideline.
However, a US Army PI project recently reported an Fresh whole blood (FWB) transfusion. Pgs 1–31.
average time to transfusion of 26.7 minutes by imple- 8. Cassella D, et al. From donor to patient in 20 minutes: emer-
gency resuscitation with whole blood during Operation Iraqi
menting a prescreening program and extensive training Freedom. Crit Care Nursing. 2009;29(2).
9
in the collection and administration of FWB. The earli- 9. Cahill BP, Stinar TR. Improving the emergency whole blood
est known time to transfusion of FWB in the literature program. Mil Med. 2011;176.
8
is 20 minutes after activation of the WBB. The concept 10. Strandenes G, et al. Blood far forward: a whole blood re-
of early activation has not been discussed formally by search and training program for austere environments. Trans-
fusion. 2013;53(suppl).
the CPG, but formalized documentation and procedures
make implementation of this concept feasible. A shorter
time to transfusion has the potential to allow medical
personal at forward deployed units the ability to pro- LCDR Bassett, USN, MC, is affiliated with the Naval Medi-
vide FWB when access to apheresis platelets is limited or cal Center San Diego, California. He has aviation medicine
4
nonexistent. The benefit of FWB transfusion has been and forward deployed operational experience, and emergency
shown in the austere, forward deployed environment. A medicine training with specific professional interest in trauma
US Army study at large in-theater medical facilities found care and wilderness medicine.
that patients with hemorrhagic shock had improved 30-
4
day mortality rates with the use of warm FWB. A re- LCDR Auten, USN, MC, is affiliated with the Naval Medi-
duced mortality rate was reported with transfusion with cal Center San Diego, California. He has shipboard and for-
FWB compared with limited component therapy when ward deployed operational experience. He is dual trained in
4
apheresis platelets are not available. Earlier availability pediatric and adult emergency medicine, with specific profes-
sional interest in trauma care and humanitarian medicine.
of FWB allows providers to offer BCT in forward de-
ployed medical units closer to the POI. CAPT Zieber, USN, MC, is affiliated with the Naval Hos-
pital Camp Pendleton, California. She has emergency medi-
Conclusion cine training and forward deployed operational experience. Dr
Zieber is a Marine Expeditionary Force surgeon.
This case series reports the effect prehospital, MOI-
based activation of the WBB has on time to transfusion. LCDR Lunceford, USN, MC, is affiliated with the Naval
Early activation appears to reduce the time to FWB de- Medical Center San Diego, California. Dr Lunceford is trained
livery to critically injured patients. Combat injuries with in emergency medicine and has forward deployed operational
prehospital MOI likely to require massive transfusion experience. E-mail: nicole.l.lunceford.mil@mail.mil.
may benefit from early activation of the WBB.

Disclosures

The authors declare no conflicts of interest.

8 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016