Page 99 - JSOM Winter 2021

TABLE 1 Fresh Whole Blood Transfusion Packing List the role 2 and 3 follow-up, reviewed all documentation and
1. Fresh Whole Blood Transfusion Packing List 26 edited the manuscript. All authors read and approved the final
2. FDA-approved blood collection bag (Fenwal [McKesson] manuscript.
bag used)
3. Blood administration set (either Y type or straight line with References
170- to 260-µm filter) 1. Beckett MA, Callum J, da Luz LT, et al. Fresh whole blood trans-
fusion capability for Special Operations Forces. Can J Surg. 2015;
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5. Normal saline (100mL bag used) 2. Advanced Tactical Paramedic Protocols (ATP-P) Handbook.
6. Intravenous (IV) catheter × 2 (18-G used) 10th ed. St. Petersburg, FL: J Spec Oper Med; 2017.
7. Alcohol prep pads × 2 3. Fisher AD, Miles EA, Cap AP, et al. Tactical damage control re-
8. Eldon blood typing kit × 2 suscitation. Mil Med. 2015;180(8):869–875.
4. Cannon WB. Nature and treatment of wound shock and allied
9. PRN adapter (needless saline lock) conditions. JAMA. 1918;70:607–621.
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a. Anaphylaxis medications 1969;280:327–328.
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d. Ranitidine IM/IV 7. Bjerkvig CK, Strandenes G, Eliassen HS, et al. “Blood failure”
time to view blood as an organ: how oxygen debt contributes
11. Decadron to blood failure and its implications for remote damage control
12. Tape resuscitation. Transfusion. 2016;56 Suppl 2:S182–S189.
13. Op-Site/Tegaderm 8. Repine TB, Perkins JG, Kauvar DS, Blackborne L. The use of fresh
whole blood in massive transfusion. J Trauma. 2006;60:S59–S69.
14. Constricting band 9. Spinella PC, Perkins JG, Grathwohl JG, et al. Warm fresh whole
15. 18-gauge needle blood is independently associated with improved survival for pa-
tients with combat-related traumatic injuries. J Trauma. 2009;66:
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vital signs. With proper training and familiarization, the abil- 10. Nessen SC, Eastridge BJ, Cronk D, et al. Fresh whole blood use
ity to execute the WBB procedure rapidly and safely is prac- by forward surgical teams in Afghanistan is associated with im-
tical, especially when donors’ blood types are preidentified. proved survival compared to component therapy without plate-
lets. Transfusion. 2013; 53(Suppl 1):107S–113S.
Transfusion of relatively small volumes of a warm, fresh whole 11. Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Asso-
blood product provides an optimal resuscitation intervention ciation of prehospital blood product transfusion during medical
to bleeding casualties and may bridge casualties to evacuation evacuation of combat casualties in Afghanistan with acute and
and damage control surgery. This is especially relevant in cases 30-day survival. JAMA. 2017;318(16):1581–1591.
where hemorrhage control can be achieved with prehospital 12. Cordova C, Cap A, Spinella P. Fresh whole blood transfusion for
interventions. a combat casualty in austere combat environment. J Spec Oper
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Conclusion a far forward environment. South Med J. 2005;98(8):809–810.
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Uncontrolled hemorrhage prior to reaching damage control Joint Trauma System Clinical Practice Guideline. 12 July 2019.
surgical care contributes disproportionately to battlefield mor- https://jts.amedd.army.mil/assets/docs/cpgs/Damage_Control
tality. Resuscitation from hemorrhagic shock requires blood _Resuscitation_12_Jul_2019_ID18.pdf. Accessed 1 Oct 2021.
products, however there are significant logistic barriers to car- 15. Weiskopf RB, Ness PM. Transfusion for remote damage control
resuscitation. Transfusion. 2013;53(1):8–12.
rying cold-stored blood products to the point of injury. The 16. Medby C. Is there a place for crystalloids and colloids in remote
WBB capability is a lightweight and rapid method to provide damage control resuscitation? Shock. 2014;41:47–50.
medics with FWB, enable early resuscitation, and improve 17. Zielinski MD, Jenkins DH, Hughes JD, et al. Back to the future:
survival from severe traumatic injury. This capability should The renaissance of whole-blood transfusions for massively hem-
be expanded to all military medics, and medic training must orrhaging patients. Surgery. 2014;155(5);883–886.
include WBB with goal-directed tactical damage control re- 18. Taylor AL, Eastridge BJ. Advances in the use of whole blood in
combat trauma resuscitation. Transfusion. 2016;56:15a–16a.
suscitation. These skills should be considered standard for all 19. Bassett A, Auten J, Lunceford N. Early, prehospital activation of
combat medics across the Department of Defense (DoD) the walking blood bank based on mechanism of injury improves
time to fresh whole blood transfusion. J Spec Oper Med. 2016;
Disclosures 16:5–918.
The authors declare that they have no competing interests. 20. Rush S. Podcast episode 29: Dr. Cap on fresh whole blood and
resuscitation for PFC. 18 Sept 2018. https://prolongedfieldcare
.org/2017/09/28/podcast-episode-29-dr-cap-on-fresh-whole
Disclaimer -blood-and-resuscitation-for-pfc/. Accessed 1 Oct 2021.
The opinions or assertions contained herein are the private 21. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
views of the authors and not to be construed as official or as (2001–2011): implications for the future of combat casualty care.
reflecting the views of the Defense Health Agency or the De- J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–S437.
partment of Defense. Public affairs office and operational se- 22. Malsby RF, Quesada J, Powell-Dunford N, et al. Prehospital
curity reviews were conducted by the Defense Health Agency. blood product transfusion by U.S Army MEDEVAC during com-
bat operations in Afghanistan: a process improvement initiative.
Mil Med. 2013;178:785–791.
Authorship Contributions 23. Donham BP, Barbee GA, Deaton TG, et al. Risk associated with
MG and AF conducted the mission and collected the docu- autologous fresh whole blood training. J Spec Oper Med. 2019;
mentation. MG and VH drafted the manuscript. SS provided 19(3):24–25.

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