Page 66 - JSOM Fall 2025

The present study was limited by the measures. Blood volume performed poorly throughout and cannot be recommended as
was inferred from the weight (mass) of the bag and blood us- presently taught within Valkyrie. PC and OG conferred mixed
ing a digital scale, which is unlikely to be available in a combat results, with OG largely superior to BC and PC. Combined,
environment. Time to fill (i.e., rate of fill) was not a measured present findings highlight the importance of studying tech-
variable. niques to determine accurate donor blood bag fills towards
preserving the life of the traumatically hemorrhaging warf-
The present study was limited by the design. While employing ighter. Finally, we do recommend that the JTS validate whether
a true experimental randomized within-subjects design was a the ±10% tolerance for WBB is clinically appropriate for WBB
study strength, each participant was measured only once, so it operations or establish an appropriate tolerance standard to
was not feasible to determine the stability of findings over time facilitate targeted training feedback and quality control.
or the impact of practice repetitions on the relative efficacy of
BC, PC, and OG. Acknowledgments
The Authors wholeheartedly thank the Corpsmen of the 1st
Areas for Future Research Marine Division, Navy Education and Training Office, for
The present study should be replicated with larger, more di- their support during this study and for their dedication to ex-
verse samples, including SOF medics and Corpsmen/medics cellence in combat resuscitation.
across service branches. The present study should be repli-
cated in challenging, battlefield-relevant environments, such Author Contributions
as wind, simulated casualty collection points (e.g., fighting JA, DC, GJZ, and SW designed the study. DC submitted QI/PI
holes, bunkers), and low-light conditions with tactical light- protocol approval. DC, CJ, KM, BD, and SW developed study
ing, night-vision goggles, and night-vision goggles with focus- procedures and executed data collection. Data were reviewed
ing adaptors. 19 by all authors. GJZ conducted statistical analyses. MC drafted
the initial manuscript. All authors made contributions to the
It is important to measure the fill rate differences between BC, final manuscript.
PC, and OG. Study participants reported perceptions that BC
fill rates slowed as the bag filled (suspected due to increasing re- Disclaimer
striction-induced pressure within the donor bag). This is an em- The views expressed in this article are those of the authors and
pirical question that can be answered by measuring flow rates do not necessarily reflect the official policy or position of the
during bag fills using a similar method to that of Wier et al. 17 Department of the Navy, the Department of Defense, or the
United States Government.
The relative impact of underfilled versus overfilled donor blood
bags on patient outcomes remains unclear. It is therefore cru- Disclosures
cial to accurately determine the relationships between blood- All authors have no conflicts of interest to declare.
to-citrate ratios and the physiological impact on the blood
recipient. We modeled our 450mL ±10% target on Meledeo et Funding
al., who followed the procedures of the Armed Services Blood This work was supported by a Naval Medical Center San Diego
Program. The origin of this standard is unclear. FDA guidelines (NMCSD) Clinical Investigation Department Grant ($10,000).
and AABB Technical Manual justify the ±10% standard in the
context of quality control for fractionation blood products References
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Conclusion 0b013e31819d85fb
7. Spinella PC, Reddy HL, Jaffe JS, Cap AP, Goodrich RP. Fresh
The present study of Valkyrie program novices and experts whole blood use for hemorrhagic shock: preserving benefit while
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64 | JSOM Volume 25, Edition 3 / Fall 2025