Page 135 - JSOM Fall 2025

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Erin Snyder, MD ; Carsten Good, NRP, DiMM ; Johanna 1 Combat Trauma Research Group, Portsmouth, Emergency
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Meyer, MD ; Dave Allen, DiMM ; Lucas Devenny, DiMM ; Medicine Department, Naval Medical Center Portsmouth,
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Jonathan Auten, DO ; Gregory Zarow, PhD ; Ryan Snow, DO 1,2 Portsmouth, VA
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2 Culmen International, Alexandria, VA
1 Combat Trauma Research Group – West, San Diego, CA
2 Naval Medical Center San Diego, Department of Emergency Introduction
Medicine, San Diego, CA
3 Naval Special Warfare Group 1 TACMED, Silver Strand Rapid intravenous (IV) infusion of fluids and blood products
Training Center, San Diego, CA is critical in resuscitative emergency medicine. Needleless con-
4 The Emergency Statistician, Idyllwild, CA nectors reduce the risk of infections and blood-borne pathogen
exposure but may limit flow rates. While three-way stopcocks
Introduction are known to increase flow rates, the impact of one-way stop-
cocks remains underexplored. This study compared flow rates
Hemorrhage remains the leading cause of preventable battle- among various catheter connection devices to assess their util-
field death, and whole blood is superior to component therapy ity in high-volume resuscitation.
in fluid resuscitation. When whole blood is not available, a
walking blood bank (WBB) strategy can be employed, with Methods
on-site universal donors contributing blood for the casualty. It
is crucial to fill the donor bag within ±10% of the 450mL tar- A 500mL circuit of normal saline was connected to high-flow
get because overfills can overpower the citrate coagulant in the one-way and three-way stopcocks, standard stopcocks, and
donor bag, risking line clots and thrombosis, while underfills needleless connectors. Flow rates were measured under gravity
risk hypocalcemia. Present field methods for determining ac- and pressurized (300mmHg) conditions using a control setup of
curate bag fills (e.g., 6.5-inch beaded cable, 10-inch paracord, IV tubing connected to a 16-gauge catheter. Flow was calculated
operator gestalt) have high mis-fill rates. What was needed as the first derivative of volume over time (dV/dt). Each condition
was a novel method for accurately filling donor blood bags in was tested in quadruplicate. Statistical significance was assessed
WBB scenarios. It was unclear whether a ruler to premark the via one-way ANOVA and Tukey’s post hoc testing (p<.05).
donor bags might result in accurate fills.
Results
Methods
Needleless connectors significantly decreased flow under both
Chinook Medical – Field Blood Transfusion Kit donor bag gravity (1.19 [SD 0.05] vs. 0.952 [SD 0.018] mL/s; p<.0001)
(n=17) collection lines were clamped and cut adjacent to the and pressurized conditions (3.47 [SD 0.072] vs. 3.10 [SD
bag, then fitted with a ruggedized lock. Bags were weighed, 0.048] mL/s; p<.0001) compared to control. High-flow one-
then 450mL water was injected into the donor bag via syringe way and three-way stopcocks maintained flow rates compara-
and 14g needle through the ruggedized lock port to prevent ble to control under both gravity (1.212 [SD 0.05] and 1.240
introducing air into the donor bag. The left and right edges of [SD 0.02] mL/s, respectively) and pressurized conditions (3.42
each bag were marked with the kit felt pen at the fill line. Filled [SD 0.048] and 3.43 [SD 0.064] mL/s).
bags were weighed and drained. Emptied bags were placed on
a flat gridded mat, with bag corners aligned with zero on the Discussion
grid. Distances from the bag corners to the fill marks were
recorded. High-flow stopcocks allow a 4%–10% improvement in flow
rates compared to needleless connectors. In an ideal system,
this translates to delivering up to 400mL more fluid per 20
Results
minutes, potentially improving resuscitation outcomes. The
Distances from bag corners to fill line markings averaged compact design and small footprint of one-way stopcocks
6.14 inches (median 6.13 [SD 0.16, SE 0.03]; range 5.68– make them particularly suited for far-forward operational sce-
6.38 inches). Left- and right-side markings were similar (6.13 narios where space and speed are critical. By optimizing device
vs. 6.16 inches). A lightweight 6.14-inch ruler was then devel- selection, clinicians can improve the efficiency of resuscitative
oped for fill-accuracy testing with Corpsmen and SOF medics. efforts in emergency settings.
Discussion and Conclusion Conclusion
A 6.14-inch ruler may facilitate accurate WBB blood bag fills High-flow stopcocks are effective alternatives to needleless con-
to the 450±10%mL target. This study sets the stage for con- nectors, optimizing fluid delivery during high-volume resuscita-
trasting the volumetric ruler versus other methods for deter- tion. Future research should explore clinical outcomes associated
mining when a WBB blood bag is accurately filled, all toward with these devices to guide practice in emergency medicine.
preserving the life of the traumatically wounded warfighter in
need of safe WBB transfusion. To Warm or Not to Warm in a Fast Pace Prehospital Blood
Resuscitation Program: That is the Question
Sydney Caputo, BS ; Gerrit T. Holleman, BS ; Caroline A.
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HONORABLE MENTIONS
Taylor ; Thomas Dransfield, NRP ; Megan Marino, MD ;
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Comparative Analysis of Flow Rates in Peripheral Catheter David Rayburn, MD ; Jacob Broome, MD ; Mark Piehl, MD,
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Devices: Implications for Emergency Fluid Resuscitation MPH ; Juan Duchesne, MD 6
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Matthew Tovar, MD ; Dominique Ferguson, DO ; Daniel 1 Tulane University School of Medicine, New Orleans, LA
Weinberg, MD ; Brittany L. Dellinger, MS, MBA ; Eric Sulava, 2 New Orleans EMS
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MD ; Christopher Treager, MD 1 3 MedStar Georgetown University Hospital, Washington, DC
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2025 SOMSA Abstracts | 133