Page 96 - JSOM Fall 2024

Special Operations Medical Association

Training, Education & Scientific Assembly 2024

Recognized Research Track Abstracts

BEST OVERALL PRESENTATION Future work in this area should concentrate on demanding,
battlefield-specific tasks.
Effect of Fresh Whole Blood Donation on Human
Performance in United States Special Forces
HONORABLE MENTIONS
Alex P. Houser, DO, FAAFP , Mario A. Soto, MD, FACEP ,
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Kathryn S. Bell, MS , Paul G. Goldberg, MS, RD , Kevin J. Evaluation of the Performance of Medical Interventions in
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Cronin, MS, CSCS*D, RSCC*D , Rick C. Caldwell, 18D, Simulated Arctic Conditions
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SO-ATP , Brian K. Schilling, PhD 2 1 1 1
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1 US Army Special Operations Command (USASOC) Vik Bebarta, MD , Anne Ritter, DrPH , Elan Small, MD , James
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2 Kinesiology & Nutrition Sciences, University of Nevada Las Eazor, MPH , Todd Getz, PhD , Arian Anderson, MD , Mar-
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Vegas, Las Vegas, NV tin Musi, MD , Todd Miner, Ed.D , Sean Keenan, MD , Elaine
Reno, MD , Gordon Giesbrecht, PhD , Charisse Comart, BS,
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Introduction: Fresh whole blood has been the standard of care Tessa Vallin, BS, Jay Lemery, MD 1
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for the treatment of hypovolemia secondary to blood loss in 1 Department of Emergency Medicine, University of Colo-
the Tactical Combat Casualty Care guidelines since 2014. Cur- rado School of Medicine, Aurora, CO, USA
rent recommendations from the Prolonged Field Care Working 2 University of Manitoba, Winnipeg, MB, Canada
Group state the impact to mission performance is not degraded
with a 1-unit (450mL) donation. Many questions remain con- Introduction/Background: Increased activities in the Arctic
cerning the effects on small unit forces that donate at or near the have garnered significant geopolitical interest, necessitating
point of injury while on mission. Because there is limited infor- a robust Department of Defense Arctic Strategy. Conducting
mation on combat performance after donation, the purpose of arctic military operations incurs exposure to harsh environ-
this investigation was to examine the effects of blood donation mental conditions, including extreme cold temperatures. While
on simulated battlefield tasks in U.S. Special Forces Soldiers. limited data have demonstrated cold-induced deterioration in
cognitive and physical performance, the full impact of cold on
Materials and Methods: A total of 17 U.S. Special Forces Sol- medical personnel performance is not well understood. The
diers participated in this study. Soldiers served as their own goal of this study was to elucidate the impact of an extreme
controls and were subject to blinded blood draw and a sham cold environment on cognitive abilities and physical perfor-
draw, which were ordered randomly and separated by 6 days. mance of life-saving interventions (LSIs) by medical personnel.
Outcome measures consisted of performance, capillary blood
lactate, salivary osmolality, heart rate, and estimated core tem- Methods: This study was a prospective, repeated measures
perature. These measures were taken at baseline, then immedi- trial of military servicemembers and medical providers in an
ately following a 1,200m shuttle run, 3-event stress shoot, and extreme cold environment. The time to task completion and
5-mile run, all while wearing a typical combat load. success rate for various LSIs as well as cognitive response
and perceived stress were examined in warm (20ºC) and cold
Results: There was a moderate-to-large, statistically significant (–24ºC) conditions. Trial protocol involved pre-exposure cog-
(P<.05) increase in shuttle run time due to blood donation nition/physical testing, ambulation, medical task completion,
(Δ=12.5s, Hedges’ g=.0). We also detected moderate, statisti- and post-exposure cognition/physical testing. LSIs included
cally significant increases in shooting scores (Δ=29.2s, Hedges’ (but were not limited to): extraglottic airway placement, needle
g=.5) and 8km run times (Δ=3.9m, Hedges’ g=.7) due to blood decompression, hypothermia wrap application, peripheral in-
donation. There was no interaction between event and blood travenous (IV) access, blood transfusion, and cricothyrotomy.
draw condition for heart rate, estimated core temperature,
blood lactate, or salivary osmolality. Blinding was only 26% Results: This study enrolled 27 participants, with a mean of
effective, as Soldiers were able to correctly identify the proce- age of 34 year; 22 participants (81%) were male. Eleven (41%)
dure they were subjected to 74% of the time. were paramedics. The total time to task completion was sig-
nificantly longer in the cold trial (increase of 5.2min, P<.01),
Conclusions: The moderate-to-large performance decrements including for cricothyrotomy (P=.045), hypothermia wrap ap-
found in this study are somewhat greater than those of previ- plication (P=.013), peripheral IV insertion (P=.01), tourniquet
ous studies. We believe that our results may be different due application (P<.01), junctional wound packing (P<.01), chest
to the more demanding tasks that were performed after the seal application (P<.001), and tranexamic acid administration
blood draw in our investigation. It is also important to note (P<.005). In pre/post-testing between the warm and cold trial,
that the performance effects were not related to heart rate, hy- there was a significant decrease for grip strength (P<.04), but
dration, estimated core temperature, or lactate concentration. not for other physical or cognitive measures.

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