Page 96 - JSOM Fall 2025

damage or degradation; and assessment of alternative storage Disclosures
durations and their effects on blood viability. There are no competing interests to disclose.
Other methods could have been explored for blood storage in Funding
this scenario. The use of portable blood warmers, while effec- No funding was received for this study beyond the generosity
tive, requires additional equipment and power sources, which of Black Flag Response LLC in providing the tools that were
may not always be available in remote locations and are less used.
man-portable due to weight. Insulated pouches with chemical
warming elements could provide more consistent temperature References
control, reducing dependence on the rescuer’s body heat. A 1. Association for the Advancement of Blood & Biotherapies. Stan-
potential future study could explore the feasibility of using dards for Blood Banks and Transfusion Services. 34th edition.
a Meal-Ready-to-Eat (MRE) flameless ration heater, or sim- Published April 1, 2024. Accessed August 5, 2025. https://www.
ilar commercially available chemical heat packs, for the rapid aabb.org/aabb-store/product/standards-for-blood-banks-and-
transfusion-services-34th-edition---print-17353885
warming of blood products in field settings. These heaters 2. Poder TG, Nonkani WG, Tsakeu Leponkouo É. Blood warming
have been successfully employed for warming meals in austere and hemolysis: a systematic review with meta-analysis. Transfus
environments. However, previous research has shown them to Med Rev. 2015;29(3):172–180. doi:10.1016/j.tmrv.2015.03.00
be suboptimal for use rewarming blood or plasma. Whole 3. Russell WJ. A review of blood warmers for massive transfu-
14
blood stored above frozen temperatures would be easier to sion. Anaesth Intensive Care. 1974;2(2):109–130. doi:10.1177/
0310057X7400200202
rewarm and, thus, may be a candidate for the MRE heater 4. Singh K, Peng HT, Moes K, Kretz CA, Beckett A. Past meets pres-
method. ent: reviving 80-year-old Canadian dried serum from World War
II and its significance in advancing modern freeze-dried plasma
A shorter storage duration with periodic transfusion or faster for prehospital management of hemorrhage. Br J Haematol.
transportation of blood to a medical facility could minimize 2024;204(4):1515–1522. doi:10.1111/bjh.19298
risks associated with extended field storage. Each alternative 5. Pusateri AE, Given MB, Schreiber MA, et al. Dried plasma: state of
presents trade-offs in terms of logistical complexity, effective- the science and recent developments. Transfusion. 2016;56(Suppl
2)S128–S139. doi:10.1111/trf.13580
ness, and practical application in field settings. Future research 6. Watson JJ, Pati S, Schreiber MA. Plasma transfusion: history, cur-
could also include following the same procedure but storing rent realities, and novel improvements. Shock. 2016;46(5):468–
the blood cold and using body heat to rewarm rather than 479. doi:10.1097/SHK.0000000000000663
maintain warmth over extended periods. 7. Baker MS. Military medical advances resulting from the con-
flict in Korea, Part I: systems advances that enhanced patient
survival. Mil Med. 2012;177(4):423–429. doi:10.7205/milmed-
Conclusion d-11-00311
8. Monaghan WP, Levan DR, Camp FR Jr. Military blood bank-
This case study provides insights into an ‘old fashioned’ but ing: blood transfusion aboard a naval hospital ship receiving
potentially effective approach to field blood storage. While multiple casualties in a combat zone, a controlled medical envi-
the results suggest feasibility, further research and controlled ronment. Transfusion. 1977;17(5):473–478. doi:10.1046/j.1537-
testing are necessary to validate this method’s reliability for 2995.1977.17578014586.x
emergency transfusions. Future studies should focus on opti- 9. Strandenes G, Cap AP, Cacic D, et al. Blood far forward—A
mizing storage techniques and establishing protocols to ensure whole blood research and training program for austere environ-
ments. Transfusion. 2013;53(Suppl 1):124S–130S. doi:10.1111/
maximum blood viability in austere environments. trf.12046
10. Bjerkvig C, Sivertsen J, Braathen H, et al. Cold-stored whole
Author Contributions blood in a Norwegian emergency helicopter service: An observa-
JG and ZM conceived and designed the study and collected tional study on storage conditions and product quality. Transfu-
the data. JG drafted the initial manuscript. ZM contributed sion. 2020;60(7);1544–1551. doi:10.1111/trf.15802
to data analysis and manuscript revisions. KC assisted with 11. Strandenes G, Austlid I, Apelseth TO, et al. Coagulation func-
the literature review and helped guide the development of the tion of stored whole blood is preserved for 14 days in austere
conditions: a ROTEM feasibility study during a Norwegian anti-
study concept. All authors reviewed and approved the final piracy mission and comparison to equal ratio reconstituted blood.
manuscript and are accountable for its content. J Trauma Acute Care Surg. 2015;78(6 Suppl 1):S31–S38. doi:10.
1097/TA.0000000000000628
Disclaimer 12. Hughes JD, Macdonald VW, Hess JR). Warm storage of whole
The views expressed in the submitted article are those of the blood for 72 hours. Transfusion. 2007;47(11):2050–2056. doi:10.
1111/j.1537-2995.2007.01429.x
authors and not an official position of any entity of the United 13. Thibault L, Beauséjour A, Jacques A, Ducas E, Tremblay M. Over-
States Government or the Department of Defense. night storage of whole blood: cooling and transporting blood at
room temperature under extreme temperature conditions. Vox
Source of Support: This case study was conducted at an event Sang. 2014;106(2):127–136. doi:10.1111/vox.12081
run by Black Flag Response LLC and, as such, they provided 14. Meledeo MA, Peltier GC, McIntosh CS, Corley JB, Bynum JA,
the resources that were used. Neither the authors nor Black Cap AP. Field-expedient thawing of fresh-frozen plasma. Transfu-
Flag Response LLC are affiliated with Combat Medical or sion. 2020;60(S3);S159–S166. doi:10.1111/trf.15652
®
Safeguard Medical .
®
PMID: 40956788; DOI: 10.55460/W3GD-C40G

94 | JSOM Volume 25, Edition 3 / Fall 2025