Page 19 - JSOM Winter 2021

blood can be given quickly. Ensure good blood flow through 1. Golden Hour Container (GHC) maximum capacity is 4
IV or IO access before initiating transfusion. Refer to Appen- units RBC/FFP or 2 units of whole blood.
dix D for Transfusion Procedures and Appendix F for Pearls 2. If whole blood or plasma is unavailable, evacuation per-
for Transfusion. sonnel will fly with RBCs exclusively.
3. Product must finish infusion within 4 hours of spiking the
CAUTION: Rapid infusion against resistance can cause me-
chanical shearing of RBCs and should be avoided. bag. If not complete, then it needs to be stopped and the
remainder of the product discarded. If the initiation of
1. Blood products will be administered in the following pri- transfusion (spiking of the bag) is delayed, then the blood
ority depending on availability and according to TCCC may be returned to storage if it hasn’t exceeded appropri-
Guidelines: ate transport temperature, which is a max of 10°C. The
a. Cold Stored Low titer Group O whole blood (LTOWB), only way this can be determined is with use of a Safe-T-Vue
or, if not available sticker on the actual blood bag.
b. Fresh Low titer Group O whole blood (LTOWB), or, if 4. Unused blood products (i.e. WB and freeze dried plasma
not available [FDP]) furnished by forward U.S. or Coalition Forces will
c. Plasma, RBCs, and platelets in a 1:1:1 ratio, or, if not not be used by evacuation personnel. Recommend products
available be left with forward forces. Blood products (WB and FDP)
d. Plasma and RBCs in 1:1 ratio, or, if not available spiked by forward forces and transfusing at time of pick up
e. Reconstituted dried plasma, liquid plasma, or, thawed will be continued during evacuation.
plasma alone or RBCs alone, or, if not available Pediatric patients:
f. Fresh group O (typed by Eldon card or equivalent) 1. Emergency transfusion of pediatric patients relies on clini-
whole blood from unknown titer walking blood bank
cal assessment rather than specific vital signs, since normal
NOTE: LTOWB has been screened for anti-A and anti-B anti- heart rate and blood pressure are age-dependent.
bodies; these units contained a low titer of anti-A and anti-B 2. Clinical signs of shock are the same as in adults (cool, pale,
and are therefore considered a universal donor product that weak or absent radial pulse, delayed capillary refill, de-
may be given to recipients of any blood type with a minimum creased mental status).
risk for a minor ABO incompatibility (typically minor and 3. Pediatric fluid resuscitation related to trauma begins with
most often subclinical clinical consequences). The whole blood 10mL/kg of first blood product, then repeat as needed
supplied to MEDEVAC units will be exclusively drawn in the based on response.
United States from the ASBP-approved sites and distributed in
theater by the ASBP blood distribution system. The LTOWB Receiving Blood Components from an Issuing Facility
units will be fully tested following FDA current guidelines. (U.S. and Coalition)
U.S. issuing facility personnel from the Blood Support Detach-
2. POS (either low titer Group O WB or Type O RBCs) is the ment (BSD), MTF (Role 2/3) or lab will:
standard for transfusion during evacuation.
NOTE: Patients requiring blood can safely receive un-cross 1. If requested and available, thaw frozen plasma IAW local
matched low titer Group O WB or Type O RBCs until procedures and label products (A or AB) with 5 day expi-
type-specific products are available. ration date.
3. If available, use O NEG on females of childbearing poten- 2. Ensure GHC is properly charged and removed from freezer
tial age < 50 years old. Inform receiving facility regarding 25–30 minutes prior to loading blood products.
female given O POS blood for documentation in the med- 3. Ensure all blood products issued have a Safe-T-VUE (NSN
ical record. If a minimal amount (just a few milliliters) is 6515-08-T00-3056) attached and activated for tempera-
given, consider Rhogam therapy. The immunologic conse- ture monitoring (Appendix E). Ensure thawed plasma is
quences of administration of an entire unit of O POS whole at refrigerated temperature (1-6°C) before placing Safe-T-
blood or RBC to an O NEG female of child-bearing po- VUE on unit.
tential cannot safely be reversed with Rhogam. Treatment 4. Evacuation personnel will follow Safe-T-VUE procedures
of exsanguination takes precedence over potential future (Appendix E) when required.
pregnancy outcomes. 5. Document in TMDS the issuance of blood products to
CAUTION: WB collected in theater will NOT be supplied an evacuation team (e.g., DUSTOFF; Pararescue; Tactical
for use onboard MEDEVAC aircraft. Critical Care Evacuation Team).
6. Complete appropriate sections of the SF 518 Blood or
Plasma is recognized as an important component in prevent-
ing and treating coagulopathy in trauma. On average a unit Blood Component Transfusion Record for issuing blood
contains a volume of 200–250mL and is transfused rapidly. products; place inside GHC pocket or attach form to each
unit of blood product issued.
1. Type A or AB thawed plasma is the current standard for 7. Verify the blood information on the SF 518 against the blood
transfusion during evacuation. product label with receiving evacuation unit personnel.
2. Thawed plasma only has a shelf life of 5 days and may Non-U.S. Issuing Facility: When U.S. blood products are to be
not be available for the pre-hospital mission. Liquid plasma issued from a Coalition facility, contact the Joint Blood Pro-
(never frozen) has a shelf life of 26 days. Check with issuing gram Office to coordinate issuing requirements and documen-
facility or blood supply unit for availability.
tation of units received.
The recommended mission loads for tactical evacuation are
based on operations tempo and determined by the theater or Receiving unit (Evacuation Unit) personnel will:
Joint Task Force surgeon. Specific missions may require addi- 1. Prior to sealing GHC, ensure each blood product loaded
tional blood products; units will refer to the Joint Blood Pro- into the GHC has an activated Safe-T-VUE attached (Ap-
gram Office. pendix E) and an SF 518 Form.
Prehospital Blood Transfusion | 17