Making whole blood available in austere medical environments: donor performance and safety

Abstract

BACKGROUND:To provide whole blood on the battlefield can be a challenge, but a buddy system protocol is both an elegant and the only currently available means to supply blood to a Special Forces team in far-forward locations. Our aim was to investigate donor-safety associated with such a protocol. METHODS:This study was a randomized, doubleblinded, controlled trial that aimed to evaluate the immediate effects of a 450 cc blood donation on physical performance in fatigued and dehydrated Special Forces soldiers. The primary outcome variables were absolute and relative maximal oxygen uptake (VO 2max ), exercise tolerance time (ETT) and heart rate (HR). RESULTS:Relative VO 2max decreased by 7.1% in the donation group between pre and posttest, compared to no change in the control group. Absolute VO 2max decreased by 11.2 and 3.6% between pre and posttest in the donation and control groups, respectively. Mean ETT in the donation group was on average 92 seconds shorter compared to baseline, which represents a decrease of 9.5%.CONCLUSION: Donating blood after a week of strenuous physical activity is feasible for Special Forces personnel. While the donation results in some diminishment of VO 2max , a 3.6%-11.2% decrease in relative VO 2max , and in elevation of submaximal HR levels highly trained personnel continue to perform well both at both sub-maximal and maximal effort levels. INTRODUCTIONK nowledge gained by medical practitioners in military conflicts over the last decade has contributed to significant changes in transfusion strategies addressing traumatic hemorrhagic shock.1 The transition from a crystalloid and/or colloidbased resuscitation approach to one that is blood-based is reflected in the fluid preferences for resuscitation of hemorrhagic shock recommended in the recent Tactical Combat Casualty Care (TCCC) guidelines. TCCC guidelines now recommend that whole blood (WB) be used as the primary resuscitation fluid. 2 This is also a current trend in the civilian EMS services in several countries. 3 And an increasing number of NATO and other allied nations are implementing TCCC guidelines in recognition of the published improvements in the survival of severely injured combat wounded over the course of the decade-long conflict. The guidelines have undergone continuousFrom the

Minimal tactical impact and maximal donor safety after a buddy transfusion: A study on elite soldier performances in both laboratory and field environments

“…To fulfill this objective, we focus on the immediate effect of a 450‐ml blood donation (i.e., a standard blood donation) on physical performance, vigilance, hematological parameters, and psychological aspects (e.g., stress, fatigue, well‐being) of SF operators. Over the past few decades, a few studies have arisen in the literature investigating some of these parameters among a military population 8–10 . With regard to vigilance, no effects of the blood donation were reported 11 .…”

Anaesthesia in austere environments: literature review and considerations for future space exploration missions

“… 35 , 36 , 45 In these circumstances, the prevention and prompt correction of major blood loss is critical and requires the availability of blood products. 31 , 36 , 49 , 64 , 65 Postoperative infections are usually prevented with antibiotic prophylaxis and sterilization of instruments, 31 , 66 although the risk of post-operative infection persists in situations such as trauma with contamination, hollow viscus perforation or intra-abdominal abscess and will require full course of antibiotics.…”

“… 98 This would imply that blood compatibility could become a selection criteria. 45 , 49 , 65 Ultrasonography is likely to remain the leading imaging modality in future SEM. 13 It can be used for a variety of tasks related to anaesthesia and surgery, such as nerve localisation, assessment of volaemia and cardiac function, line placement, and assisting external fixation of fractures.…”

Implementation of a low titer group O whole blood program for a law enforcement tactical team

“…As outlined by Strandenes et al, after the donation, it is recommended that the donor consume an oral hydration solution and/or 0.5 L of water. Even without hydration, donor performance is not degraded after donating one unit of FWB . However, this is donor specific, and the medic should evaluate the donor before allowing him to return to his duties.…”