Page 60 - JSOM Spring 2024

reasons. First, time spent retrieving and assembling materials is concern in acquiring blood from a WBB donor to treat a ca-
important in the context of drawing blood in a WBB scenario. sualty. In contrast, the RL was preferred by study participants
Second, these steps might contribute to differences between SS because of perceived stability, reliability, donor comfort, and
and RL in time to venipuncture. flexibility in swapping out blood collection bags when needed,
as well as tactical concerns. The present study highlights the
No sex or age data were collected. For precision, the present importance of studying FWB collection techniques to make
study used a calibrated digital weight scale to measure blood the appropriate choices toward preserving the lives of trau-
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bag fill rates, which is not feasible in the field. For these rea- matically wounded warfighters.
sons, the present findings should be generalized only with ap-
propriate caution. Acknowledgments
The authors gratefully acknowledge the instructors at the Navy
Areas of Future Research Education and Training Office, First Marine Division, the Valky-
The present study should be replicated with more diverse sam- rie students, and the role-players who made this study possible.
ples, including experienced conventional medics, members of
the special warfare community, and members of the wilderness Author Contributions
medicine community. Future scholars may seek to acquire suf- RW, BD, and SW conceived the study. SW and TD obtained
ficient sample sizes in demographic categories of interest (e.g., funding and recruited participants. RW, SW, and GJZ designed
sex and age) for meaningful multivariate and subgroup anal- the study. RW, CW, CJ, and KM coordinated and collected
yses. It is equally important to replicate the present study in the data. GJZ analyzed the data. All authors made substan-
challenging battlefield-relevant environments, including wind, tive contributions to interpretations of the data. RW wrote the
inclement weather, chaotic noise, and under various lighting first draft. All authors then critically reviewed and substan-
conditions, such as tactical lighting, night vision goggles, and tively contributed to iterative drafts. All authors approved the
13
night vision goggles with focusing adaptors. Quantitative final manuscript.
analyses of SS and RL workflow may prove fruitful in mini-
mizing blood donation time, whether through studies of how Disclosures
to optimally retrieve and lay-out equipment or through hand The authors have indicated that they have no financial rela-
motion analyses toward maximizing the efficiency of physi- tionships relevant to this article to disclose.
cally obtaining IV access.
Disclaimer
It is most vital to safely minimize transfusion time from donor The views expressed in this article are those of the author and
to recipient to improve casualty outcomes. For example, it is do not necessarily reflect the official policy or position of the
possible that greater cardiac output in a donor sufficiently in- Department of the Navy, Department of Defense, nor the U.S.
creases venous pressure to meaningfully decrease blood bag Government.
fill times. It is therefore important to investigate whether in-
creasing cardiac output immediately prior to donation (e.g., CDR Russell Wier is a military Servicemember or employee of
brief exercises like running in place or pushups) yields tacti- the U.S. Government. This work was prepared as part of my
cally and clinically useful results. It is also important to assess official duties. Title 17, U.S.C., §105 provides that copyright
comparative differences in qualities of FWB cellular compo- protection under this title is not available for any work of the
nents between SS and RL. Turbulent flow, shear stresses, and U.S. Government. Title 17, U.S.C., §101 defines U.S. Govern-
prolonged fill times might impact hemolysis, platelet count, ment work as work prepared by a military Servicemember or
factor activity, and INR, but it is presently unclear whether the employee of the U.S. Government as part of that person’s of-
quality of donated blood differs by SS and RL techniques. Fur- ficial duties.
ther, research is needed toward the development of superior
devices and techniques. For example, efforts to create a shorter Funding
needle would likely reduce blood bag fill times by reducing This work was supported by the First Marine Division as part
resistance to flow (Equation 1) and may improve both device of an internal process improvement project.
stability and donor discomfort by decreasing the lever arm
length. Next-generation improvements to blood collection kits References
may synthesize elements of SS and RL techniques, using mul- 1. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
tiple, detachable SS needles that use quick-connect fittings to (2001–2011): implications for the future of combat casualty care.
[published correction appears in J Trauma Acute Care Surg. 2013
collection bag tubing. Lastly, all the present techniques require Feb;74(2):706. Kotwal, Russell S [corrected to Kotwal, Russ S]].
filling a collection bag, which is immediately emptied into a J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–S437. DOI:
combat casualty. Technology advances to safely permit direct 10.1097/TA.0b013e3182755dcc.

donor-to-patient blood transfer have the potential to eliminate 2. Shackelford SA, Deborah JD, Nicole P, et al. Association of prehos-
time-consuming intermediate steps when minutes matter. pital blood product transfusion during medical evacuation of com-
bat casualties in Afghanistan with acute and 30-day survival. JAMA.
2017;318(16):1581–1591. DOI:10.1001/jama.2017.15097.
Conclusion 3. Nessen SC, Eastridge BJ, Cronk D, et al. Fresh whole blood use by
forward surgical teams in Afghanistan is associated with improved
This study of Valkyrie Emergency Whole Blood Transfusion survival compared to component therapy without platelets. Trans-
Training Program students revealed that the SS blood col- fusion. 2013;53(Suppl 1):107S–113S.
lection method was associated with somewhat higher first- 4. Spinella PC, Perkins JG, Grathwohl JG, Beekley AC, Holcomb
attempt IV access success rates, significantly faster IV access JB. Warm fresh whole blood is independently associated with
improved survival for patients with combat-related traumatic
times, and significantly faster blood collection times. There- injuries. J Trauma. 2009;66(Suppl 4):S69–76. DOI:10.1097/TA.
fore, SS should be the default when speed is the dominant 0b013e31819d85fb.

58 | JSOM Volume 23, Edition 1 / Spring 2024