Page 40 - JSOM Spring 2024

Emergency Fresh Whole Blood Transfusion Training
for Ukrainian Health Professionals in Austere Environments

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Zachery L. Brown, USA *; Joshua P. Cuestas, USN ;
Kevin J. Matthews, USN ; Jonathan T. Shumaker, USN ;
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Durwood W. Moore, MS ; Rebekah Cole, PhD 6

ABSTRACT
Background: Blood is a highly valuable medical resource that cold-stored low titer O whole blood (CS-LTOWB) through the
necessitates strict guidelines to ensure the safety and well- being use of low- titer group O blood donors, whose titer count is
of the recipient. Since the onset of the war in Ukraine there screened and vetted at a duration dependent on administrative
has been an increased demand for training in emergency fresh policy. For elements operating far forward of optimal hospi-
whole blood transfusion (EFWBT) to improve damage con- tal care, as would be expected in a resource-limited, near-peer
trol resuscitation capabilities. To meet this demand, we devel- threat operating environment, low-titer group O blood donors
oped, implemented, and evaluated a training program aimed are crucial for rapid-recall or immediate blood draw during
at enhancing Ukrainian EFWBT proficiency. Methods: Eight routine combat operations. Furthermore, administrative over-
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Ukrainian healthcare professionals (UHPs), including six phy- sight of an EFWBT program is paramount in preventing ad-
sicians and two medics, completed our training, derived from verse transfusion reactions, blood type incompatibilities, or
the Joint Trauma System Clinical Practice Guidelines, Tacti- relapse in EFWBT training. Thus, clear administrative over-
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cal Combat Casualty Care (TCCC) Guidelines, 75th Ranger sight and routine proficiency training in EFWBT procedures
Regiment Ranger O-Low Titer (ROLO) program, and Marine are necessary to ensure the success of the EFWBT program and
Corps Valkyrie program. Participants were assessed on their increase the survivability rates of hemodynamically unstable
confidence in the practical application and administrative over- patients.
sight requirements of an EFWBT program. A cross- comparison
was conducted between a larger data set of third-year medi- Ukrainian casualties in isolated and resource-limited envi-
cal students from the Uniformed Services University and the ronments have limited means of expediting an immediate
UHPs to determine the statistical significance of the program. evacuation to a higher level of care. Furthermore, Ukrainian
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Results: The difference in mean scores of UHPs during pre- and healthcare professionals (UHPs) lack the logistical means to
post-training was statistically significant (p<.001). Addition- access a reliable supply of CS-LTOWB for their hemodynam-
ally, the average rate of improvement was greater for the UHPs ically unstable patients. To alleviate logistical constraints, it
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compared with the third-year medical students (p=.000065). becomes evident that effective use, understanding, and imple-
Conclusion: Our study revealed that the application of an mentation of an EFWBT protocol are paramount in improving
EFWBT training program for UHPs can significantly increase the survivability of their patients. However, several challenges
confidence in their ability to conduct EFWBTs on the battle- exist for the implementation of EFWBT within Ukraine.
field. Further larger-scale research is needed to determine the
impact of this training on performance outcomes. Since the onset of the Russian invasion, Ukraine’s healthcare
system has continued functioning overall, but challenges such
Keywords: Ukraine; fresh whole blood; transfusion medicine; as the rising costs of managing medical resources, logistical
emergency medical services; Russian-Ukrainian War obstacles, and damaged infrastructure are increasingly limiting
access to essential services for both civilians and military per-
sonnel. Ukraine’s decentralized medical system has created a
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logistical lag in the appropriate distribution of medical supplies
Introduction
and equipment. These limitations are compounded by Russia’s
From 2014 to 2023, war in Ukraine has led to over 17,500 deliberate targeting of Ukrainian health infrastructure, with
deaths and 125,000 casualties, and the conflict is still ongo- nearly 700 attacks on Ukrainian healthcare facilities to date,
ing. Reducing patient mortality in this conflict can be achieved including hospitals, blood transfusion centers, pharmaceutical
through the implementation and use of emergency fresh whole warehouses and factories, and ambulances, with 64 attacks on
blood transfusion (EFWBT) programs. These programs al- healthcare infrastructure in the first week of the current war
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low healthcare professionals to augment limited supplies of in Ukraine alone. 7,8
*Correspondence to zachery.brown@usuhs.edu
1 SFC Zachery L. Brown, HM1 Joshua Cuestas, and HM1 Kevin J. Matthews are Enlisted to the Medical Degree Preparatory Program (EMDP2),
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School of Medicine, Uniformed Services University of Health Sciences, MD and graduate students of the Department of Systems Biology, George
Mason University, Manassas, VA. HM1 Jonathan T. Shumaker is a Senior Enlisted Advisor in the Department of Military and Emergency Med-
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icine, Uniformed Services University of the Health Sciences, Bethesda, MD. Durwood W. Moore is a Biostatician in the Department of Systems
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Biology, George Mason University, Manassas, VA. Dr. Rebekah Cole is a Research Associate Professor in the Department of Military and Emer-
gency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
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