Page 23 - JSOM Spring 2020

Fall 2008, Volume 8, Edition 4, Page 27 Spring 2018, Volume 18, Edition 1, Page 15
Battlefield Use of Human Plasma by Special Operations Military Prehospital Use of Low Titer Group O Whole Blood,
Forces, MSG Christopher Murphy Nicholas Warner; Jackson Zheng; Greg Nix, MPAS, APA-C;
ABSTRACT Recently a select group of Special Operations Andrew D. Fisher, MPAS, PA-C, MS-2; Jeffery C. Johnson,
medical providers have carried fresh thawed human plasma as MD, FACS; John E. Williams, CRNA; D. Marc Northern,
a resuscitative fluid on the battlefield at the evacuation phase MD; John S. Hellums, MD, MPH
of Tactical Combat Casualty Care (TCCC) and in rare occa- ABSTRACT The military’s use of whole-blood transfusions is
sions at the tactical field care phase of TCCC. Plasma in certain not new but has recently received new emphasis by the Tactical
circumstances should be considered as an adjunct to treatment Combat Casualty Care Committee. US Army units are imple-
of coagulapathic battlefield casualties. Plasma does however menting a systematic approach to obtain and use whole blood
have limitations due to logistical constraints. The long-term on the battlefield. This case report reviews the care of the first
solution is to develop a field stable variant of plasma which patient to receive low titer group O whole blood (LTOWB)
would make this life-saving fluid available to a broader range transfusion, using a new protocol.
of care providers. Recent studies have shown that the develop-
ment of lyophilized plasma is feasible. Fall 2018, Volume 18, Edition 3, Page 50
A Pilot Study of Four Intraosseous Blood Transfusion Strat-
egies, Jonathan Auten; Julie B. Mclean, PhD, CTR; Jean D.
ARTICLES ON WHOLE BLOOD, NOW Kemp; Paul J. Roszko; Grady A. Fortner; Alyssa L. Krepela;
Alexandra C. Walchak, MS, CTR; Chemely M. Walker, CTR;
And now 2015 – 2020. To read/reread these great articles, you Travis G. Deaton; Joanna E. Fishback
will either have the hard copies of these editions or be a digital ABSTRACT Background: Intraosseous (IO) access is used
subscriber. by military first responders administering fluids, blood, and
medications. Current IO transfusion strategies include gravity,
To subscribe to our digital versions of the Journal of Special pressure bags, rapid transfusion devices, and manual push-
Operations Medicine go to https://jsom.us/subscribe. The dig- pull through a three-way stopcock. In a swine model of hem-
ital subscription gives you access to all 20 years of journals orrhagic shock, we compared flow rates among four different
plus much more.
IO blood trans fusion strategies. Methods: Nine Yorkshire
swine were placed under general anesthesia. We removed 20
Spring 2016, Volume 16, Edition 1, Page 112 to 25mL/kg of each animal’s estimated blood volume using
Prolonged Field Care Ongoing Series: Prolonged Field Care flow of gravity. IO access was obtained in the proximal hu-
Working Group Fluid Therapy Recommendations, Benjamin merus. We then autologously infused 10 to 15mL/kg of the
Baker, DO; Doug Powell, MD; Jamie Riesberg, MD; Sean animal’s estimated blood volume through one of four ran-
Keenan, MD domly assigned treatment arms. Results: The average weight
of the swine was 77.3kg (interquartile range, 72.7kg–88.8kg).
ABSTRACT The Prolonged Field Care Working Group con- Infusion rates were as follows: gravity, 5mL/min; Belmont
curs that fresh whole blood (FWB) is the fluid of choice for rapid infuser, 31mL/min; single-site pressure bag, 78mL/min;
patients in hemorrhagic shock, and the capability to trans- double-site pressure bag, 103mL/min; and push-pull tech-
fuse FWB should be a basic skill set for Special Operations nique, 109mL/min. No pulmonary arterial fat emboli were
Forces (SOF) Medics. Prolonged field care (PFC) must also noted. Conclusion: The optimal IO transfusion strategy for
address resuscitative and maintenance fluid requirements in injured Servicemembers appears to be single-site transfusion
non- hemorrhagic conditions.
with a 10mL to 20mL flush of normal saline, followed im-
mediately by transfusion under a pressure bag. Further study,
Summer 2016, Volume 16, Edition 2, Page 5 powered to detect differences in flow rate and clinical compli-
Early, Prehospital Activation of the Walking Blood Bank cations, is required.
Based on Mechanism of Injury Improves Time to Fresh Whole
Blood Transfusion, Aaron K. Bassett, DO; Jonathan D. Auten, Summer 2019, Volume 19, Edition 2, Page 134
DO; Tara J. Zieber, MD; Nicole L. Lunceford, DO
A Case Presentation: Creation and Utilization of a Novel Field
ABSTRACT Balanced component therapy (BCT) remains the Improvised Autologous Transfusion System in a Combat Ca-
main stay in trauma resuscitation of the critically battle in- sualty, Tyler Scarborough, HMC; Michael Turconi, NSOCM;
jured. In austere medical environments, access to packed red David Callaway, MD, MPA
blood cells, apheresis platelets, and fresh frozen plasma is of- ABSTRACT This case report describes the technical aspects
ten limited. Transfusion of warm, fresh whole blood (FWB) in first use of a novel field improvised autologous transfusion
has been used to augment limited access to full BCT in these (FIAT) system. It highlights a potential solution for specific
settings. The main limitation of FWB is that it is not readily trauma patients during advanced resuscitative care (ARC) and
available for transfusion on casualty arrival. This small case prolonged field care (PFC) scenarios where other blood prod-
series evaluates the impact early, mechanism-of-injury (MOI)- ucts are not available.
based, preactivation of the walking blood bank has on time to
transfusion. We report an average time of 18 minutes to FWB
transfusion from patient arrival. Early activation of the walk-
ing blood bank based on prehospital MOI may further reduce
the time to FWB transfusion.

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