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when every minute counts for survival. This study provides the References
time until SWB, when stored in TICs under different methods, 1. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
will go out of temperature tolerance. (2001–2011): implications for the future of combat casualty care.
J Trauma Acute Care Surg. 2012;73(6 Suppl 5): S431–S437.
2. Kotwal RS, Staudt AM, Mazuchowski EL, et al. A US military
Our study demonstrates that SWB will go out of threshold Role 2 forward surgical team database study of combat mortality
temperature in approximately 90 minutes, despite adding in­ in Afghanistan. J Trauma Acute Care Surg. 2018;85(3):603–612.
stant chemically activated cold packs, when the combat cooler 3. Meyer DE, Vincent LE, Fox EE, et al. Every minute counts: time
is stored at room temperature. This time increases to more to delivery of initial massive transfusion cooler and its impact on
than 8 hours when the combat cooler is prechilled to a stan­ mortality. J Trauma Acute Care Surg. 2017;83(1):19–24.
dard refrigerator temperature of 4.0°C (39.2°F). Furthermore, 4. Voller J, Tobin JM, Cap AP, et al. Joint Trauma System Clinical
the time increases to more than 36 hours when the combat Practice Guideline (JTS CPG): Prehospital Blood Transfusion
(CPG ID:82). Published 30 October 2020. https://jts.amedd.army
cooler is prechilled to the standard freezer temperature of .mil/assets/docs/cpgs/Prehospital_Blood_Transfusion_30_Oct
0.0°C (32.0°). Hence, adding a prechilled combat cooler to _2020_ID82.pdf. Accessed August 2021.
the standard method of refrigeration will extend the time of 5. Pusateri, AE, Moore EE, Moore HB, et al. Association of pre­
storage at proper temperature by at least 8 hours. hospital plasma transfusion with survival in trauma patients with
hemorrhagic shock when transport times are longer than 20 min­
utes: a post hoc analysis of the PAMPer and COMBAT clinical
The additional time provided by using the prechilled combat trials. JAMA Surg. 2020;155(2):1–10.
cooler will maintain mission readiness, allowing for activation 6. Kotwal RS, Howard JT, Orman JA, et al. The effect of a golden
of a walking blood bank, procurance of an alternative power hour policy on the morbidity and mortality of combat casualties.
source, or a request of resupply of SWB. This would ensure JAMA Surg. 2016;151(1):15–24.
that there is no delay in blood to aid the survival of poten­ 7. Miller BT, Lin AH, Clark SC, Cap AP, Dubose JJ. Red tides:
tial casualties. The ERSS now places combat coolers inside the mass casualty and whole blood at sea. J Trauma Acute Care Surg.
combat refrigerator in preparation for possible loss of active 2018;85(1S Supp 2):S134–S139.
refrigeration.

This study has limitations intrinsic to the nature of its being an
expeditionary medical unit, its area of operation, and the size
of sample for analysis. This study performed only a tempera­
ture investigation of SWB in expeditionary medical settings; it
did not assess the full viability of SWB, because hemolysis from
hemolytic motion trauma can occur. Additionally, the initial
TIC temperature for condition 4 was 0.39°C (32.7°F), which
is below the 1°C (33.8°F) storage recommendation. Although
the SWB did not go below 1°C (33.8°F), some components of
the SWB could have reached that temperature, and the effects
on viability or function are not clear. Our blood products and
medical gear consist of SWB and a combat­ issued refrigera­
tion system, which are not readily accessible to general medi­
cal facilities. Furthermore, the Middle East has environmental
factors that are difficult to reproduce. Finally, expired units of
SWB were used, although we minimized the impact of this by
conducting the study within 2 days after expiration. Despite
these limitations, this study attempts to fill the gap of informa­
tion regarding the logistical concerns of using SWB in austere
environments.

Conclusion
Combining active and passive refrigeration methods will in­
crease the time before the loss of blood product resources in
case of power failure. To our knowledge, this is the first study
looking at the logistical methods of refrigerated preservation
of SWB products in expeditionary medical units in theater. Al­
though the viability of blood products may not be guaranteed
by temperature alone, this study demonstrates an adaptable
approach to preserve the temperature of blood products using
our prespecified conditions despite refrigeration power failure
in austere settings, thereby maintaining mission readiness to
increase the survival of potential casualties.

Disclosure
The authors have nothing to disclose.

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