Practical Considerations for a Military Whole Blood Program

Abstract

Introduction Prehospital care in the combat environment has always been of great importance to the U.S. military, and trauma resuscitation has remained a cornerstone. More evidence continues to demonstrate the advantages of intervention with early transfusion of blood products at the point of injury. The military has recognized these benefits; as such, the Department of Defense Joint Trauma System and the Committee on Tactical Combat Casualty Care have developed new advanced resuscitation guidelines, which now encourage the use of whole blood (WB) in the prehospital setting. Materials and Methods This general review of peer-reviewed journal articles was performed through an extensive electronic search from the databases of PubMed Central (MEDLINE) and the Cochrane Library. Results Based on this literature search, the current evidence suggests that transfusion with WB is safe and efficacious. Additionally, soldier function is preserved after donating fresh WB in the field. Currently, the collection and implementation of WB is accomplished through several different protocol-driven techniques. Conclusion WB has become the favored transfusion product as it provides all of the components of blood in a convenient package that is easy to store and transport. Specifically, group O WB containing low titers of anti-A and -B antibodies has become the transfusion product of choice, offering the ability to universally fluid resuscitate patients despite not knowing their blood group. This new ability to obtain low titer group O WB has transformed the approach to the management of hemorrhagic shock in the prehospital combat environment.

Clinical features and risk factors for mortality in patients with open pelvic fracture: A retrospective study of 46 cases

“…31 With the widespread adoption of damage control resuscitation and the experience gained in the battlefield, there is an increasing awareness that fluid resuscitation for casualties in hemorrhagic shock is best accomplished with fluid that is identical to that lost by the casualty. 59 According to Tactical Combat Casualty Care Guidelines for hemorrhagic shock, 60 whole blood is the first choice for fluid resuscitation followed by 1:1:1 plasma:RBCs:platelets and others. However, due to the limitations of blood product storage and pathogen screening technology, whole blood transfusion seems impractical in the current clinical situation.…”

How do I implement a whole blood–based blood preparedness program in a small rural hospital?

“…However, successful whole blood preparedness plans can be established in every type of rural health care facility. 13,22,23 2 | HOW TO ESTABLISH A WHOLE-BLOOD-BASED BLOOD PREPAREDNESS PROGRAM…”

“…Routines for walking blood banks have successfully been established in military and civilian health care services. 12,13,22,24,25 Civilian hospitals and blood collection centers have also published blood emergency preparedness plans, including use of walking blood bank protocols for treatment of bleeding patients in case of a depletion of inventories of whole blood and platelets. 22,24,25,27 In Norway, we have trained health personnel working in the oil industry on operations with long evacuation times to collect and transfuse whole blood from prescreened fellow workers in case of a bleeding patient.…”

“…Because blood can be collected locally on demand, this system makes it easier to establish a local blood preparedness plan. However, successful whole blood preparedness plans can be established in every type of rural health care facility 13,22,23 …”

“…Low-titer group O whole blood (LTOWB) was widely available and used successfully in treatment of combat casualties in past military conflicts such as World War II, the Korean War, and the Vietnam War [8][9][10][11] and has been reintroduced as the preferred blood product for military remote damage control resuscitation in several countries today. 12,13 Despite several hundred thousand documented transfusions, the number of reported serious adverse reactions are few. 10,14 Whole blood has been reintroduced as a blood product for massive bleeding situations because it affords plasma, red blood cells (RBCs) and platelets in a balanced ratio in a logistical advantageous way.…”