Blood far forward program: Update on French armed forces policy

Martinaud, Christophe; Travers, Stéphane; Pasquier, Pierre; Sailliol, A.; Ausset, Sylvain

doi:10.1111/trf.16457

Cited by 10 publications

(37 citation statements)

References 10 publications

(8 reference statements)

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“…Its use is aimed at decreasing the time to the first transfusion after injury 35,37 . Two types of WB are available: warm fresh WB (wFWB), collected in the field by military medical teams, and cold‐stored low‐titer group O WB (CS‐LTOWB), prepared by the French Military Blood Institute since 2021 20 . Therefore, platelet needs are met through the use of WB.…”

Section: Methodsmentioning

confidence: 99%

An observational study of the blood use in combat casualties of the French Armed Forces, 2013–2021

Pons

Boyé

et al. 2022

Transfusion

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Background The French Armed Forces conduct asymmetric warfare in the Sahara‐Sahel Strip. Casualties are treated with damage control resuscitation to the extent possible. Questions remain about the feasibility and sustainability of using blood for wider use in austere environments. Methods We performed a retrospective analysis of all French military trauma patients transfused after injury in overseas military operations in Sahel‐Saharan Strip, from the point of injury, until day 7, between January 11, 2013 to December 31, 2021. Results Forty‐five patients were transfused. Twenty‐three (51%) of them required four red blood cells units (RBC) or more in the first 24H defining a severe hemorrhage. The median blood product consumption within the first 48 h, was 8 (IQR [3; 18]) units of blood products (BP) for all study population but up to 17 units (IQR [10; 27.5]) for the trauma patients with severe hemorrhage. Transfusion started at prehospital stage for 20 patients (45%) and included several blood products: French lyophilized plasma, RBCs, and whole blood. Patients with severe hemorrhage required a median of 2 [IQR 0; 34] further units of BP from day 3 to day 7 after injury. Eight patients died in theater, 4 with severe hemorrhage and these 4 used an average of 12 products at Role 1 and 2. Conclusion The transfusion needs were predominant in the first 48 h after the injury but also continued throughout the first week for the most severe trauma patients. Importantly, our study involved a low‐intensity conflict, with a small number of injured combatants.

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Section: Methodsmentioning

confidence: 99%

An observational study of the blood use in combat casualties of the French Armed Forces, 2013–2021

Pons

Boyé

et al. 2022

Transfusion

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“…However, the French system of care for war-wounded has its own characteristics,27 28 limiting the external validity of our analysis. Its main characteristics are medicalisation at the front29 with a transfusion strategy initiated as soon as possible,30 29 30 early surgical management in the theatre of war (damage control surgery) and strategic medical evacuation less than 24 hours after the injury to a French ATH. Extrapolating our results to those of other armies is therefore difficult.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of tranexamic acid administration in French war-wounded between October 2016 and September 2020

Pinna

Aigle

et al. 2023

BMJ Mil Health

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IntroductionSince 2013, the French Army Health Service, in agreement with international experts, has recommended the administration of 1 g of tranexamic acid (TXA) in trauma patients in haemorrhagic shock or at risk of bleeding within 3 hours of the trauma.MethodsThe aim of this analysis was to describe the administration of TXA in French military personnel wounded during military operations in the Sahelo-Sahelian band between October 2016 and September 2020. Data were collected from forward health records and hospital data from the French hospital where the casualty was finally evacuated. Underuse of TXA was defined as the lack of administration in casualties who had received a blood transfusion with one or more of red blood cells, low-titre whole blood or French lyophilised plasma within the first 24 hours of injury and overuse as its administration in the non-transfused casualty.ResultsOf the 76 patients included, 75 were men with an average age of 28 years. Five patients died during their management. 19 patients received TXA (25%) and 16 patients were transfused (21%). Underuse of TXA occurred in 3 of the 16 patients (18.8%) transfused. Overuse occurred in 6 of 60 (10%) non-transfused patients.ConclusionThe analysis found an important underuse of TXA (almost 20%) and highlighted the need for optimising the prehospital clinical practice guidelines to aid prehospital medical practitioners more accurately in administering TXA to casualties that will require blood products.

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“…Administration of fibrinogen concentrate is required if fibrinogen is less than 1.5 g/L (Recommendation Grade 2+). The French Military Medical Service recommends using the following blood products, in order of preference, as soon as possible and within the first hour: CS‐LTOWB; French lyophilized plasma, and red blood cells with a 1:1 ratio; French lyophilized plasma or red blood cells; and, as a last resort, hypertonic saline 7 . Due to logistical limitations, platelets are not available in combat areas and are provided only with whole blood, either with CS‐LTOWB or warm fresh whole blood.…”

Section: Discussionmentioning

confidence: 99%

“…The French Military Medical Service recommends using the following blood products, in order of preference, as soon as possible and within the first hour: CS-LTOWB; French lyophilized plasma, and red blood cells with a 1:1 ratio; French lyophilized plasma or red blood cells; and, as a last resort, hypertonic saline. 7 Due to logistical limitations, platelets are not available in combat areas and are provided only with whole blood, either with CS-LTOWB or warm fresh whole blood. The case report presented here-peripheral location of the injury, with a venous injury leading to severe hemorrhage-is characteristic of the combat casualty in modern conflicts.…”

Section: Discussionmentioning

confidence: 99%

First transfusion of cold‐stored low‐titer group O whole blood in the French armed forces

Aloird¹,

Martinaud

Pasquier

2022

Transfusion

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Background Hemorrhage is the most frequent cause of preventable death in the combat setting. Therefore, early transfusion can improve survival of combat casualties. In the case of hemorrhagic shock, massive transfusion must be performed immediately with high transfusion ratios (i.e., approximately 1:1:1 plasma:platelet:red blood cells). The use of cold‐stored low‐titer group O whole blood could address this challenging transfusion strategy in combat setting. Results We present here a clinical case illustrating this strategy of high transfusion ratios, which includes—for the first time in a modern conflict involving French Armed Forces—the use of cold‐stored low‐titer group O whole blood. A 29‐year‐old French soldier suffered multiple gunshot wounds. Because of the critical condition of the patient in hemorrhagic shock, successive medical teams initiated an early and massive transfusion, using French lyophilized plasma, red blood cells, cold‐stored low‐titer group O whole blood, and warm fresh whole blood. Conclusion This case report of a bleeding combat casualty, transfused with cold‐stored low‐titer group O whole blood for the first time in the French Armed Forces, emphasizes two important points: the importance of clinical assessment in the management of a bleeding patient with hemorrhagic shock and the feasibility of early massive transfusion using cold‐stored low‐titer group O whole blood.

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Blood far forward program: Update on French armed forces policy

Cited by 10 publications

References 10 publications

An observational study of the blood use in combat casualties of the French Armed Forces, 2013–2021

An observational study of the blood use in combat casualties of the French Armed Forces, 2013–2021

Retrospective analysis of tranexamic acid administration in French war-wounded between October 2016 and September 2020

First transfusion of cold‐stored low‐titer group O whole blood in the French armed forces

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