Page 74 - PJ MED OPS Handbook 8th Ed

7. Blood Administration and Protocol

Overview

1. As the medical community gains a better understanding of hemorrhagic shock and fluid resus-
citation, traditional protocols are being revisited. Many studies are now suggesting that the use
of crystalloids and colloids, in these casualties, will likely increase the risk of morbidity and mor-
tality due to the damaging effects on pH and the clotting cascade; therefore, when it comes
to resuscitation in hemorrhagic shock, it is recommended to limit fluid replacement to Whole
Blood (WB) or blood products.
2. When treating a casualty suffering from hemorrhagic shock, fluid selection should be prioritized
in the following order:
a. Cold stored Low Titer ‘O’ Whole Blood (LTOWB)
b. Low titer ‘O’ Fresh Whole Blood (FWB)
c. Plasma (reconstituted dried, liquid or thawed), Red Blood Cells (RBCs) and platelets in a 1:1:1
ratio
d. Plasma and RBCs in a 1:1 ratio
e. Plasma alone or RBCs alone
f. Non-screened/untitered type ‘O’ FWB
g. Non-screened/untitered type specific FWB
3. Cold stored WB is blood that has not been modified except for the addition of an anticoagulant.
WB provides the equivalent of plasma, RBCs and platelets in a 1:1:1 ratio and has been tested
and certified free of blood-borne pathogens or other infectious diseases.
4. Low titer FWB is drawn from pre-screened/titered donors to make up a walking blood bank
(WBB) program. FWB will have a shelf-life of 24 hours and should be transfused immediately or
stored at 33–43°F (1–6°C) within 8 hours after collection.
5. Any separated component, including plasma, RBCs or platelets is considered a blood component
and therefore CANNOT be correctly referred to as blood.
a. Plasma is recognized as an important component in preventing and treating coagulopathy in
trauma as well as serving as an effective volume replacement. On average, a unit contains a
volume of 200–250mL. Due to the lack of RBCs, type matching is not necessary.
b. RBCs increase the recipient’s oxygen-carrying capacity by increasing the mass of circulating
red cells. On average, a unit of WB contains a volume of 500–600mL and a unit of RBC’s con-
tains a volume of 300–400mL. For battlefield emergency use, type ‘O’ positive or negative will
typically be available.
c. Platelets work with plasma to improve blood clot formation and clot stability.
6. If neither LTOWB (cold stored or fresh) nor blood products are available, then it may be appro-
priate to draw from a non-screened/untitered type ‘O’ FWB donor. If a type ‘O’ donor is not
available, then, as a last resort, draw from a type specific donor, type-matched to the casualty.
If available and time and tactics permit, donor blood should be tested with rapid test kits to de-
crease the risk of infectious disease transmission.

72 n Pararescue Medical Operations Handbook / 8th Edition