Page 39 - JSOM Winter 2024

preventing accidental administration of incorrect products to run, and fly” concept. For example, the BDE nurse can use the
recipients as shown in Figure 9. Medical Simulation Training Center (MSTC) to achieve the
first three steps. The crawl and walk phase can be conducted
jointly in a classroom setting through didactic and hands-on
(autologous blood transfusion) training as shown in Figure 10
and Figure 11.

FIGURE 9 Properly labeled military
working dog blood product.

Another issue logisticians need to keep in mind is that donor
MWDs will require chemical sedation, as blood is typically
drawn from the jugular vein, and so the pharmaceutical re- FIGURE 10 Blood
quirements to meet this demand must be annotated. Whole collection training.
blood needing to be collected should be administered within
4–6 hours.

If blood cannot be administered, it must be stored at 4–6°C
within 4 to 6 hours of collection. whole blood collected in
citrate donor bags can last 21 days. If frozen (–20 to –80°C)
within 8 hours of collection, it can be stored for up to 1 year
and later become frozen plasma. After blood is donated, the
MWD donor will require 24 hours off duty to recover (to in-
clude no flying). 18
FIGURE 11 (BELOW) In 2019, then 1LT Jesspal Bachhal (SPO
MEDLOG) and CPT James Bills (BDE Nurse) conducted the exact
However, the challenges with MWD blood banking are: the training outlined for the “crawl” to “run” phase in 3rd Brigade
“walking blood bank” concept is inapplicable in most cases Combat Team, 82nd Airborne Division at Ft. Liberty’s MSTC site.
due to the limited number of MWDs in the area the DoD does
not have a centralized MWD blood donor collection and dis-
tribution site, which leaves Veterinary Treatment Facilities to
find the solution on their own (usually through commercial
procurement or immediate donor collection). 18

As for whole blood substitutes, blood products such as freeze-
dried plasma are currently in development and are much
closer to being finalized for use than human blood substitute
products. The challenge for these products will be ensuring a
supply demand that is adequate enough for industry to con-
tinue to support. 18

We recommend that the DoD policy adjusts so that MWD
blood support is possible. This could take place through mul- The “run” phase can be conducted the following day using a
tiple avenues, such as exploring training opportunities for the medical lane to verify students’ confidence with blood collec-
Veterinary Services to build familiarity with blood collection, tion and administration individual tasks, using volunteers
storage, and administration of blood products; closing equip- from the unit to act as role-players and autologous subjects for
ment gaps within veterinarian units and facilities; or, by incor- the students. The “fly” phase must be observed through BDE
porating MWD blood support into the ASBP. 18 training events like Combined Training Center rotations. Med-
ical training at these events typically ends at the Role 1 or 2
and have very little avenue for medical personnel to test capac-
Training: Delivery and Use
ity. We acknowledge the risk with this type of training but be-
Tactical and operational units need to become familiar with lieve risk mitigations can make these training events possible,
blood collection, storage, transportation, and administration. especially if observer, controllers, trainers (OTCs) become fa-
Current schoolhouses, like the Army’s Combat Medic Ad- miliar with this requirement and incorporate safety precau-
vanced Individual Training, have introduced autologous blood tions within the training event (i.e., internal unit nurse conducts
transfusion into their training. This concept of training is when floating observation to help assist OCTs validate each echelon
individuals learn how to draw blood from an individual and of care training).
provide it back to the same individual in order to understand
the individual tasks associated with both blood collection and We must also consider the potential for CLS to conduct blood
administration. However, we argue that medics and providers transfusion tasks. The LSCO environment challenges may re-
need to continue refresher training at their units to maintain duce medical personnel capacity. To help commanders main-
proficiency, and this must be conducted in a “crawl, walk, tain a large breadth of administration capacity, we advocate

Blood: The Liquid Will to Fight | 37