Page 68 - JSOM Fall 2021

Blood Product Administration During Transport

Throughout the US Africa Command Theater of Operation

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Steven G. Schauer, DO, MS *; Jason F. Naylor, DSc, PA-C ; Andrew D. Fisher, MD, LP ;
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Darren G. Hyams, MD ; Brandon M. Carius, DSc, PA-C ; Mireya A. Escandon, BS ;
Carlissa D. Linscomb, BS ; Harry McDonald, PhD, MS, SBB ;
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Andrew P. Cap, MD, PhD ; James Bynum, PhD 10
ABSTRACT
Background: United States Africa Command (US AFRICOM) Introduction
is one of six US Defense Department’s geographic combatant During the recent wars in Iraq and Afghanistan, approximately
commands and is responsible to the Secretary of Defense for 90% of US military Servicemembers’ deaths occurred in the
military relations with African nations, the African Union, prehospital setting, and nearly 25% of deaths were second-
and African regional security organizations. A full-spectrum ary to potentially survivable injury, among which >90% was
combatant command, US AFRICOM is responsible for all related to hemorrhage. The deployed US military medical
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US Department of Defense operations, exercises, and security system implemented strategies for rapid casualty evacuation to
cooperation on the African continent, its island nations, and surgical facilities and early hemostatic resuscitation of severely
surrounding waters. We seek to characterize blood product injured patients to optimize survival. Published data demon-
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administration within AFRICOM using the in-transit visibility strate prehospital administration of blood products, and early
tracking tool known as TRAC2ES (TRANSCOM Regulating surgical intervention improved combat casualty outcomes. 8–12
and Command & Control Evacuation System). Methods: We The “Golden Hour” evacuation policy and damage control re-
performed a retrospective review of TRAC2ES medical evac- suscitation (DCR) paradigm, however, owes its success in part
uations from the AFRICOM theater of operations conducted to a military trauma system supported by established medical
between 1 January 2008 and 31 December 2018. Results: and logistical infrastructure. 13,14
During this time, there were 963 cases recorded in TRAC2ES
originating within AFRICOM, of which 10 (1%) cases re- The US Africa Command (AFRICOM) manages military op-
ceived blood products. All patients were males. One was a erations across a continent that is 3 times larger than the con-
Department of State employee, one was a military working tinental United States with immature medical and logistical
dog, and the remainder were military personnel. Of the ten systems. 15,16 Increasing numbers of US military forces deploy
humans, seven were the result of trauma, most by way of gun- to AFRICOM and published data demonstrate few battle in-
shot wound, and three were due to medical causes. Among juries. However, such injuries are predominantly from pene-
human subjects receiving blood products for traumatic inju- trating trauma and require evacuation out of theater to the
ries, a total of 5 units of type O negative whole blood, 29 US military hospital in Landstuhl, Germany. 17,18 Adherence
units of packed red blood cells (pRBCs), and 9 units of fresh to the “Golden Hour” standard is not feasible throughout
frozen plasma (FFP) were transfused. No subjects underwent all of AFRICOM, which should prompt emphasis of remote
massive transfusion of blood products, and only one subject DCR principles to optimize outcomes. 19–21 It is unclear if he-
received pRBCs and FFP in 1:1 fashion. All subjects survived mostatic resuscitation is possible given the sheer geography
until evacuation. Conclusions: Within the TRAC2ES data- of AFRICOM and limited resources. However, freeze-dried
base, blood product administration within AFRICOM was plasma (FDP), warm fresh whole blood (WFWB), stored whole
infrequent, with some cases highlighting lack of access to ade- blood (SWB), and cold-stored low-titer group O whole blood
quate blood products. Furthermore, the limitations within this (CS-LTOWB) may be potential options. 22–27 To date, there a
database highlight the need for systems designed to capture little published data on hemostatic resuscitation of casualties
medical care performance improvement, as this database is within AFRICOM.
not designed to support such analyses. A mandate for perfor-
mance improvement within AFRICOM that is similar to that
of the US Central Command would be beneficial if major im- Goal of This Investigation
provements are to occur.
We are seeking to describe blood product administration
Keywords: prehospital; blood; Africa; prolonged field care; throughout the AFRICOM theater of operations within the
AFRICOM TRAC2ES data repository.

*Correspondence to 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234; or Steven.G.Schauer.mil@mail.mil
1 MAJ Steven G. Schauer is affiliated with the US Army Institute of Surgical Research and the Brooke Army Medical Center of JBSA of Fort Sam
Houston, TX, and the Uniformed Services University of the Health Sciences, in Bethesda, MD. LTC Jason F. Naylor is affiliated with Madigan
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Army Medical Center, Joint Base Lewis McChord, WA. MAJ Andrew Fisher is affiliated with the Department of Surgery, University of New Mex-
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ico School of Medicine, Albuquerque, NM, and the Medical Command, Texas Army National Guard, Austin, TX. MAJ Darren G. Hyams and
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5 Brandon M. Carius are affiliated with the Brooke Army Medical Center, JBSA Fort Sam Houston, TX. Mireya A. Escandon, Carlissa D.
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Linscomb, LTC Harry McDonald, COL Andrew P. Cap, and Dr James Bynum are affiliated with the US Army Institute of Surgical Research,
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JBSA Fort Sam Houston, TX.
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