Page 24 - JSOM Spring 2020

Fall 2019, Volume 19, Edition 3, Page 24 Tactical Combat Casualty Care (TCCC) guidelines and their
clinical practice guidelines (CPGs). Clinical data from nearly
Risk Associated With Autologous Fresh Whole Blood Train-
ing, Benjamin P. Donham, MD; George A. Barbee, DSc, EM 2 decades of war during Operation Iraqi Freedom (OIF)
PA-C; Travis G. Deaton, MD; Win Kerr, ATP, NREMT-P; and Operation Enduring Freedom (OEF) suggest that whole
Russell P. Wier, DO; Andrew D. Fisher, MPAS, PA-C, LP blood (WB) is safe, effective, and far superior to crystalloid
and colloid resuscitation fluids. The JTS CPG for whole blood
ABSTRACT Fresh whole blood (FWB) is increasingly being transfusion reflects the most recent clinical evidence but poses
recognized as the ideal resuscitative fluid for hemorrhagic unique challenges for execution by Special Operations Forces
shock. Because of this, military units are working to establish (SOF) operating in austere environments. Given the limited
the capability to give FWB from a walking blood bank donor shelf-life of 35 days, WB requires a constant steady pool of
in environments that are unsupported by conventional blood donors. Additionally, the cold-chain requirement for storage
bank services. Therefore, many military units are performing poses challenges for SOF on long missions without access to
autologous blood transfusion training. In this training, a vol- blood refrigerators. SOF operating in less-developed theaters
unteer has a unit of blood collected and then transfused back face additional logistical challenges. To mitigate the challenges
into the same donor. The authors report their experience per- of WB delivery, US SOF have implemented various protocols
forming an estimated 3,408 autologous transfusions in train- to ensure optimal donor pool, awareness/education among
ing and report no instances of hemolytic transfusion reactions medics and specialized equipment for tactical methods of
or other major complications. With appropriate control mea- blood-carry and delivery. In general, steps taken include the
sures in place, autologous FWB training is low-risk training. following: (1) Prior to deployment, Soldiers are screened for
blood type and titers in order to establish a large donor pool.
Winter 2019, Volume 19, Edition 4, Page 85 Support Soldiers have been found to be particularly beneficial
donors as they typically are in closer proximity to the blood
Shared Blood Expeditionary Resuscitative Surgical Team
(ERST-5) Use of Local Whole Blood to Improve Resuscitation support detachment. (2) In units that operate in smaller teams,
of Host Nation Partner Forces, Melanie Bowman, RN; Joshua such as ODAs, medics are outfitted with “blood kits” to carry
Ashbaucher, SOCM; Brian Cohee, MD; Michael S. Fisher, blood on missions for point of injury transfusion. In units with
CRNA; John B. Jennette, MD; John D. Huse, DSc, MPAS; larger teams, LTOWB donors are identified on missions and
Chans Copeland; Kathryn B. Muir, MD deliver fresh WB in the event of casualties. (3) Medics receive a
WB transfusion refresher tabletop exercise and review after ac-
ABSTRACT US Special Operations Forces work by, with, tion reviews from previous rotations. Additionally, prehospital
and through partner forces (PFs) to accomplish mutual ob- WB delivery is a required component of scenario-based prem-
jectives. Surgical teams support these forces directly and may ission training. The expectation is that medics will administer
assist in treating injuries sustained by PF, based on established WB on missions when tactically feasible. Using the prolonged
medical rules of engagement. These surgical operations are field care framework (ruck, truck, house) as a template, med-
often conducted in austere conditions, with limited access to ics now use different methods to store and transport the SWB
blood products. Limited blood product availability decreases depending on phase. Medic “truck” and “house” kits include
™
US medical capacity to resuscitate injured PFs and augment the Dometic CFX powered coolers that run on AC, DC, or
the local trauma system. We present an innovative solution solar power and allow for constant temperature monitoring.
used by an expeditionary resuscitative surgical team (ERST) When on foot, medics have been outfitted with tactical blood
™
and Special Operations civil affairs team to partner with host coolers including the Pelican Biomedical Medic 4 or Com-
™
nation (HN) medical personnel to improve PF access to dam- bat Medical Blood Box along with a Belmont Buddy-Lite ™
age control resuscitation and surgery. Whole blood obtained intravenous (IV) infusion warmer and IV administration kit
through a local HN hospital was provided to the ERST to with standard micron filter. Presently, SOF medics have the
allow for in- creased capacity to resuscitate PF casualties and donor support, logistical framework, training, and equipment
augment the local trauma system. The ERST subsequently to deliver WB at the point of injury. However, widespread im-
used this blood to resuscitate two PF surgical casualties. plementation will require expanded distribution and standard-
ization of “blood kits.” Additionally, SOF medical planners
Winter 2019, Volume 19, Edition 4, Page 88 must put greater emphasis on education and the importance
of WB over crystalloids or colloids—as many medics continue
Prehospital Whole Blood in SOF: Current Use and Future Di-
rections, Thomas B. Jones, 18D; Virgil L. Moore, 18D; Akira to carry only these products out of convenience. As SOF strive
A. Shishido, MD to establish tactics, techniques, and procedures (TTPs) and
streamline pre-hospital WB delivery, we must constantly reas-
ABSTRACT The US Joint Trauma System (JTS) recommends sess and refine our procedures, incorporate the latest evidence
stored whole blood (SWB) as the preferred product for pre- and technology, and adapt to an evolving battlefield.
hospital resuscitation of battlefield casualties in both their

20 | JSOM Volume 20, Edition 1 / Spring 2020