Page 62 - JSOM Spring 2024

Prescreened Whole O Blood Group Walking Blood Bank Capabilities
for Nontraditional Maritime Medical Receiving Platforms

A Case Series

2
Raymond K. Chang, MD ; Burke P. Boyle, DO ; Mike O. Udoh, MD ; Joshua M. Maestas ;
1
3
4
Joseph A. Gehrz, MD ; Eddy Ruano, MS ; Leticia Banker, PA-C ; Andrew P. Cap, MD ;
8
6
5
7
9
10
Jeffrey W. Bitterman, MD ; Travis G. Deaton, MD ; Jonathan D. Auten, DO *
11
ABSTRACT
Background: Tactical Combat Casualty Care (TCCC) guide- casualty care. Transfusion of stored or fresh whole blood prod-
1
lines recognize low-titer group O whole blood (LTOWB) as ucts is a cornerstone of advanced resuscitative care of critically
the resuscitative fluid of choice for combat wounded. Utiliza- injured warfighters and has been used extensively in ground-
tion of prescreened LTOWB in a walking blood bank (WBB) based forward-deployed medical facilities during the military
format has been well described by the Ranger O low-titer conflicts in Iraq and Afghanistan. The Association for the
2–4
blood (ROLO) and the United States Marine Corps Valkyrie Advancement of Blood & Biotherapies has also recognized
programs, but it has not been applied to the maritime setting. LTOWB as a whole blood product that can be given for severe
Methods: We describe three WBB experiences of an expedi- bleeding to patients of all blood groups. Recent TCCC case
5
tionary resuscitative surgical system (ERSS) team, attached scenarios and a review of Falkland Islands War casualties high-
to three nontraditional maritime medical receiving platforms, light the importance of remote damage control resuscitation
over 6 months. Results: Significant variations were identified in (RDCR) in a maritime setting. Post–Korean War descriptions
6,7
the number of screened eligible donors, the number of LTOWB of whole blood product use for RDCR in the maritime envi-
donors, and the timely arrival at WBB activation sites between ronment are limited to two case series on traditional maritime
the platforms. Overall, 95% and 84% of the screened eligible medical receiving amphibious ships. The use of a prescreened
8,9
group O blood donors on the Arleigh Burke Class Destroyer LTOWB pool of donors has been well described by the Ranger
(DDG) and Nimitz Class Aircraft Carrier (CVN), respectively, O low-titer blood (ROLO) and the U.S. Marine Corps Valkyrie
were determined to be LTOWB. However, only 37% of the program, but the application of these programs to the maritime
eligible screened group O blood donors aboard the Harp- environment is lacking. 10
er’s Ferry Class Dock Landing Ship (LSD) were found to be
LTOWB. Of the eligible donors, 66% did not complete screen- The U.S. Navy provides platform-agnostic, mobile, rapidly
ing, with 52% citing a correctable reason for nonparticipation. deployable expeditionary resuscitative surgical system (ERSS)
Conclusion: LTOWB attained through WBBs may be the only teams to treat battle-injured warfighters both ashore and afloat.
practical resuscitative fluid on maritime platforms without in- The ERSSs are single-surgeon teams (SSTs) that have tradition-
herent blood product storage capabilities to perform remote ally been assigned to large amphibious ships like landing heli-
damage control resuscitation. Future efforts should focus on copter docks (LHDs) and landing helicopter assault (LHA) or
optimizing WBBs through capability development, education, hospital ships like the United States Naval Ship (USNS) Mercy
and training efforts. or USNS Comfort, where blood banking capabilities are ro-
bust. However, the SSTs also attach to nontraditional maritime
Keywords: Low titer O; whole blood transfusion; damage medical receiving platforms like expeditionary sea base (ESB),
control resuscitation; distributed maritime operations; walk- guided missile destroyer (DDG), dock landing ship (LSD), or
ing blood bank nuclear-powered aircraft carriers (CVNs). The DDG, ESB, and
LSD are nontraditional maritime receiving platforms that do
not have inherent blood product storage capabilities and pos-
sess limited experience with prescreened walking blood banks
Introduction
(WBBs) that could produce fresh LTOWB or group-specific
Background whole blood. The CVN does have a WBB doctrine, but the im-
The current Tactical Combat Casualty Care (TCCC) guidelines plementation of that policy for the ship’s medical department
for fluid resuscitation of hemorrhagic shock recommend the has been challenging since its inception. In the U.S. Military
11
use of cold stored or prescreened fresh group O whole blood population, the prevalence of group O is approximately 38%
with low anti-A and anti-B titers (low- titer group O whole and, among these potential donors, roughly 70%–75% have
blood [LTOWB]) as the resuscitation fluid of choice for combat low anti-A and anti-B titers. 12–14 The use of a prescreened O
*Correspondence to jonathan.d.auten.mil@health.mil
7
5
1 LT Raymond K. Chang, LT Burke P. Boyle, ENS Mike O. Udoh, HM1 Joshua M. Maestas, LCDR Joseph A. Gehrz, LCDR Leticia Banker,
4
3
2
and CDR Jonathan D. Auten are affiliated with the Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, CA.
11
5 LCDR Joseph A. Gehrz and CDR Jonathan D. Auten are affiliated with the Uniformed Services University of the Health Sciences, Department
11
6
of Military and Emergency Medicine, Bethesda, MD. LT Eddy Ruano is the Blood Donor Center Manger, Department of Pathology, Naval
Medical Center San Diego, San Diego, CA. COL Andrew P. Cap is the Director of Research, United States Army Institute of Surgical Re-
8
search, Fort Sam Houston, TX. CAPT Jeffrey W. Bitterman is the Force Surgeon, United States Indo-Pacific Command, Camp H. M. Smith, HI.
9
10 CAPT Travis G. Deaton is Force Surgeon, First Marine Expeditionary Force, Camp Pendleton, CA.
60