Page 56 - JSOM Spring 2024

Marines (24) enrolled as students in one of the three iterations
of the Valkyrie Emergency Whole Blood Transfusion Training
course between November 2020 and February 2021. Accord-
ing to participant self-report, roughly half (47%) of the par-
ticipants had deployment experience (mean 0.81 deployments,
FIGURE 1 Blood collection bag range 0–5) and 10% were deployed in combat zones. Over-
with integrated tubing and needle all, 5% reported providing point-of-care trauma treatment
(capped).
in combat zones, and 39% reported providing point-of-care
trauma treatment in noncombat environments. Most student
participants (82%) reported having never collected a unit of
blood. Of those who reported experience collecting blood,
roughly half (53%) reported collecting blood in training sce-
narios only, and roughly half (47%) reported collecting blood
in field or combat settings.

Our sample size was determined by the practical and scientific
considerations of obtaining complete data from three rounds
FIGURE 2 Straight stick of Valkyrie training, as we wanted to avoid the risk of over-
blood collection technique. generalizing from one Valkyrie training cohort that might not,
A gauze roll is commonly for whatever reason, be representative. A priori tests of power
used to maintain the position using G*Power software revealed that, assuming a 95% con-
8
of the needle.
fidence interval and a medium effect size of 0.50 standard
deviations (Cohen’s d=0.50), statistically significant results
would be found in 80% of opportunities (power=0.80) with
as few as 34 participants for this within-subjects design. It was
therefore assumed that the data from three rounds of Valkyrie
training, each including about 30 participants, would be rep-
FIGURE 3 The ruggedized
lock blood collection resentative of Valkyrie participants and confer adequate power
technique uses an IV catheter to test the study hypotheses.
capped with an injectable
port. The apparatus is Materials
protected by an occlusive The SS (Figure 1, Figure 2) is a one-piece device that incorporates
dressing. The integrated
needle from the blood a 1.25-in, 16-gauge, Ultra Thin Wall Fenwal HighFlo needle,
collection bag is inserted connected to the collection bag by a 1.5-meter length of tubing.
through the dressing and into Single Fenwal blood bags (Fresenius Kabi AG, Lake Zurich, Illi-
the injectable port. nois) optimally store 450mL of blood (Figure 1). The collection
bag, tubing, needle, and 63mL of citrate-phosphate-dextrose
(CPD) anticoagulant solution weigh 112g in total.

While both the SS and RL techniques are commonly used for The RL device (Figure 3) utilizes the same integrated one-
WBBs, to date, no studies have been specifically designed to piece apparatus as the SS device but additionally includes a
compare the SS and RL techniques using battlefield-relevant 16-gauge × 1.25-in IV catheter that is capped with an inject-
measures. The present study was designed to fill this import- able male luer lock (Cat No. DD-001-14, MPS Medical Inc.,
ant gap. Our null hypotheses were that SS and RL techniques Brea, California), commonly referred to as an injectable saline
would not significantly differ in venipuncture success rates lock or needle port, for connecting the needle to the donor’s
(H1), time to intravenous (IV) access (H2), blood collection arm. The RL is covered and secured with an occlusive dressing.
times (H3), total time (H4), and user preferences (H5).
Valkyrie Emergency Whole Blood Transfusion Training
Methods Valkyrie Emergency Whole Blood Transfusion Training is a
4-day course taught at Marine Corps Base Camp Pendleton,
Setting and Sample CA. Students participate in training scenarios where activation
Study data were collected at Marine Corps Base Camp Pend- of a unit-level WBB is required. For each trauma scenario, a
leton, California. Survey data were collected in a classroom role-player donates one unit of blood. Once blood collection
setting. Blood collection data were gathered during training is complete, the role-player switches their role to simulate a
scenarios in an outdoor setting. This study was granted ex- combat casualty and receives an autologous transfusion of
empt status as a process improvement project by the Clinical their previously collected blood, infused by the same student
Investigation Department and Institutional Review Board of who collected it. This model maximizes training value while
Naval Medical Center San Diego, San Diego, California (Ref- minimizing potential risks.
erence #938597). Approval for public release was granted by
the Public Affairs Office at Naval Medical Center San Diego. Students start the first training day with a precourse survey.
On days 1 and 2, all students practice venipuncture skills using
Study participants (N=86) included U.S. Navy Physicians 16-gauge IV catheters, without the complete RL apparatus or
(2), Physician Assistants (3), Independent Duty Corpsmen an attached blood collection bag. Blood collection and autol-
(5), Hospital Corpsmen (52), and Combat Life Saver (CLS) ogous transfusion are incorporated into training scenarios on

54 | JSOM Volume 23, Edition 1 / Spring 2024