Page 34 - JSOM Winter 2024

Planning Factors platelets, and can also store 300 units. Field Hospitals (Role
8
3) can hold up to 480 units of whole blood/WBE. Roles 1 and
Before diving into blood planning support for an LSCO fight, 2 are currently ongoing materiel solution fielding.
we must consider three factors: blood needed per patient,
blood capacity starting from the ASWBPL and working down What we can say so far is that the Role 1 requires capacity to
to the maneuvering medics, and blood package considerations. hold enough blood to support maneuvering medics (who, in-
To remedy this, the Joint Staff Surgeon’s Office hosted an Op- dividually, can carry 2 units each) within their battalion, while
erational Planning Team in March 2022 to find a standard the Brigade Support Medical Company (BSMC) will require
planning factor needed for WIA casualties.
enough blood to support their Medical Treatment Platoon and
the Brigade Medical Supply Office (BMSO) team, so that they
The OPT concluded with the recommendation to future GCCs can meet the resupply demands of each supported unit within
to plan for 8 units of whole blood or whole blood equivalent the Brigade (BDE). If assigned, the Forward Resuscitative Sur-
(WBE) per WIA casualty and that historically only 20% of gical Detachment (FRSD) also has a 200-unit capacity and
2
casualties will require blood. The assumption is that 2 units may be positioned far forward in the fight. Although doctrine
will be required at the POI, and the remaining 6 units will be states BSUs can distribute blood to Role 2 assets like the FRSD,
required at follow-on roles of care.
it may be worth advising against based on probability of sur-
vivability to conduct the blood resupply mission. Combatant
Therefore, hypothetically, if a GCC estimates that 1,000 war- commanders at each echelon will need to consider how far
fighters will be wounded within 24 hours, 200 of them will external support can maneuver, and at which point they will
require 8 units of whole blood or WBE each. This totals to need to sustain resupply efforts internally. This will require
1,600 units needed within that 24-hr time span.
Sustainers to understand the packaging considerations needed
for blood to ensure supplies are not compromised.
Next, we will explore the capacity of our known blood support
capabilities. The ASWBPL can store and process up to 1,000 These packaging considerations include weight, cubic di-
packed red blood cells (PRBC), 1,000 fresh frozen plasma (FFP/ mensions, delivery system, temperature control, and time in
PF24), 500 cryoprecipitate (CRYO), and 500 frozen red blood custody. Blood products, once provided to the Brigade, may
cells (FRBC) per week. BPDs can store frozen blood products, only have 10–14 days of shelf life left. To further challenge
as well as thaw and deglycerolize frozen RBC, prior to being company-level logisticians, blood products require temperature
issued to BSUs. It should be noted that the BPD focuses on monitoring to ensure that they are safe for use (see figure 2).
storing frozen group O and A RBCs for use during the initial It is advised that resupply efforts are made as easily as possi-
stages of a contingency operation before liquid blood can be ble. The fastest possible way to do this is conducting one-for-
shipped from the CONUS donor centers and the ASWBPL or one transfers in which BMSOs maintain the same containers
as an emergency supplement to theater blood supplies. 6
as the end users and provide resupply with pre-filled packaged
containers through a Forward Support Company’s (FSC) Lo-
There is no doctrinal quantity provided for the BPD’s carry- gistics Train.
ing capacity, as these are often stood up just prior to conflict.
Practitioners need to keep this in mind because the ability to The FSC can issue the new, pre-filled container to the end user
prepare prior to engagement may be more challenging than and collect the old container from the end user, much like what
estimated. EBTCs can process and store 3,000 units of blood is done with pallet swaps. Regardless of a unit’s standard op-
per week. 6
erating procedure for conducting resupply, logisticians will be
successful if they apply fundamentals taught within the plan-
BSUs are typically the Army’s MDBS, which are doctrinally ning phase of Logistics Captain’s Career Course, such as cal-
composed of 30 personnel, can perform emergency collection culating weight and cubic requirements.
of 3,900 units of fresh whole blood and 900 units of apheresis
FIGURE 2 The Armed Services Blood Program’s blood product storage consideration snapshot.

Red Blood Cells – Liquid Frozen Red Blood Cells Low Titer Group O Whole Blood
• Expiration: 35 or 42 days • Expiration: 10 years frozen • Expiration: 21 or 35 days
• Storage temp: at 1–6°C • Storage temp: at ≤65°C • Storage temp: at 1–6°C
• Shipment temp: at 1–10°C • Shipment temp: at ≤40°C • Shipment temp: at 1–10°C
• Thawed/deglycerolized 14 days
Platelets – Liquid at 1–6°C (*only on units frozen Cryoprecipitate
• Expiration: 5 or 7 days since 2005 in closed system) • Expiration: 1 year
• Store/ship temp: at 20–24°C • Prepositioned in some theaters • Store/ship temp: at ≤18°C
• Not available for shipment and shipboard • Infuse within 6 hr of thaw/pool
to theater.
• Performing in-theater platelet Plasma (Fresh Frozen/Frozen Convalescent Plasma
apheresis collections (not fully Within 24 hrs.) • Expiration: 1 year
tested). • Expiration: 1 year • Store/ship temp: at ≤18°C
• Stored/ship temp: at ≤18°C
Liquid Plasma
• Expiration: 26 or 40 days Cold Stored Platelets
• Storage temp: at 1–6°C • Expiration: 14 days
• Shipment temp: at 1–10°C • Storage temp: at 1–6°C
• Shipment temp: at 1–10°C

Note: All expiration dates are from date of collection.

32 | JSOM Volume 24, Edition 4 / Winter 2024