Blood Product Administration During the Role 1 Phase of Care: The Prehospital Trauma Registry Experience

Abstract

Background The majority of combat deaths occur in the prehospital setting. Efforts to increase survival including blood transfusions are made in the prehospital setting. The blood products available in the Role 1 setting include whole blood (WB), red blood cells (RBCs), fresh frozen plasma (FFP), and lyophilized (freeze-dried) plasma (FDP). Methods This is a secondary analysis of a previously published dataset within the Prehospital Trauma Registry (PHTR) from 2003 through May 2019. Deterministic linking was used when possible with the DoD Trauma Registry for outcome data. Descriptive statistics were used to analyze the data. Results We identified 1,357 patient encounters in the PHTR. Within that group, 28 patients received a prehospital blood product, with 41 total administrations: WB (18), RBCs (12), FFP (6), FDP (3), and blood not otherwise specified (2). Outcome data were available for 17 of the 28 patients. The median injury severity score was 20, with the thorax being the most frequent seriously injured body region. Most (94%) patients survived to discharge. The median ICU days was 11 (Interquartile Range [IQR] 3-19), and the median hospital days was 19 (IQR 8-29). The average volume (units) of RBCs was 6.0 (95% CI 1.9-10.1), WB 2.8 (95% CI 0.0-5.6), platelets 0.7 (95% CI 0.0-1.4), and FFP 5.0 (95% CI 1.2-8.8). Conclusions The use of prehospital blood products is uncommon in U.S. combat settings. Patients who received blood products sustained severe injuries but had a high survival rate. Given the infrequent but critical use and potentially increased need for adequate prolonged casualty care in future near-peer conflicts, optimizing logistical chain circulation is required.

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

“…Regarding transfusion at the pre‐hospital stage, 31% of the French military trauma patients transfused in this study received a transfusion before arrival at a Role 2 facility. As a comparison, in the study of Fisher et al, among 1357 patients on the pre‐hospital trauma registry, between 2013 and 2019 in Middle East conflicts, 2% had received prehospital transfusions 61 . This early pre‐hospital transfusion may have reduced the need for further transfusion 62 .…”

Use of Dried Plasma in Prehospital and Austere Environments

“…The United States has also used French lyophilized plasma in military operations, with prehospital transfusion of 11 patients reported. 45,46 Similar to French reports, ease of storage and rapid availability for transfusion were viewed as advantageous. The authors noted the importance of specific training on reconstitution procedures for emergency personnel.…”

“…Reports of the use of French lyophilized plasma in prehospital and austere environments have also been promising. 37,[44][45][46] Vitalis et al 37 reported the experience from a French Military Health Service in the Sahel region of Africa. French lyophilized plasma was provided to field medical teams located near the point of injury (combat rescue, combat medics), and this was augmented with red blood cells during medical evacuation (nurse, emergency physician) and other products at medical treatment facilities.…”

Blood consumption in the Role 2 setting: A Department of Defense Trauma Registry analysis

“…This study has limitations that are similar to those found in previous studies. 30,31 Although the DODTR serves as a crucial tool for retrospective evaluation of trauma-related injuries in military medicine, it does have certain limitations and potential biases. The DODTR dataset used in this analysis includes a large proportion of military personnel, and consequently, the analysis might not be suitable for applicability and extrapolation to civilian or noncombat environments.…”