Page 44 - JSOM Spring 2024

the requirements of continued education and training, and research should evaluate the differences in performing autol-
necessitates the requirement for effective administrative over- ogous EFWBT versus simulated arm/IV trainers to determine
sight to prevent undesirable patient outcomes. whether autologous blood transfusions replicate real-world
applications. This is paramount in ensuring the validity of
Through international collaboration, the U.S. Military and this research in assessing participants’ performance of DCR
UHPs can enhance EFWBT awareness and training, reduc- for hemodynamically unstable patients in simulated combat
ing mortality rates for patients in austere operating environ- conditions and the assessment of whether IV trainers create
24
ments. Implementing a Ukrainian EFWBT program on a disparities in confidence or competence in EFWBT training.
larger scale requires careful planning, coordination, and adher-
ence to regulatory guidelines to improve emergency medical Conclusion
response, enhance patient survivability, and reduce mortality
rates in conflict zones. By clearly outlining objectives, the pro- Our results demonstrated that the application of a Ukrainian
gram can set a clear direction for the implementation efforts of EFWBT training program can significantly increase UHPs’
medical professionals, military leaders, logistical experts, and confidence in conducting EFWBTs. Further larger-scale re-
regulatory representatives to ensure effective oversight and co- search is required to determine the impact of this training on
ordination. This multidisciplinary approach ensures that the concurrent performance outcomes. EFWBT has the potential
EFWBT program benefits from the expertise and perspectives to be a critical lifesaving capability in near-peer threat environ-
of various stakeholders by enabling a comprehensive and inte- ments and resource-restricted settings. However, its successful
grated implementation strategy. implementation requires ongoing research, collaboration, and
training to optimize its impact on patient outcomes.
Furthermore, collaboration between U.S. Military healthcare
professionals and experts in transfusion medicine can improve Acknowledgments
developmental strategies and EFWBT guidelines, with the aim The authors would like to thank CAPT Sherri Rudinsky, MD
of ensuring safety, quality control, and compliance with regu- (Chair – Department of Military and Emergency Medicine
latory guidelines. EFWBT guidelines should define standard- at the Uniformed Services University) and Col Cynthia Shen,
ized protocols to ensure consistent and safe practices, periodic DO (Operation Gunpowder Course Director – Department of
proficiency training requirements, and clear administrative Military and Emergency Medicine at the Uniformed Services
guidance in WBB protocols. Effective collaboration and a mul- University) for their unwavering support, expert advice, and
tifaceted approach toward improving patient outcomes will mentorship.
not only save lives but continue to refine and develop transfu-
sion practices on the battlefield. Author Contributions
ZLB wrote the manuscript; developed the curriculum, train-
Limitations ing, and evaluation of EFWBT trainees; and developed the
Limitations in resource acquisition, language barriers between data for Figure 7. JPC contributed to the Limitations section
instructors and participants, and participant prior medical train- and Discussion section of the manuscript; developed the cur-
ing may have adversely impacted training outcomes. The testing riculum, training, and evaluation of EFWBT trainees; and de-
conditions for the EFWBT course involved the use of a simulated veloped the data for Figure 1. KJM contributed to the Training
arm/IV trainer, which could degrade the efficacy of training in Development section; developed the curriculum, training, and
real-world applications. Autologous blood transfusions and evaluation of EFWBT trainees; and developed the data for
assessment of skill proficiency should be incorporated in high- Appendices A and B. JTS contributed to the Training Partici-
fidelity simulated TCCC patient scenarios to provide a more pants section of the manuscript. DWM developed the data for
accurate assessment of the capabilities of medical providers in Figures 5 and 6 and contributed to the Results section of the
treating real-world casualties. Another limitation of our study manuscript. RC agreed to evaluate all aspects of the work en-
was the language barrier between instructors and Ukrainian suring that questions related to the accuracy or integrity of any
participants. Since the EFWBT program was taught in English, part of the work were appropriately investigated and resolved.
which was the Ukrainian participants’ second language, the du-
ration of didactics and hands-on EFWBT training was expanded Disclosures
to allow for adequate translation of certain topics. Presentations, The authors have nothing to disclose.
training materials, and assessments translated into the partici-
pants’ native language may bridge the language barrier between Funding
instructors and participants. Furthermore, when comparing the No funding was received for this work.
UHPs to third-year medical students, the program may have had
more of an impact on the UHPs based on the limited exposure Disclaimer
to prior experiences in transfusion medicine. The views expressed are solely those of the authors and do not
reflect the official policy or position of the Uniformed Services
Future Research University, the U.S. Army, the U.S. Navy, or the Department
A longitudinal cohort study of Ukrainian participants should of Defense.
be conducted to assess the long-term effects and administrative
oversight of Ukrainian EFWBT programs and the develop- References
ment of concurrent Ukrainian EFWBT programs. Moreover, 1. Haque U, Naeem A, Wang S, et al. The human toll and humanitar-
research evaluating enduring Ukrainian EFWBT program ian crisis of the Russia-Ukraine war: the first 162 days. BMJ Glob
Health. 2022;7(9):e009550. DOI:10.1136/bmjgh-2022-009550.
capabilities should be assessed to determine whether UHPs 2. United Nations High Commissioner for Human Rights. Conflict-
trained in a Ukrainian-specific EFWBT program are able to re- related Civilian Casualties in Ukraine. Office of the UN High Com-
tain long-term confidence and competence in EFWBT. Future missioner for Human Rights; 2022. https://ukraine.un.org/sites/

42 | JSOM Volume 23, Edition 1 / Spring 2024