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hoc training solution on this topic is available at the websites Materials and methods: We conducted an engaged qualita-
noted in this articles. Additional training modalities may fol- tive phenomenological study to explore ECC training needs
low in the near future. for future conflicts. We interviewed 9 senior health care pro-
fessionals (medics and physicians) who had extensive combat
Prescreened Whole O Blood Group Walking Blood Bank and deployment experiences and served primarily in the Role
Capabilities for Nontraditional Maritime Medical Receiving 1 environment. The interviews averaged 45 min each and
Platforms: A Case Series were conducted via phone. To analyze this interview data,
J Spec Oper Med. Published online March 13, 2024. we reviewed the interview transcripts and then noted terms,
doi:10.55460/PC7T-LML9 phrases, and concepts within the interview transcripts that we
Raymond K. Chang, Burke P. Boyle, Mike O. Udoh, found to be salient to answering the research question. Our
Joshua M. Maestas, Joseph A. Gehrz, Eddy Ruano, team then met to review these codes and grouped them into
Leticia Banker, Andrew P. Cap, Jeffrey W Bitterman, categories. These categories served as the themes of this study
Travis G. Deaton, Jonathan D. Auten that illustrated the participants’ perceptions and experiences.
Background: Tactical Combat Casualty Care (TCCC) guide- Results: Five themes emerged from our data: (1) There is a
lines recognize low-titer group O whole blood (LTOWB) as current gap in ECC training for enlisted Role 1 caregivers
the resuscitative fluid of choice for combat wounded. Utiliza- throughout the military; (2) ECC training is needed to shift
tion of prescreened LTOWB in a walking blood bank (WBB) organizational culture; (3) ECC training should be compre-
format has been well described by the Ranger O low-titer hensive; (4) ECC training should be deliberate; and (5) Time
blood (ROLO) and the United States Marine Corps Valkyrie is the greatest challenge to implementing ECC training. Our
programs, but it has not been applied to the maritime setting. participants noted that developing guidelines and filling train-
ing gaps is not only critical for preparing Role 1 providers for
Methods: We describe three WBB experiences of an expedi-
tionary resuscitative surgical system (ERSS) team, attached effective and ethical military medical decision-making but also
to three nontraditional maritime medical receiving platforms, for addressing death and dying on the battlefield and building
over 6 months. moral resilience across the medical corps.
Conclusion: Our results provide direction for development of
Results: Significant variations were identified in the number of ECC clinical guidance and collective team training recommen-
screened eligible donors, the number of LTOWB donors, and dations. Following these guidelines may increase life-saving
the timely arrival at WBB activation sites between the plat- capabilities on the far-forward battlefield and equip medical
forms. Overall, 95% and 84% of the screened eligible group directors and medics to provide ethical and compassionate
O blood donors on the Arleigh Burke Class Destroyer (DDG) care to those who cannot be saved in the setting of limited
and Nimitz Class Aircraft Carrier (CVN), respectively, were resources and evacuation opportunities.
determined to be LTOWB. However, only 37% of the eligi-
ble screened group O blood donors aboard the Harper’s Ferry
Class Dock Landing Ship (LSD) were found to be LTOWB. An Analysis of Tube Thoracostomy in Combat Implications
Of the eligible donors, 66% did not complete screening, with for Improved Prehospital Recognition and Treatment
J Spec Oper Med. 2024;24(2):17–21.
52% citing a correctable reason for nonparticipation.
doi:10.55460/RAZM-U139
Conclusion: LTOWB attained through WBBs may be the only Andrew D. Fisher, Joseph W. Jude, Michael D. April,
practical resuscitative fluid on maritime platforms without in- Steven A. Lavender, Xander S. Augustson, John Maitha,
herent blood product storage capabilities to perform remote Steven G. Schauer
damage control resuscitation. Future efforts should focus on
optimizing WBBs through capability development, education, Background: Thoracic trauma occurs frequently in combat
and training efforts. and is associated with high mortality. Tube thoracostomy
(chest tube) is the treatment for pneumothorax resulting from
thoracic trauma, but little data exist to characterize combat
Expectant Casualty Care Training Needs for casualties undergoing this intervention. We sought to describe
Future Conflicts the incidence of these injuries and procedures to inform train-
Mil Med. 2025;190(3-4):e797–e803.
doi:10.1093/milmed/usae389 ing and materiel development priorities.
Rebekah Cole, Sean Keenan, Matthew D Tadlock, Methods: This is a secondary analysis of a Department of De-
Shawna Grover, Melissa Givens, Sherri L. Rudinsky fense Trauma Registry (DoDTR) data set from 2007 to 2020
describing prehospital care within all theaters in the registry.
Introduction: The demands of future large-scale combat op- We described all casualties who received a tube thoracostomy
erations may require medics and corpsmen to increasingly within 24 hours of admission to a military treatment facil-
perform expectant casualty care (ECC). However, no detailed ity. Variables described included casualty demographics; ab-
guidelines currently exist for providing ECC within military breviated injury scale (AIS) score by body region, presented
medicine. To guide the development of education and train- as binary serious (=3) or not serious (<3); and prehospital
ing guidelines and advance team training of both medics and interventions.
non-medics, an in-depth understanding is first needed regard-
ing caregivers’ experiences providing ECC in recent conflicts as Results: The database identified 25,897 casualties, 2,178
well as perceived training gaps. Therefore, this study explored (8.4%) of whom received a tube thoracostomy within 24
the experiences of medics and physicians providing ECC and hours of admission. Of those casualties, the body regions with
investigated their perceptions of training needs in this area for the highest proportions of common serious injury (AIS >3)
future conflicts characterized by large-scale combat operations were thorax 62% (1,351), extremities 29% (629), abdomen
and prolonged casualty care operational settings. 22% (473), and head/neck 22% (473). Of those casualties,

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