Page 76 - PJ MED OPS Handbook 8th Ed

Transfusions – General Information

WARNING Do not attempt these procedures if not trained or qualified. NOT ALL PJs are taught,
or qualified, to perform this procedure. Pararescue Medical Directors will authorize prop-
erly trained Pararescuemen to perform this procedure.

1. Resuscitate with whole blood (preferred), or plasma and PRBCs in a 1:1 ratio, or plasma or PRBCs
alone.
2. Prior to initiation of transfusion, the following will be checked if able:
a. Vital signs (Temperature, Pulse, Respirations, BP). Measure, evaluate and record baseline vi-
tal signs. Every effort should be made to monitor temperature as an increase in temperature
may be the first indicator of a transfusion reaction. In the field, mental status and radial
pulse substitute for BP measurement.
b. Casualty blood type should be confirmed.
i) Pre-deployment – use local MTF/Blood Bank to confirm teammates’ blood types and
anti body titers (if Type O).
ii) Use EldonCard® on scene to confirm all blood types if not vetted teammate.
iii) Last option is to rely on dog tags, tattoos, or patches.

WARNING Identification tags for ABO/Rh verification should be utilized as a last resort only. Ac-
curate identification and verification of the donor’s blood and the intended recipient may
be the single most important step in ensuring transfusion safety.

c. Active warming loss prevention should be used to prevent casualty hypothermia – fluid
warmers, HPMKs.
3. Ideally blood products should be warmed to approximately 98.6°F (37°C) prior to transfusion.

WARNING Do not exceed 102°F (39°C). This may cause an inflammatory reaction and lyse some
of the red cells.
Do not use warmers directly against the fluid bag because of the risk of hemolysis or
damage to the blood or blood product. Blood or blood components should not be warmed
in a microwave, unless it is specifically designed for that purpose.

4. Blood/blood components may be infused using a pressure infuser that encases the entire blood
collection bag. Do not exceed 300mmHg with the pressure infusion device.

PJ PEARL:
• A 60cc syringe with a 3-way stopcock is an acceptable alternative to pressure infusion but
is labor intensive.
5. The largest bore IV catheter should be used. An IO device may be used. Ensure that a strong flush
is done and good flow is obtained prior to using an IO infusion. Attempt to establish 2 lines. If IO
lines have been established, these can be converted to 2 large bore IV lines when time, tactics
and clinical conditions permit.
6. Resuscitate and attempt to maintain a palpable radial pulse or clinical improvement. If BP monitor-
ing is available, maintain target systolic BP of 110 to 120 if no active hemorrhage, at least 100mmHg
in the presence of TBI, and in the range of 90 to 100 if there was active torso hemorrhage.

74 n Pararescue Medical Operations Handbook / 8th Edition