Page 15 - JSOM Fall 2022

FIGURE 6 Comparison of Airdrop
Versus Control Values
LDH, lactate dehydrogenase;
PT, prothrombin time; PTT,
partial thromboplastin time

Mean pH did decrease and glucose increased across both the It is important to note that the first line of care would continue
airdrop and control groups, although this has been previously to be to use FDA­approved cold­stored low­titer O WB and
observed when mixing blood with the acidic anticoagulants of other FDA­approved cold­stored blood products. However,
CPDA­1. Additionally, the baseline values are within normal airdropped WB for a patient with massive trauma and hemor­
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limits based on the timeframe in which the blood was stored, rhage in the pre­hospital setting could be employed in remote
including the potassium levels for the units used in the C­145 theater situations with no other expedient options available.
airdrop. There is also potential for storage lesions—referring The risks and benefits of using airdropped WB will need to
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to the structural and functional changes of donated red blood be considered by combat medics and combatant command
cells that can cause increased hemolysis—that typically starts to surgeons.
occur after about 2 weeks of storage. WB in CPDA­1 bags can
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be stored for up to 35 days prior to transfusion. Studies and The other unique aspect of this study was the utilization of
standard use have shown that even with these laboratory value more than one type of military aircraft with slightly different
changes over the duration of storage, the WB was still safe for drop profiles. This demonstrates the portability of this life­
transfusion. Ideally, all units of blood would have been collected saving procedure that will increase the operational flexibility
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and airdropped with the same number of days spent in storage, to potentially use any aircraft of opportunity should the need
but this was challenging because of constraints with collecting arise. Unmanned aerial vehicles may also provide yet another
high volumes of blood products and then coordinating airdrop way to deliver medical supplies, including WB to combat units
missions. The capability of WB to coagulate was assessed with using similar drop procedures.
PT/PTT, which did not appear to be significantly affected in pre­
and post­intervention analysis in the airdrop and control groups.
The temperature of the units was 7.6°C and 6.8°C in the exper­ Conclusions
imental and control groups, respectively, which is inside of the Our findings suggest that airdrop is a safe method to deliver
target temperature to transport WB 1°C to 10°C. fresh or stored WB to combat medics treating massively hem­
orrhaging patients in the austere pre­hospital setting. The next
As can be observed, there was significant variance in the base­ step will be to incorporate the chute minimum weight waiver
line values of the WB unit based on time of storage versus into TO 13C7­1­11 to ensure that all US military airdrop units
the use of fresh WB. This may have potential as a confound­ can use these findings to save lives. The authors continue to
ing factor; however, it may also be useful as a mimic of re­ coordinate with the appropriate Air Force and Army agencies
al­world conditions where airdrop would be used, which may for the TO updates. The techniques evaluated in this study
include the use of either stored WB or fresh WB via either the have the potential for use in other austere settings, such as wil­
Ranger O Low Titer (ROLO) protocol, the Air Force Special derness medicine or humanitarian disasters, where there could
Operations Command (AFSOC) Special Operations Low Titer be an acute need for WB delivery in which airdrop is the only
(SOLO) protocol, or the low­titer O WB protocol.7 option.

Accelerometer data showed a variance of G forces with in­ Acknowledgment
creased Gz for the C­145 bundle—which was heavier with the The authors would like to thank the 6 SOS, 492 SOTRG Det
10­lb weight. This additional poundage was added to meet the 2, SOCOM Det 1, and 417 FLTS for their assistance in rig­
C­145 ramp airdrop requirements of 28 psf minimum. The ging bundles as well as coordinating the flights and air drops.
increased mechanical shock did not correlate to any signs of Additionally, they would like to acknowledge Brian Casleton,
increased hemolysis. Additionally, the increased altitude of the Armed Services Blood Program, and Joseph Rose, AFSOC/
C­130 drop of 500­feet AGL compared with the C­145 200­ SGR, for their assistance completing this project. Finally,
feet AGL did not show a significant effect on the pre­ and the authors would like to thank Jisuk Parks, PhD, at JBSA­
post­laboratory values between the two aircraft drops. Lackland, TX, for statistical analysis assistance

Effect of Airdrop on Fresh and Stored Whole Blood | 13