Page 16 - JSOM Summer 2025

Discussion Disclaimer
The views expressed in this article are those of the authors and
This was a very small, simple study using only three units of do not reflect the official policy or position of the U.S. Army
non-typed, non-ASBP drawn WB from non-screened volunteer Medical Department, Department of the Army, Department of
donors, conducted simply to determine whether maintaining Defense, or the U.S. Government.
CWB/blood products at appropriate temperatures with equip-
ment organic to a Special Forces battalion was feasible during Funding
transportation to potential locations of injury throughout the No funding was received for this work.
shelf-life of the storage bag.
References
As expected, there were variations in temperatures for those 1. Pierce S. Blood Transfusion in the First World War. Univer-
bags removed from fixed (electronically powered) refrigera- sity Of Kansas Medical Center; 2019. https://www.kumc.edu/
tion units, but no incidents that would have led to “wasting” school-of-medicine/academics/departments/history-and-
of products. This study demonstrates an internal validity of philosophy-of-medicine/archives/wwi/essays/medicine/
our ability to appropriately manage cold blood if procured. blood-transfusion.html
Additional blood storage devices in the form of APRUs, Blood- 2. Blood Transfusion on the Battlefield: Blood Plasma. National
Boxx, and purpose-built blood refrigerators will be required if WWII Museum;2017. https://www.nationalww2museum.org/
sites/default/files/2017-07/blood-plasma-fact-sheet.pdf
these findings are to be expanded and applied at a larger scale. 3. Thompson PT, Standenes G. The history of fluid resuscitation
for bleeding. In: Spinella PC, ed. Damage Control Resuscitation.
The process of procuring FDA-approved WB products for Springer; 2020. doi:10.1007/978-3-030-20820-2_1
real-world use during training emergencies in the U.S. is the 4. Coulthard SL, Kaplan LJ, Cannon JW. What’s new in whole blood
next significant hurdle. Coordination for scheduling blood resuscitation? In the trauma bay and beyond. Curr Opin Crit Care.
2024;30(3):209–216. doi:10.1097/MCC.0000000000001140
donation events at the unit level and as well as coordination 5. Spinella PC, Pidcoke HF, Strandenes G, et al. Whole blood for
with local ASBPs will be required to support this advancement hemostatic resuscitation of major bleeding. Transfusion. 2016;56
of care. An ancillary, but advantageous outcome may be an Suppl 2:S190–S202. doi:10.1111/trf.13491
increased supply of the unfortunately depleted supplies of do- 6. Taylor AL, Corley JB, Cap AP, et al. The U.S. Armed Services
nor blood for Armed Service Blood Banks (ASBB) at large and Blood Program support to U.S. Central Command 2014-2021:
contingency blood supplies also throughout the multiple com- transformation of combat trauma resuscitation through blood
batant commands they support. As it stands today, multiple product innovation and expansion of blood availability far for-
ward. Transfusion. 2022;62 Suppl 1:S167–S176. doi:10.1111/
regulatory processes overseen by the FDA, ASBP, and other trf.16951
governing bodies limit the ability of blood products that go 7. Zhu CS, Pokorny DM, Eastridge BJ, et al. Give the trauma pa-
unused by SOF units to be rotated back into the military hos- tient what they bleed, when and where they need it: establishing
pitals’ use cycle. For clarity, if a hospital or donation center a comprehensive regional system of resuscitation based on pa-
issues blood to a SOF unit, they must consider it “wasted” tient need utilizing cold-stored, low-titer O+ whole blood. Trans-
since they will not be allowed to accept its return under most fusion. 2019;59(S2):1429–1438. doi:10.1111/trf.15264. PMID:
30980748
circumstances. As hospitals and blood banks are charged with 8. Shackelford SA, Gurney JM, Taylor AL, et al. Joint Trauma Sys-
ensuring the best use of this scarce resource, this may serve tem, Defense Committee on Trauma, and Armed Services Blood
as a barrier to routine issuing of WB to SOF Operators. With Program consensus statement on whole blood. Transfusion. 2021;
this study demonstrating the ability of SOF medics to store 61 Suppl 1:S333–S335. doi:10.1111/trf.16454
and handle blood at appropriate temperatures throughout its 9. Voller J, Tobin JM, Cap AP, et al. Joint Trauma System clinical
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between Armed Services Blood Bank Center – Pacific North- 30 October 2020. J Spec Oper Med. 2021;21(4):11–21. doi:10.
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west and 2nd Bn 1st SFG(A) to incentivize donations and im- 10. Cap AP, Beckett A, Benov A, et al. Whole Blood Transfusion (CPG
plement continuous access to CWB at JBLM, it is our hope ID:21). Joint Trauma System Clinical Practice Guideline. May 15,
that a discussion can be initiated about allowing hospitals to 2018. Accessed June 19, 2025. https://jts.health.mil/assets/docs/
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further remove some of the barriers in access to CWB at the 11. Song KH, Winebrenner HM, Able TE, et al. Ranger O Low Titer
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in CONUS. PMID: 40552986; DOI: 10.55460/QCA3-5N0M

Disclosures
The authors have indicated they have no financial relation-
ships relevant to this article to disclose.

14 | JSOM Volume 25, Edition 2 / Summer 2025