Page 94 - JSOM Fall 2025

A Back-to-Basics Approach for Resuscitation

Storage and Transportation of Whole Blood in Chest Harness

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Jamison P. Geracci, BS *; Zachary Mitchell ; Kyle W. Carr, MSc 3

ABSTRACT
This case study evaluates a simple, reliable technique for pre- (450mL) of type O positive blood from one of the authors,
serving a unit of blood in the field. During a search and rescue a 33-year-old physically active male. Sterile procedures were
exercise in mountainous terrain, a unit of blood was drawn followed as effectively as can be expected outdoors in accor-
and stored in the rescuer’s chest pocket for 13 hours while dance with Association for the Advancement of Blood & Bio-
engaging in rigorous training. Despite temperatures as low as therapies (AABB) Standards for Blood Banks and Transfusion
4°C (40°F), the blood remained liquid and appeared visually Services section 5.28.8. After the blood draw, the subject ate,
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viable, suggesting that body heat may help maintain adequate drank, and was observed for 30 minutes before returning to
storage temperature. This method offers a low-resource alter- search and rescue training.
native to expensive or logistically complex storage solutions.
A review of historical and modern literature supports the After performing a check to ensure the blood storage bag was
potential effectiveness of this approach, though the absence appropriately sealed, the bag was immediately placed in the
of laboratory analysis limits definitive conclusions. Given its interior chest pocket of a rescue chest harness on a rescuer
practicality and historical precedent, this approach warrants who wore moisture wicking baselayer and cotton sweatshirt
further research on biochemical integrity and long-term feasi- for the duration of the exercise (see Figure 1). The purpose of
bility to assess its viability for emergency transfusions in com- this was to test whether the conducted and radiated body heat
bat and wilderness rescue settings. of the rescuer would be sufficient to keep the blood warm and
viable for the duration of the training event.
Keywords: blood; whole blood; blood storage; austere
medicine; wilderness medicine; tactical medicine FIGURE 1 Image of the interior chest pocket in which the blood was
stored.

Introduction
The storage and transport of whole blood in austere, wilder-
ness environments present unique challenges because of the
need to maintain hemostatic function and prevent degradation
of blood components. While conducting search and rescue
training in suboptimal temperatures, the authors attempted to
draw, transport, and store a unit of blood in the most efficient
and least resource-intensive way possible. Current methods and
technology often suggest expensive, resource-heavy methods or
focus on preserving large numbers of precious units of whole
blood or blood products. This case study explores a method The training event involved technical rescue, climbing, rap-
that requires minimal resources and can deliver 1–2 units of pelling, and hiking more than 8 miles over the course of one
blood at the point of injury in combat or austere rescue scenar- full night. The weather conditions were rainy, and the tem-
ios. The effectiveness of the transport was not fully understood perature dropped as low as 4°C (40°F). The rescuer kept the
as the authors were not able to bring the blood to a lab, but the blood stored in the chest pocket for the duration of the train-
findings suggest further research might prove fruitful. ing exercise from 1900 to 0800 the following morning, with-
out taking any additional steps to warm or protect the blood
product.
Illustrative Case
During a search and rescue exercise in the mountains south Outcome
of San Diego, California, the authors performed a field blood After 13 hours stored in the chest pocket of the rescuer con-
draw using a fresh whole blood transfusion set (Combat ducting rigorous physical activity, the blood storage container
Medical/Safeguard Medical, Huntersville, NC). At approxi- remained intact. This is well within both the 72-hour and
mately 1800 Pacific Time, a paramedic on site drew 1 unit 24-hour time limits offered in the AABB Standards for Blood
*Correspondence to jpgeracci30@gmail.com
1 Jamison P. Geracci was formerly affiliated with the United States Army. Zachary Mitchell was formerly affiliated with the United States Navy.
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3 Kyle W. Carr is affiliated with the Uniformed Services University F. Edward Hébert School of Medicine, Bethesda, MD.
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