Page 30 - JSOM Spring 2024

Development and Implementation of a
Standard Operating Procedure for Military Working Dog
Blood Collection, Storage, and Transport

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Elizabeth L. Evernham, DVM ; Benjamin T. Fedeles , MD; Kayla M. Knuf, MD *
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ABSTRACT

Military working canines are critical assets and force multipli- platelets, and packed red blood cells [pRBCs]) demonstrated
ers for the Joint Force. Most often deployed forward of Role improved hemostasis and fewer deaths due to hemorrhage
2 assets, they are reliant on non-veterinary resources when with administration of balanced blood components (1:1:1
wounded, ill, or injured in an operational environment. Hem- plasma:platelets:pRBCs). This approach, combined with the
orrhagic shock is the most prevalent form of shock seen in fact that components can be stored longer than whole blood,
battlefield injuries and is most effectively treated with whole resulted in a shift to component therapy. However, over
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blood transfusion. Dogs cannot be transfused with human the past two decades, civilian trauma centers have been re-
blood and there is no formal Department of Defense (DoD) implementing whole blood transfusion protocols (specifically
canine blood product distribution system to operational set- low anti-A/B titer type O whole blood), sparking an interest in
tings. A walking blood bank is helpful when multiple dogs are military research into this approach. Preliminary studies show
geographically co-located and the resource can be provided equivalent or improved resuscitation and hemostatic markers
to an injured patient quickly. In areas as widely dispersed as along with decreased processing and equipment needs from
the Horn of Africa, the likelihood of co-location is slim and using whole blood instead of component therapy. Plus, im-
delaying this vital resource can mean the difference between provements in whole blood storage make these products more
life and death. Therefore, personnel at the Role 2 facility in readily available than before. Because much of the literature
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Camp Lemonnier, Djibouti, filled a critical capability gap for on trauma in dogs has followed human medicine, the transi-
the operational area by producing a local canine whole blood tion to whole blood has been adopted by veterinary medicine.
bank with distribution to multiple countries. This protocol can
be replicated by other locations to improve medical readiness The Unique Nature of Canine Trauma Resuscitation
for the working canines who serve to maintain DoD Force in Austere Environments
Protection.
Dogs cannot be transfused with human blood or blood prod-
Keywords: military working dogs; whole blood transfusion; ucts because of the risk of severe allergic reactions. Addition-
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transfusion medicine; veterinary medicine ally, canine blood products are often limited in operational
settings, and there is no formal Department of Defense pro-
gram in place for canine blood products disbursement. To
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bridge the notable capability gap and continue to improve
Introduction
access to battlefield care for working dogs, a source of rap-
Military working dogs (MWDs) and multipurpose canines idly accessible canine blood products located near high-risk
(MPCs)** are critical assets and force multipliers for the missions involving MWDs is needed.
Joint Force. Wounded, ill, or injured MWDs require combat
casualty care in the operational environment, many of which Role 2 veterinary assets with robust canine populations gener-
are forward deployed from a Role 2 facility. When veteri- ally include a walking blood bank. This panel of viable blood
nary personnel are not available, this care may be provided donors is prepared for emergencies where whole blood is
by a nonveterinary healthcare provider to preserve life, limb, needed. The value of a canine walking blood bank program
or eyesight or stabilize the animal for transport to a veter- is valid as it provides blood products when needed, without
inary treatment facility. In these battlefield injuries, shock, wasting resources. However, it cannot be the sole solution
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if present, is most commonly hemorrhagic. Hemorrhagic for a widely dispersed area of operation such as the Horn of
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shock management in dogs is similar to treatment in humans: Africa (HOA). The low number of MWDs stationed together
targeted fluid administration in conjunction with control of makes this effort unrealistic. Following blood collection, ex-
hemorrhage. While treatment with crystalloid solutions and pert guidance dictates that the donor must be maintained on
colloids can be helpful, aggressive use leads to coagulopathy a harness, with no neck leads, and cannot work or travel by
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and increased bleeding in humans. aircraft for a minimum of 24 hours. Solo canines or those
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in theater for only a short duration cannot be removed from
Efforts to advance transfusion medicine are continuously on- the fight because of the time it takes for donation prior to an
going, evidenced by historical shifts in treatment protocols. operation. Plus, having properly trained personnel, appropri-
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Fifty years ago, studies evaluating blood components (plasma, ate equipment and supplies, and the time and planning needed
*Correspondence to kayla.knuf@gmail.com
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1 CPT Elizabeth L Evernham, Capt Benjamin T. Fedeles, and Maj Kayla M. Knuf are officers at Special Operations Command Africa, Djibouti,
Africa.
**For the purposes of this article, the term MWD includes MPCs.
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