Page 92 - JSOM Winter 2019

Along with education and resourcing, technological advance- Disclosure
ments will also shape the future of WB resuscitation. The Nor- Products mentioned in this manuscript were purchased by
wegian THOR program is developing methods of far forward 1SFG(A). The authors have no financial conflicts to disclose.
blood delivery via unmanned aerial systems, and US developers
are researching methods to modify blood to make any blood Author Contributions
type a universal donor (R. Knight, email communication, 12 TJ created initial blood kits. VM implemented kits through-
March 2019; S. Patrick, email communication, 11 March out 1SFG(A) and presented to 1SFC(A) during innovations
2019). Additionally, ruggedizing and miniaturizing of blood briefing. AS wrote the first draft, and all authors read and
11
coolers, or the development of an additive to extend shelf life approved the final manuscript.
will likely promote WB practice due to ease of transport.
References
Taken together, the next stages of expanded WB use must be: 1. Cap AP, Beckett A, et al. Joint Trauma System Clinical Prac-
tice Guideline: Whole Blood Transfusion. May 2018. https://
1. Making prehospital WB delivery to casualties on mission jts.amedd.army.mil/assets/docs/cpgs/JTS_Clinical_Practice
a standard expectation at the lowest unit levels. The in- _Guidelines_(CPGs)/Whole_Blood_Transfusion_15_May_2018
_ID21.pdf
frastructure to carry and deliver WB at the point of injury 2. Fisher AD, Miles EA, Cap AP, et al. Tactical damage control
exists—medics and providers must now follow through on resuscitation. Mil Med. 2015;180(8):869–875. doi:10.7205
executing the practice. /MILMED-D-14-00721. PubMed PMID: 26226529.
2. As the practice expands, developments in technology and 3. Strandenes G, Berséus O, Cap AP, et al. Low titer group O whole
techniques of delivery will further shape and optimize far blood in emergency situations. Shock. 2014;41(suppl 1):70–75.
forward blood delivery. 4. Warner N, Zheng J, Nix G, et al. Military prehospital use of low
titer group O whole blood. J Spec Oper Med. 2018;18(1):15–18.
5. Clayton D, Perkins J, et al. Fresh frozen plasma. US Army Med
As SOF strive to establish TTPs and streamline prehospital Dep J. 2009;January–March:64–67. www.cs.amedd.army.mil
WB delivery, we must constantly reassess and refine our pro- /references_publications.aspx
cedures, incorporate the latest evidence and technology, and 6. Spinella PC, Perkins JG, Grathwohl JG, et al. Warm fresh whole
adapt to an evolving battlefield. blood is independently associated with improved survival for pa-
tients with combat-related traumatic injuries. J Trauma. 2009;66:
S69–S76.
7. Perkins JG, Cap AP, Spinella PC, et al. Comparison of platelet
transfusion as fresh whole blood versus apheresis platelets for
massively transfused combat trauma patients (CME). Transfusion.
2011;51(2):242–252.
8. Yazer MH, Cap AP, Spinella PC. Raising the standards on whole
blood. J Trauma Acute Care Surg. 2017’December 28.
9. Fisher AD, Washburn G, et al. Joint Trauma System Clinical Prac-
tice Guideline: Damage Control Resuscitation in Prolonged Field
Care. October 2018. https://jts.amedd.army.mil/assets/docs/cpgs
/Prehospital_En_Route_CPGs/Damage_Control_Resuscitation
_PFC_01_Oct_2018_ID73.pdf
10. Krainin B, Nelson P. MFR: Standard Operating Procedure for
Special Operations Task Force – Afghanistan (SOTF-A) Special
Operations Low O Titer (SOLO) Blood Program. 4 December
2018.
11. Norwegian Naval Special Operations Commando (MUK). Blood
Far Forward: A Research, Education and Training Program to
Make Whole-Blood Safe and Available on the Battlefield. Octo-
ber 2012. https://rdcr.org/research/blood-far-forward/

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