Page 33 - JSOM Winter 2024

FIGURE 1 Armed Services
Blood Program blood
product flow chart.

Department of Defense (DoD) that allow for interoperability sourcing, and that may require sourcing from the indigenous
between all Services. The two standardized message formats population or from host nation hospitals.
are called the Blood Report (BLDREP) and the Blood Ship-
ment Report (BLDSHIPREP). All medical assets are required Next, future practitioners need to consider end-user require-
to submit a daily BLDREP to their blood product supplier. The ments. Bulk shipment of blood may be needed at the Role 2, but
exact report format and reporting period will be provided by medical personnel at the Role 1 to point of injury (POI) may re-
the AJBPO/JBPO according to theater policy. 6 quire a more modular package because of their reduced carrying
capacity. Package requirements need to be conditioned prior to
conflict, as this will maximize the effect of blood reaching every
Blood Support in LSCOs
end user and reduce wastage. Push packages, or “speedballs,”
The future practitioners of tomorrow’s war need to assume should be standardized as a menu of options for all requesters to
that there will be high casualty rates in large-scale combat select from within theater; these must support both the owner
operations (LSCOs), and that there will be surges of superi- of delivery and delivery system. For example, if the option to re-
ority throughout the various domains. Regardless of the con- supply blood via partner force air assets is available, our practi-
7
ditions, our planners need to be able to capture the capacity tioners need to ensure that the bundle meets the requirements of
required to meet the supply demand. This challenge is what we said partner force and their platform. If they are unfamiliar with
refer to as the Warfighter Supply Chain Management Effort the requirements needed to sustain the package, (i.e., refilling ice
(WSCME), and we argue that each of its four fundamental within package every 4 hours), or their platform cannot support
pillars requires redundant solutions with omnidirectional con- the current package, it will only aid our adversaries.
sideration. These four pillars are: materiel sourcing, materiel
package, delivery ownership, and delivery system. Within a combined joint fight, logisticians may need sustain-
ment support from external entities. Current doctrine concep-
To begin, the first way to increase capacity is within the ma- tualizes linear delivery for each Service, but as shown in World
teriel sourcing process. FDA-approved blood products are War II, LSCO requires omnidirectional consideration. Sustain-
not the only solution. We know this because blood support ment will require a combined joint effort, and this needs to be
efforts have leaned into solutions, such as FDA-like approved considered prior to armed conflict. The use of blood or blood
blood from seven countries of origin and the development ef- collection from host nations may not be feasible prior to con-
forts for blood substitutes (i.e., freeze-dried plasma). However, flict due to Title 10 of the U.S. Code, but the coordination for
many leaders continue to list “walking blood bank” as their support can still be productive since it raises capacity levels
alternative source for blood in combat during simulation and through other means, such as potential locations for blood
training exercises. The walking blood bank is an option, but storage or management support.
it needs to be considered as the emergent solution within the
Primary, Alternate, Contingency, and Emergency (PACE) plan Lastly, future practitioners need to consider the delivery means
to preserve the performance and survivability of the fighting through which blood will be delivered. Many current leaders
force as much as possible. Future practitioners should look are looking into “smart” delivery systems, like aerial drones.
at where blood can be sourced before and during conflict. Drones are an option, but we must also consider the potential
The best solution would be for our forces to have BPDs fully of our adversaries to contest these systems and the costs asso-
stocked, partner nation support, and blood substitutes created ciated with drone capability. We argue that logisticians need to
that have a long shelf life and require no temperature manage- also consider other economical options, and looking into the
ment. However, even the best planned materiel sourcing can past, there are multiple solutions ranging from the possibility
change within conflict. Our BPDs may become targeted, our of mule resupply to artillery-fired resupply. Additionally, logis-
partners may run out of supplies to support, and industry may ticians must also consider the feasibility of other domain ave-
fail to meet the demand for blood substitutes. Logisticians in nues and their potential solutions, like torpedo-fired resupply
the future must consider other ongoing solutions for materiel or submersible drone delivery.

Blood: The Liquid Will to Fight | 31