Page 11 - JSOM Fall 2022

Operation Blood Rain Phase 2

Evaluating the Effect of Airdrop on Fresh and Stored Whole Blood

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Roselyn W. Clemente Fuentes, MD *; Evan K. Shawler, MD ;
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William D. Smith, MD ; Robert L. Tong, MD ; William J. Barnes, MS ;
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Manuel Moncada, MLS(ASCP)CMSBB ; Cody W. Bohlke, IDMT ; Anthony L. Mitchell, MD 8
ABSTRACT
Background: Transfusion of whole blood (WB) is a lifesaving in other austere settings such as wilderness medicine or hu­
treatment that prolongs life until definitive surgical interven­ manitarian disasters where an acute need for WB delivery by
tion can be performed; however, collecting WB is a time­ airdrop is the only option.
consuming and resource­intensive process. Furthermore, it
may be difficult to collect sufficient WB at the point of injury Keywords: whole blood transfusion; airdrop; airdrop blood;
to treat critically wounded patients or multiple hemorrhaging aerial resupply; tactical combat casualty care
casualties. This study is a follow­up to the proof­of­concept
study on the effect of airdrop on WB. In addition, this study
confirms the statistical significance for the plausibility of using
airdrop to deliver WB to combat medics treating casualties in Introduction
the pre­hospital setting when Food and Drug Administration Data collected throughout the Afghanistan theater have as­
(FDA)–approved cold­stored blood products are not available. sociated better outcomes when the timeline to damage con­
Methods: Forty­eight units of WB were collected and loaded trol surgery is less than an hour and when patients receive
into a blood cooler that was dropped from a fixed­wing air­ pre­ hospital blood product transfusions. Although patient
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craft under a Standard Airdrop Training Bundle (SATB) para­ outcomes have improved drastically throughout the last two
chute or 68­in pilot chute. Twenty­four of these units were decades, most combat­related deaths occur before reaching
dropped from a C­145 aircraft, and 24 were dropped from a medical treatment facilities. About 25% of these deaths are
C­130 aircraft. A control group of 15 units of WB was stored considered avoidable, with nearly 90% of the latter caused
in a blood cooler that was not dropped. Baseline and post­in­ by hemorrhage. This information has led to a more robust
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tervention laboratory tests were measured in both airdropped network for pre­hospital care and has driven advancements
and control units, including complete blood count; prothrom­ in damage control resuscitation strategies, including point­of­
bin time/partial thromboplastin time (PT/PTT); pH, lactate, injury or en­route blood transfusions for both military and
potassium, bilirubin, glucose, fibrinogen, and lactate dehydro­ civilian trauma centers. 4,5
genase (LDH) levels; and peripheral blood smears. Results:
The blood cooler, cooling packs, and all 48 WB units did not Several tactics have been developed within the military to pro­
sustain any major damage from the airdrop. There was no vide early blood transfusion capabilities, including combat
evidence of hemolysis. Except for the one slightly damaged medics carrying low­titer O whole blood or collecting units
bag that was not sampled, all airdropped blood met parame­ of pre­screened type O blood from other unit members at the
ters for transfusion per the Joint Trauma System Whole Blood point of injury. Despite these efforts, a gap remains in capa­
Transfusion Clinical Practice Guideline and the Association bilities when the blood required outpaces the blood available
for the Advancement of Blood and Biotherapies (AABB) Cir- in situations such as massive hemorrhage, mass casualty inci­
cular of Information for the Use of Human Blood and Blood dents, or prolonged casualty care. Many studies have shown
Components. Conclusions: Airdrop of fresh or stored WB in a the importance of patient survival with pre­hospital transfu­
blood cooler with a chute is a viable way of delivering blood sion; however, few studies have demonstrated alternative, safe
products to combat medics treating hemorrhaging patients delivery methods.
in the pre­hospital setting. This study also demonstrated the
portability of this technique for multiple aircraft. The tech­ In the previous investigation published in this journal by
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niques evaluated in this study have the potential for utilization Tong et al, fresh WB was airdropped from a C­145 Combat
*Correspondence to roselynjan.w.fuentes.mil@mail.mil
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1 Lt Col Roselyn W. Clemente Fuentes is affiliated with the Flight and Operational Medicine Clinic, Eglin Air Force Base, FL. Capt Evan K.
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Shawler is affiliated with Operational Support Medicine Flight at Hurlburt Field, FL. Lt Col William D. Smith is affiliated with the Air Force
Special Operations Command, Innovation Division, Hurlburt Field, FL. Maj Robert L. Tong is Combat Aviation Advisor, 6th Special Oper­
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ations Squadron, Eglin Auxiliary Field 4, Duke Field, FL. William J. Barnes is a Medical Technologist affiliated with the Air Force Special
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Operations Command, School of General Reconnaissance, Hurlburt Field. Capt Manuel Moncada is affiliated with the Elgin Laboratory,
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Elgin Air Force Base. TSgt Cody W. Bohlke is Combat Aviation Advisor, 6th Special Operations Squadron, Eglin Auxiliary Field 4, Duke Field.
8 Col Anthony L. Mitchell is affiliated with the 8th Medical Group, Unit 2022 Kunsan, South Korea.
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