Page 38 - JSOM Winter 2024

Arctic Considerations practitioners need to determine the approach that best sup-
ports the mission.
Further discussion is required to identify solutions to known
capability gaps in arctic environments. As stated earlier, the The Naval Medical Center San Diego’s Combat Trauma Re-
goal of infusing warmed IV fluids/blood is to reduce negative search Group-West is studying the validation between two
heat balance rather than to actively warm the patient, since ev- emergency low-titer O whole blood (LTOWB) approaches us-
ery decrease of 1.0°C (1.8°F) in core temperature below 36°C ing cold stored whole blood (CSWB) to meet blood demand
(96.8°F) results in a 10% increase in red blood cell (RBC) con- afloat. Much like ground forces, the Navy is assuming blood
sumption in the first 24 hours of admission. Additionally, we products will be scarce and the walking blood bank may not
discussed how data emphasizes the need for effective hypo- meet the demand for immediate action, as it will be extremely
thermia prevention at the POI, along with continued patient difficult to move personnel during an active combat engage-
warming during massive transfusion, with warmed 38–42°C ment. Additionally, the FDA states that donors must wait 56
(100.4–107.6°F) whole blood at a rate of 150mL/min.¹¹ days to donate blood again. These limiting factors have in-
fluenced the two revolving blood bank (RBB) concepts: Ex-
Equipment modernization efforts must aim to not only meet change Transfusion RBB and Rotating Donors RBB. 17
the temperature challenges of hot climates, but also frigid cli-
mates. The arctic poses a real challenge because current devices The Exchange Transfusion RBB concept works by
and products either become ineffective at maintaining required
specifications needed (flow rate, temperature, etc.) or freeze • identifying emergency donor panel (EDP)
completely (i.e., administrative IV tubing sets become brittle). • drawing 1 unit, labeling, and storing 100% of the entire
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One potential solution that may be effective is researching the EDP blood,
effects of chemical warmers, such as meals ready-to-eat (MRE) • used if needed or replaced back in same donor if unused
heaters. By redesigning these heaters with a thermal insulator prior to expiration
for blood products and the needed subcomponents (i.e., IV • drawing, labeling, and storing new unit of 100% EDP pop-
tubing), the DoD can provide a cost- effective solution to af- ulation and repeating all steps. 17
ford blood capability in frigid environments. Additionally, this
item may be useful to substitute out the current heaters found The Rotating Donors RBB concept (shown in Figure 8) will
in the cold weather MREs, to provide cross-functionality and allow for 40%–60% of the EDP blood to remain on hand and
further aid as emergency stocks for medics since these items works by:
will be essentially cross-loaded amongst the fighting force if
resupply efforts prove ineffective. • identifying all EDP
• draw 1 unit, labeling and storing only 20% of the entire
Walking Blood Bank and Revolving Blood Bank EDP
• weeks later, draw from the next fraction of EDP, and repeat
As stated earlier, the walking blood bank must be considered • blood unused that expires is discarded repeat all steps. 17
as the emergent plan for blood support. Tactical and opera-
tional leaders must be cognizant of the fact that maneuvering One concern that must be noted is that the current ASBP
Servicemembers who volunteer blood for those WIA will also Handbook states that fresh whole blood that is pulled must be
place themselves at a greater deficit in the event that they are either: a) used within 8 hours, or b) refrigerated for 24 hours.
wounded. Any additional time extension beyond the 24 hours in cold
storage requires approval from the JBPO. 6
Medical leaders also need to accept the fact that whole blood
will be difficult to resupply to the forward line of troops, and FIGURE 8 Rotating Donors RBB example timeline.
commanders need options that are as reinforced as possible to
prevent loss of life. The future fight will require medics and
Combat Life Savers (CLS) that are capable of safely admin-
istrating blood to the wounded in need; that emergency plan
needs to be exercised in discussion and training to build shared
understanding across the force on what must be avoided, but
most importantly, what is pragmatically sustainable.

For example, a study conducted by the U.S. Special Operations
Command (USSOCOM) that was designed to understand the
effects of blood donation on SOF operators after donating one
unit of fresh whole blood found that there was degradation in RBB = revolving blood bank EDP = emergency donor panel.
human performance. However, most of these volunteers were
able to remain mission capable despite the drop in oxygen-sat- Military Working Dogs
urated RBCs. 16 Practitioners need to also consider military working dog
(MWD) blood support requirements. Logisticians must under-
Further studies must be conducted to determine the effects stand that at no point can blood from a human go to a MWD
of additional donated units, and the effects of blood dona- or blood from a MWD go to a human. If this were to occur, re-
tion on the average service member population, so that com- cipients will have extreme hemolytic reactions. For this reason,
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manders can understand effects on mission capability prior canine blood products must be labeled so that prior to their use,
to decision- making. If emergency resupply is needed, future the administrator is able to determine the product with ease,

36 | JSOM Volume 24, Edition 4 / Winter 2024