Page 41 - JSOM Spring 2024

With increasing casualty rates, limited access to FWB, and re- Next, a 25-minute didactic presentation was led by a multi-
source-intensive aspects of blood component therapy, it is in- service medical team consisting of an Army Special Operations
creasingly imperative that UHPs possess sufficient experience Combat Medic, a Navy Special Operations Independent Duty
and confidence in their EFWBT protocols, damage control re- Corpsman, and an Army Special Forces Medical Sergeant. The
suscitation (DCR) training, and effective administrative over- presentation outlined all relevant transfusion procedures from
9
sight of walking blood banks (WBB). However, transfusion donor collection to transfusion of FWB, utilizing donor collec-
training among UHPs is currently limited, as are their con- tion and patient transfusion equipment used during the latter
fidence levels with the use of blood and blood components, practical-application phase (Appendixes A and B [Matthews
management of transfusion-related adverse events, and effec- et al.]).
tive training pathways for evaluating competency in blood
10
transfusion. To close this training gap, the aim of this study The donor collection and transfusion equipment consisted
was to develop and assess safe transfusion training for UHPs of a low-titer group O donor list, assessment rubric (Figure
in order to equip them with the confidence to effectively em- S2), and donor/recipient transfusion supplies (Figure 1). The
ploy an emergency blood transfusion protocol in the event of didactics were followed by a hands-on demonstration of the
a mass casualty incident (MCI). EFWBT procedure led by the multi-service medical team.
The didactics covered the assessment of ABO- and Rhesus-
systems blood type matching using EldonCards, assessment
Methods
of donor baseline vitals, inspection of collection and transfu-
Training Participants sion equipment, recipient indications for blood transfusion,
The participants in our study were eight UHPs from various identification of blood transfusion reactions and treatments
medical backgrounds, including a pediatrician, an infectious rendered, and proper procedures for blood collection and
disease specialist, two general surgeons, an anesthesiologist, transfusion at point of injury (Figures 1–4 and Appendixes A
and a pathologist, each of whom had accumulated 13–21 years and B [Matthews et al.]).
of experience in their respective disciplines before redirecting
their efforts to training Ukrainian medics in Tactical Combat FIGURE 1 Emergency fresh whole blood transfusion medical
Casualty Care (TCCC). Two of the providers serving as med- training equipment. (Photo credit: Joshua Cuestas)
ics embedded within the Ukrainian medical team did not have
previous medical experience before the Russian invasion; one 1. Sharps Container
2. Donor Collection Bag
medic had a career in engineering and was a construction man- 3. Recipient Transfusion Bag
ager, while the other was a railway manager. The UHPs visited 4. Blood Bag Label
the Uniformed Services University of the Health Sciences (USU) 5. IV Simulated Army Trainer
6. Recipient Admin Information
in Spring 2023 for training in clinical and military operational 7. Constricting Band
medical skills, during which they completed our EFWBT train- 8. Permanent Marker
9. Gauze
ing initially designed for third-year medical students. 10. Surgical Tape
11. Hemostat Forceps
Training Development 12. Antiseptic Swab
13. Medical Gloves
Our research team assembled a panel of experts in blood 14. 18-Gauge Catheter
transfusion and DCR to develop an EFWBT program aimed 15. Transfusion Y-tubing
at improving transfusion capabilities for future generations
of military physicians on the battlefield. This panel of experts
included two board-certified emergency medicine physicians,
an Army Special Operations Combat Medic, a Special Forces
Medical Sergeant, a Navy Special Operations Independent
Duty Corpsman, two Navy Fleet Marine Force Corpsmen, and
a Ph.D. curriculum researcher. This panel used the modified UHPs then engaged in supervised self-guided practice to as-
Delphi technique to identify key aspects of EFWBT necessary sess and resolve knowledge gaps in EFWBT procedures and
for effective administration and oversight of combat blood protocols. Then, adhering to a 1:1 instructor-to-student ratio,
transfusions. The research team then developed a stepwise the multiservice medical team evaluated each UHP on the ap-
EFWBT assessment and didactics utilizing the guidelines and plication of EFWBT, starting with donor collection to trans-
recommendations of the Joint Trauma System Clinical Prac- fusion of FWB using the assessment rubric (Figure S2). UHPs
tice Guideline (JTS-CPG) for Prehospital Blood Transfusion, then conducted the post-training self-reported assessment to
11
12
the JTS-CPG for Whole Blood Transfusion, the JTS-CPG for evaluate confidence levels. Only the pre- and post-training
13
Damage Control Resuscitation, the JTS-CPG for Damage self- assessment were retained for evaluation of improved con-
Control Resuscitation in Prolonged Field Care, the Tactical fidence in EFWBT techniques and procedures.
14
Combat Casualty Care Guidelines, the 75th Ranger Regi-
15
ment Ranger O-Low Titer (ROLO) Program, and the Marine Training Evaluation
16
Corps Valkyrie program (Matthews K, unpublished data). 17 Evaluation of UHP confidence was conducted by cross-
examining pre- and post-training self-reported assessments
Training Implementation to determine whether the EFWBT training program effec-
Prior to the start of training, UHPs conducted a self-reported tively increased UHP-perceived confidence levels (Figure S3).
questionnaire used to determine their pre-training confidence The questionnaire consisted of six Likert-style questions with
level in EFWBT procedures (Figure S3). The self- assessment was answer scores ranging from 1 to 5 (1 = not confident at all,
cross-examined using a post-training self-reported question- 2 = slightly confident, 3 = somewhat confident, 4 = fairly con-
naire to determine whether their confidence level increased. fident, 5 = completely confident) (Figure S3). Because of the
EFWBT in Austere Environments | 39