Page 95 - JSOM Fall 2025

9
Banks and Transfusion Services for autologous and allogenic for damage control resuscitation in remote settings. There
1
transfusion respectively. Upon inspection, the blood had main- are also documented instances of medics using body heat to
tained a temperature of 32.5°C (90.5°F), but the temperature keep blood or plasma warm during conflicts when there is a
was taken with a Medicheck Dual Scale digital thermometer the lack of portable warming devices, ensuring that blood re-
(Boundtree Inc, Dublin, OH), which is not specifically designed mained at a suitable temperature for transfusion in the field. 8
for this purpose. This result is significant because the tempera- These findings highlight the viability of small-scale, resource-
ture is above the minimum temperature for transfusion without conscious blood storage and transport methods, which align
causing hypothermia (32°C [89.6°F]) and below the tempera- with the practical needs of combat and austere rescue scenarios.
2,3
ture for suspected hemolysis (43°C [109.4°F]). With visual
inspection, the blood appeared not to have clotted, coagulated, Discussion
or become significantly hemolyzed. While the ability to retrans-
fuse is the ultimate goal, this experiment lacked a means to test This case study presents an evaluation of a field blood draw
for or guarantee the viability of the product. Consequently, the and storage method tested during a search and rescue exer-
blood was disposed of with appropriate biohazard consider- cise in mountainous terrain. The primary takeaway is that a
ations through a present and qualified third party. rescuer’s body heat may provide sufficient warmth to main-
tain the viability of stored blood for an extended period in
austere conditions. Despite exposure to cold and wet weather,
Literature Review
the stored blood did not show significant signs of clotting, co-
The storage and transport of whole blood in austere environ- agulation, or hemolysis over the 13-hour period, suggesting a
ments present unique challenges because of the need to main- potential field-expedient method for blood storage in emer-
tain hemostatic function and prevent degradation of blood gency scenarios.
components. Several studies have explored methods to opti-
mize blood preservation under these conditions. Another key takeaway is that this method, if proven viable,
could cut out several logistical and tactical burdens that blood
During World War II, the Korean War, and the Vietnam War, transfusion often presents. By having thawed blood avail-
various methods and recommendations for blood and plasma able, rescuers do not have to use valuable time either thaw-
storage were developed to address the logistical challenges of ing product or drawing it while on target. This method also
providing transfusion support in combat zones. In World War offers reassurance that rescuers can still get blood to patients
II, dried plasma was widely used due to its ease of transport without overburdening themselves with unwieldy blood stor-
and long shelf life, with Dr. Charles R. Drew pioneering plasma age devices; however, it does sacrifice certainty of the viability
isolation and drying techniques. However, this method was of blood product unless refinements are made to the process.
4
discontinued owing to disease transmission risks from pooled
4–6
donors. The Korean War saw the introduction of plastic Several factors influenced the observed outcome. The blood
blood storage bags, which improved transfusion safety and was stored in an interior chest pocket of a rescue vest, ensuring
efficiency. Additionally, the use of Mobile Army Surgical Hos- proximity to the rescuer’s core body temperature, which likely
7
pitals (MASH) and helicopters enhanced timely blood delivery contributed to its stability. The rescuer engaged in continuous
while also keeping more patients alive to actually require trans- physical exertion, generating body heat that may have helped
7
fusion. In the Vietnam War, the use of Naval Hospital Ships maintain the temperature of the stored blood. Although the
provided controlled environments for blood transfusions, with external temperature dropped to 40°F with rain, the storage
approximately 32,000 units of blood received and over 2,890 method insulated the blood from extreme cooling. The para-
severely injured patients transfused aboard the USS Sanctuary medic conducted the blood draw following best practices in a
alone. 8 remote setting, minimizing contamination risk. The 13-hour
period was long enough to assess potential degradation for
For austere, wilderness whole blood storage and transport, many field exercises but may not represent maximum viability
several methods and recommendations have been documented. limits.
Strandenes et al. describe the Blood Far Forward program, em-
phasizing the use of type-specific whole blood from uninjured This study highlights several potentially reliable practices and
combat companions, stored at 4°C to maintain hemostatic pitfalls for field-based blood storage and transport. Close
function. 9 body storage can provide a practical solution for maintain-
ing blood temperature in the field. Continuous monitoring of
Cold storage at 4°C has been shown to preserve coagulation the blood’s condition is essential to determine suitability for
properties for up to 14 days in austere conditions, and forward transfusion, and proper sealing and placement of the blood
storage in insulated containers is a viable alternative that meets bag is needed to prevent leaks or contamination. However, the
EU standards. 10,11 Warm storage at room temperature for up to lack of precise temperature measurement tools raises concerns
72 hours results in decreased pH and 2,3- diphosphoglycerate about accurately assessing blood viability. The absence of lab-
levels; however, platelet function and plasma coagulation fac- oratory testing leaves questions about microscopic hemolysis
tor activity remain largely intact, suggesting its potential utility and biochemical integrity, and individual physiological differ-
in field settings. For transport, the use of vacuum-insulated ences, such as body temperature variability, may impact results
12
panels combined with cooling packs has been effective in main- in different subjects. Another major limitation to this method
taining stable blood temperatures under extreme conditions. 13 is that it only allows each person to carry 1–4 units of blood
before sacrificing practicality. Future research areas should in-
Additionally, the walking blood bank concept, in which whole clude controlled studies comparing core-body storage against
blood is drawn from personnel on site, has been shown to traditional field methods, such as insulated pouches; biochemi-
provide a reliable and functional transfusion product suitable cal analysis of stored blood post-exercise to assess microscopic

A Back-to-Basics Approach for Resuscitation | 93