Page 22 - JSOM Summer 2022

alone. After the administration of WFWB during the re- WBB should be initiated and 5–10 units (or more if indi-
exploration for bleeding, his thrombocytopenia and ac- cated) of Group O fresh whole blood should be drawn on
idosis improved, and he showed no further evidence of the LHA. First choice would be to use LTOWB from the
coagulopathic bleeding.” 33 WBBs in the embarked Marine units; second choice would
be to obtain untitered Group O whole blood from the WBB
Miller and colleagues further describe the current WBB capa-
bility for Navy CRTS’s in the same paper: donors in the crew of the LHA.
– The supervising physician on the LHA should ensure that
“To augment the ship’s blood supply and to acquire ONLY units from Group O donors are prepared for trans-
platelets for hemostatic resuscitation, the WBB — im- fer to the casualty ship in order to avoid the possibility of a
mediate blood donation by sailors and marines — can potentially fatal ABO mismatch that might ensue if Groups
be activated to obtain WFWB. Prior to deployment, A, B, or AB blood are used for a casualty with an incom-
about 10%, or 130, of the ship’s sailors are pre-screened patible blood type.
for whole blood donation and tested for transfu- – The Group O fresh whole blood should be drawn and pre-
sion-transmitted diseases (TTDs): human immunodefi- pared for transport as the two MH-60S helicopters are con-
ciency virus, hepatitis B virus, hepatitis C virus, syphilis, ducting pre-flight procedures. This can be accomplished in
and malaria. However, to increase the donor pool, all less than 15 minutes/donor. With multiple phlebotomists
embarked sailors and Marines are potentially eligible and multiple donors, the required blood can be obtained
for blood donation. The ship carries 128 Terumo Teru- very quickly.
®
flex Blood Bag Systems (Terumo BCT, Inc. Lakewood, – When departure permission for the helicopters is granted
CO) whole blood collection kits. . . . Casualty-receiving (or is anticipated), the fresh whole blood and blood ad-
ships transfuse only type-specific WFWB, not low-titer ministration sets should be taken on board the evacuation
type O WFWB. Prior to transfusion, blood-typing and aircraft and transported to the casualty ship so the transfu-
rapid testing for TTDs is performed by a laboratory sion can be initiated as quickly as possible. Recent evidence
technician.” 33 shows that “Minutes Matter” in the administration of pre-
hospital blood products when indicated. 30,32,36
Type-specific fresh whole blood is not recommended in TCCC,
but the LHA’s walking blood bank could be used to obtain – When the first MH-60S lands to pick up the casualty in
only Type O blood. As noted previously, this option for fresh shock, the SAR Medical Technician and/or the Emergency
Group O blood would not have Anti-A and Anti-B titers quan- Medicine physician or STP corpsman that have arrived
titated, however the majority of blood transfusions in World with the first evacuation helicopter should immediately be-
War II were untitered Group O whole blood. Despite this gin the blood transfusion.
52
extensive use of untitered Group O whole blood during that If the 5–10 units of fresh whole Group O blood have been
time period, there were no incidents of transfusion reactions drawn, but either the weather or the evolving casualty sce-
typical of those caused by high Anti-A and Anti-B titers until nario prevent the MH-60S from landing on the casualty ship,
1944, when several incidents were noted. 53,54 These cases did it might be possible to deliver the whole blood as well as other
not result in any fatalities, but did result in the establishment needed TCCC equipment and additional medical personnel by
of a US military policy of screening Group O donors for An- vertical replenishment (VERTREP).
ti-A and Anti-B titers.
Control of Life-Threatening Abdominopelvic
The use of untitered Group O fresh whole blood was again Hemorrhage in the Prehospital Shipboard Environment
shown to be safe during the recent conflicts in Iraq and Af- Casualty 3 is showing signs of hemorrhagic shock from her
ghanistan, where approximately 50% of the warm fresh suspected pelvic fracture and fractured femur. She has previ-
whole blood transfused in Army Forward Surgical Teams was ously received 2g of IV TXA and has had an improvised cir-
untitered Type O. 53
cumferential pelvic compression device applied. What else can
The LTOWB walking blood bank now present in the em- be done to slow the rate of internal bleeding pending surgical
barked Marine units provides another potential source of control?
fresh whole blood. 34,35 The collection of a single unit of FWB
does not impair the ability of Special Operations personnel to The 2018 TCCC Advanced Resuscitation Care Paper discussed
perform physical tasks. When both options are available, the the need for new methods for achieving prehospital abdomino-
55
LTOWB from the USMC walking blood bank would be pre- pelvic hemorrhage control to further reduce The 2018 TCCC
ferred over the untitered Type O blood from the LHA’s walk- Advanced Resuscitation Care Paper discussed the need for new
ing blood bank. The LTOWB thus collected does not have to methods for achieving prehospital abdominopelvic hemor-
be typed after the unit is drawn; rather, the collecting person- rhage control to further reduce preventable prehospital combat
28
nel would draw blood only from prescreened LTOWB donors. fatalities.
This option would likely not, however, make the blood avail- Two options for controlling abdominopelvic NCTH are the
able to the casualty more quickly than using the WBB on the commercially manufactured Abdominal Aortic Junctional
LHA because it would have to await flight clearance and the Tourniquet (AAJT) and the Combat Ready Clamp (CRC).
completion of preflight procedures on the first helicopter to Both devices apply external pressure on the aorta just above
be launched. its bifurcation, which would control hemorrhage from bleed-
ing sites distal to that location. A third option for compress-
Given the above, the best approach for obtaining whole blood ing the aorta at its bifurcation prior to trauma laparotomy
for the casualty with noncompressible torso hemorrhage and comes from a recent paper from the Department of Surgery
shock (BEFORE she reaches the LHA), would be the following: at Changzheng Hospital at the Naval Medical University, in
– As soon as there is known to be a shipboard casualty- Shanghai, China. The authors of the paper advocate for the
producing event to which the LHA will be responding, a

20 | JSOM Volume 22, Edition 2 / Summer 2022