Page 136 - JSOM Summer 2019

Case Presentation

Creation and Utilization of a Novel Field Improvised
Autologous Transfusion System in a Combat Casualty

Tyler Scarborough, HMC ; Michael Turconi, NSOCM ; David Callaway, MD, MPA *
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ABSTRACT
This case report describes the technical aspects in first use of a TABLE 1 CoTCCC Fluid Resuscitation Guidelines 180801
novel field improvised autologous transfusion (FIAT) system. 1. Whole blood (See TCCC guidelines for detailed description of
It highlights a potential solution for specific trauma patients options)
during advanced resuscitative care (ARC) and prolonged 2. Balanced component therapy (i.e., plasma, packed red blood cells
field care (PFC) scenarios where other blood products are not (PRBCs), and platelets in 1:1:1 ratio)
available. 3. Plasma or PRBCs in 1:1 ratio
4. Plasma or PRBCs alone
Keywords: blood transfusion; resuscitation; shock, hemor- Source: https://jts.amedd.army.mil/index.cfm/committees/cotccc
rhagic; fluid therapy; military medicine; warfare; unconven- /guidelines. Accessed 5 March 2019.
tional medicine
amounted to little more than a van with a driver and ambu-
lance markings on the outside. The transport vehicle had no
medical equipment and no provider was present to tend to the
Introduction
patient en route. While there was a method for air evacuation,
Remote damage control resuscitation (R-DCR) is the standard the helicopter could hold only two patients and it was reserved
of care for management of hemorrhagic shock in the austere for critical postsurgical wounded. More ARC was performed
prehospital environment. “Hemostatic resuscitation” com- than is typical in a traditional CCP/Role I because it was hours
posed of whole blood or balanced component therapy is a key from the next echelon of care.
component of R-DCR. The most recent Committee on Tacti-
cal Combat Casualty Care guidelines for fluid resuscitation Due to the distribution and fluidity of local forces around the
focus on the importance of early whole blood and are listed in CCP, it was unrealistic to implement a true on-demand walking
Table 1. Many military units have taken aggressive action to blood bank for warm fresh whole blood transfusions during
push blood products far forward. However, there remain sit- active resuscitations. While there was the potential to receive
uations (e.g., mass casualty incidents [MCIs] or severe poly- component therapy. the CCP was limited to one HemaCool
trauma patient) where autologous transfusion (AT) may play blood refrigerator that could only be set to maintain packed
a role. red blood cells (PRBCs) or whole blood. While PRBCs were
maintained, stock was limited and they were used as a tempo-
This case report describes the technical aspects in first use of rizing measure if the patient was awaiting space in the surgical
a novel FIAT system. It highlights a potential solution for spe- suite. Early on, whole blood was collected from local national
cific trauma patients during ARC and PFC scenarios where donors. Due to language limitations and scarcity of interpret-
other blood products are not available. No clinical outcome ers, most screenings amounted to verification of blood type by
conclusions can be drawn based on the fact that the patient Eldon Card. Type O blood and type A blood were banked and
did not receive the AT and was lost to follow-up. discarded after 21 days of storage at 4°C to 6°C.

While managing this austere CCP during a large urban battle,
Case Presentation
the team responded to an MCI and a need presented itself for
Situation the ability to perform autologous blood transfusion from a
The Casualty Collection Point (CCP) was a multinational chest tube using improvised means.
medical effort composed almost solely of military medics. A
five-man surgical team from the conventional military was at- Casualty 1 (Capability Gap Recognized): At approximately
tached to the CCP for damage control surgery, which allowed 1700 (GMT +3), an allied local national Soldier arrived at the
it to function as a Role I+. Due to the austere geography and CCP. The casualty was triaged as the fifth urgent patient of the
local conflict, supplies were scarce with resupply runs occur- day. The Soldier sustained a gunshot wound (GSW) in his right
ring only about once a week. No US military casualties from upper shoulder with no apparent exit. Time from injury to ar-
this CCP were evacuated by ground in an “ambulance,” which rival was uncertain but estimated at approximately 1.5 hours.
*Correspondence to David W. Callaway, MD, 1000 Blythe Blvd, Charlotte, NC 28203 or david.callaway@atriumhealth.org
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1 Mr Scarborough is currently a hospital corpsmen, chief with the USSOCOM MARSOC MRR 2MRB. Mr Turconi is an ISTC NATO Special
Operations combat medic and a student at the University College Cork. Dr Callaway is a physician and professor of Emergency Medicine, Chief
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Operational and Disaster Medicine at Atrium Health–Carolinas Medical Center, Charlotte, NC.
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