Page 40 - JSOM Winter 2024

that all service components need to introduce blood transfusion to help support their walking blood bank protocol become
tasks in an “advanced” CLS course setting for mature Service more sustainable in the event of its needed activation.
Members that have the potential to be capable of performing
these tasks (this can even be considered as an Additional Skill Forces without a distributed EDP will fail to provide com-
Identifier). The argument against this is that in 2009 fluids manders an emergency blood support option. 24
were removed from CLS training because personnel wasted
19
time trying to gain venous access. We counterargue that this As pointed out earlier, the current ASBP states that fresh, warm
lesson will not be re-learned the hard way because it can be blood that is pulled from a donor must be administered within
easily mitigated with appropriate training and reiteration with 8 hours or refrigerated for 24 hours. Any additional time ex-
what is already being taught in CLS, such as the fundamen- tension beyond the 24 hours in cold storage requires approval
6
tal principle of applying the most important intervention (i.e., from the JBPO. Due to the nature of SOF operations, USSO-
20
tourniquet) immediately. Next, units must incorporate blood COM has developed a policy to authorize donor blood to be
support into logistical training events. So far, the training spot- returned to donor if unused known as the Special Operations
light has been focused on collection and administration, yet Low-Titer O Whole Blood (SOLO) Program. However, for the
the real “valley of death” to execute this treatment strategy rest of the force, this is not outlined specifically as a potential
is the ability to transport and store CL VIII(B) internation- solution for unused blood in the ASBP and must be further
ally and within theater. The first exercise to attempt rapid re- explored for safety efficacy for the larger DoD force to reduce
supply (within 72 hours) from the U.S. to a required theater waste and support the RBB concept. 25
in recent years was Talisman Sabre 2023. Talisman Sabre is
the largest-scale joint defense exercise between Australia and Freezing products is the best capacity building approach for
the United States to date, with 13 nations and 35,000 par- blood support, especially for contingency planning as men-
ticipating personnel conducting 15 major training events in tioned earlier owing to the long shelf life of frozen products.
the Indo-Pacific region. During this exercise, medical per- However, the equipment needed to thaw and deglycerolize
21
sonnel executed a blood resupply requirement to transfer CL blood products only exist with echelons above BDE and re-
VIII(B) products from the continental U.S. to Darwin, Austra- quire large amounts of time to make products ready for dis-
lia, with final destination being Townsville, Australia. To meet tribution. For example, the ASBP states that one technician,
the rapid demand, blood was sourced from both Japan and using a three-cell washing machine, can deglycerolize 12 units
Hawaii. in 12 hours. In LSCO, the requirement for blood may become
6
bottlenecked due to this limiting factor. It may become neces-
U.S. medical personnel had to work with their Australian sary to field and train this equipment at echelons below BDE
Army counterparts to overcome regulatory differences, such to reduce capacity limiters for frozen CL VIII(B). Additionally,
as units needing to be repackaged into boxes that hold fewer with further research, it may be determined that current CL
units, which caused delays in shipment of CL VIII(B) from Ja- VIII(B) must be frozen during delivery as high kinetic delivery
pan. This took 3 days to remedy and was eventually received (drone, artillery, etc.) increases probability of blood cells rup-
by the U.S. Marine Rotational Force-Darwin in Royal Aus- turing (hemolysis) due to vibrations or burst of speed.
tralian Air Force-Darwin, Australia. This exercise not only
highlighted the importance of partner force support but also Conclusion
cross-service support, as supplies delivered to Townsville re-
quired assistance from the Navy, Marines, and Air Force part- As the DoD transitions towards LSCO, blood will continue to
22
ners. Out of the 115 blood products shipped, only 10 FFP be an increased topic of concern for all GCCs. Blood supply
units were quarantined on receipt due to exceeding the safe has always been a critical commodity because of its ability
temperature range of said product (E Gasaway, email commu- to ensure both combat power sustainment and reduced pre-
nication, October 30, 2023). 2 ventable deaths since 1917. In the last two decades, blood has
been almost exclusively managed by the ASBP and medical
departments across the service components; however, LSCOs
Other Solutions and Considerations
may not allow such a luxury for GCC planners. Future con-
All services suggest LTOWB Type O makes up a total of 45% flict planners need to consider that one of more components
of the total American population with 7% being type O neg- to blood support may require their attention. Planners need to
ative (universal donor). However, type O negative recipients understand the current flow of blood sourcing from the ASBP,
can only receive blood from other type O negative donors. We the various storage requirements, transportation needs, and
recommend that A blood training utilization is considered be- the current administration policies and procedures in effect to
cause type A makes up a total of 40% of the American popula- ensure warfighters receive adequate and safe blood products
tion; that is a total combined population of 85% between type and supplies. Lastly, leaders across the DoD need to continue
O and A donors. This will help reduce the unnecessary use of discussion now to address solutions for capacity, artic consid-
low-titer O blood products on type A recipients. Practitioners erations, MWDs, and training.
can develop training now to help mitigate risk of wrongful ad-
ministration. We also believe that the risk of blood shortage Acknowledgments
2
is higher than the risk of wrongful administration in the future The authors would like to acknowledge COL Jason B. Cor-
LSCO environment as noted earlier in the Vietnam statistics. 5 ley (Laboratory Capability Manager) and Medical Capabil-
ity Development Integration Directorate (MED CDID) for
Additionally, tactical units need to incorporate dispersion of hosting the 2023 Blood Tabletop Exercise which generated
blood types within their formations. The Ranger O Low Titer the discussion around a critical topic and inspired us to write
Whole Blood (ROLO) Program has restructured all Platoons this journal to help leaders across the DoD gain foundational
to have dispersed low-titer O personnel within their formation understanding. Lastly, the authors would like to thank those

38 | JSOM Volume 24, Edition 4 / Winter 2024