Page 13 - JSOM Summer 2025

In Cold Blood

A Feasibility Study on Maintaining, Storing, and
Transporting Cold Whole Blood by a Special Forces Unit

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Chase J. Danell, MD *; Justin T. Vnenchak, 18D ;
Steve A. Radloff, MD 3

ABSTRACT
Transfusion of blood products at the point of injury is among by collecting it in paraffin-coated glass cylinders. That same
the most critical interventions for trauma patients. Since WWI, year, Lindemann devised a multiple syringe method, which
the U.S. Military has been attempting to perfect the methods kept syringes in constant motion from donor to recipient. They
of transfusion to limit preventable deaths on the battlefield. also used sharp-pointed metal needles to enter the vein directly
While whole blood is now universally recognized as the pre- through the skin rather than previous methods which exposed
mier blood product and a myriad of guidelines/protocols exist the vessel by incision. Later, tubing and stopcock devices sim-
advocating for its use by SOF medics and providers far for- plified the process further. In 1914–1915, the introduction of
ward in the deployed setting, there is no cohesive guidance sodium citrate anticoagulant allowed blood to be stored for
for blood product administration within the Continental days, which ended the need for the donor and recipient to be
United States (CONUS). This is despite recent data demon- in the same room. As a result of U.S. involvement in the first
strating that accidents are among the leading causes of death European War, innovation in transfusion medicine continued.
in non-deployed Servicemembers. Under current doctrine, only Shortly after arriving in France, physicians Lee and Robertson
FDA-approved cold-stored whole blood should be used while developed what many consider the world’s first blood bank.
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in the U.S. With this in mind, our unit developed this feasibility During WWII the use of blood plasma, a component of whole
study to determine whether a Special Forces Battalion would blood (WB), emerged as an essential component in treating
be able to maintain, store, and transport FDA-approved cold- wounded soldiers. 2
stored whole blood within appropriate temperature ranges
in order to support blood transfusion at the point of injury Recognizing the impact that blood products could have on
and treat hemorrhagic shock in the CONUS training environ- preventable deaths, the Armed Services Blood Program (ASBP)
ment. This was a very small and simple study. However, it did was established to help meet the need for blood in the de-
demonstrate that maintaining appropriate temperature ranges ployed setting. The Vietnam War was the first major engage-
is feasible, even as blood is transported to and from multiple ment in which this program was used and, throughout the
sites of training. This is a critical first step in ensuring that ap- conflict, the ASBP collected nearly 1.8 million units of blood
propriate blood products can be staged with and transported in support of warfighters. This was the first time that every
by our well-trained medics and providers supporting SOF unit of WB used to support a war was voluntarily donated by
training objectives within the U.S. military personnel, their dependents, or civilians employed at
military installations, and not through civilian organizations. 3
Keywords: whole blood; special operations; cold blood
In the years between conflicts, several studies demonstrated
that prolonged hemorrhagic hypotension was associated with
microvascular injury and marked extracellular fluid deficits.
Introduction
Evidence at the time was thought to show that these deficits
Blood transfusion has been attempted throughout history but could be corrected by isotonic crystalloids in volumes of two
typically failed until the early 20th century for a multitude of to three times the estimated volume of blood loss due to for-
reasons, including knowledge of ABO typing, blood storage feiture of interstitial fluid from the extravascular space. Unfor-
requirements, and the means by which to transfer blood from tunately, this treatment trend led to the overuse of crystalloids,
the donor to the recipient. Several key advances were made in and during this time it was common for severely bleeding pa-
the U.S. in the years leading up to WWII. In 1913 Klimpon and tients to receive up to 5–10L of crystalloids before any blood
Brown showed that clotting could be delayed in donor blood product administration. 3
*Correspondence to chase.j.danell@gmail.com
1 Dr. Chase Danell is an Emergency Medicine Resident affiliated with Madigan Army Medical Center, JBLM, WA. SFC Justin Vnenchak is a
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Special Forces Medical Sergeant affiliated with 2/1 Special Forces Group (Airborne), JBLM, WA. Dr. Steve Radloff is an Emergency Medicine
Physician and Battalion Surgeon affiliated with Madigan Army Medical Center and 2/1 Special Forces Group (Airborne), JBLM, WA.
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