Page 25 - JSOM Spring 2020

Slow and Risky to Safe and Briskly

Modern Implementation of Whole Blood

1
2
Andrew D. Fisher, MPAS, PA-C, LP *; Ethan A. Miles, MD ;
Stacy A. Shackelford, MD 3

aving lives on the battlefield goes beyond eliminating FIGURE 1 Use of whole blood during training.
what is currently considered preventable deaths and
Sencompasses the treatment of potentially survivable in-
juries. Eliminating potentially preventable deaths is a driving
force for identifying and implementing advanced treatment
strategies. Potentially survivable injuries present a difficult
challenge to the combat medic, because noncompressible
torso hemorrhage (NCTH) can be particularly complex to
treat. Without timely surgical care, many casualties in the po-
tentially survivable category will die because immediate evac-
uation is not always possible. Therefore, the focus of training
and treatment should be on eliminating preventable death and
the management of potentially survivable injuries through
damage control resuscitation (DCR) and advancing treatment
for NCTH.

As we look to future treatment strategies for potentially sur-
vivable injuries, it is important to remember our past. Many
of the best concepts that are implemented for battlefield care
are just reimagined concepts from previous wars. There is no
better example of this than the use of whole blood for the
treatment of hemorrhagic shock. During every conflict since
World War I, whole blood has been successfully implemented,
and during each interwar period, it has been minimized. We
are currently in the middle of a reimagining of whole blood
use for casualty care (Figure 1).

Many advances are also made in the field of surgery and
trauma care during war. During World War I, a most import-
ant concept that Cannon and colleagues noted was the effi-
1
cacy of hypotensive resuscitation. They also found that the
administration of saline worsens acidosis and is harmful to
the critically injured. Fraser and Cowell concluded in a sepa-
4
rate article that the use of saline is unsatisfactory. The same toward low-titer blood. Traditionally, there have been very
2
group noted the benefits of fresh whole blood transfusions. few deaths associated with type O transfusions, which sup-
2,3
4
This was the first time blood had been used in an appreciable ports its use in prehospital care.
amount in combat.
In World War II, the majority of blood transfusions were group
Traditionally, the preferred method of fresh whole blood O whole blood, regardless of titer. Although the number of
4
(FWB) transfusion has been to administer the exact type (type whole blood transfusion during World War II are unclear, there
specific). There is mounting evidence to show that giving type are some data on blood delivered to specific theaters. There
O regardless of the patient’s blood type is not only safe but has were 316,799 units of whole blood delivered to hospitals of
been done multiple times since War World II. There is a cor- the European Theater of Operations, US Army, from April
4
5
relation between amount of antibodies in the donor’s plasma 1944 to June 1945. During 1944, in the 11th Field Hospital,
and the severity of a reaction, which drives practical methods 2,532 casualties received a total of 8,591,300mL of blood in
*Correspondence to andrewdfisher@icloud.com
1 MAJ Fisher is affiliated with Medical Command, Texas Army National Guard, Austin, TX; Texas A&M College of Medicine, Temple, TX; and
Prehospital Research and Innovation in Military Expeditionary Environments (PRIME2). LTC Miles is affiliated with the Maneuver Center of
2
3
Excellence, Fort Benning, GA. Col Shackelford is affiliated with the Joint Trauma System, JBSA Fort Sam Houston, TX.
21