Prehospital Whole Blood in SOF: Current Use and Future Directions

Area of Science:

• Military Medicine
• Emergency Medicine
• Transfusion Medicine

Background:

• The US Joint Trauma System (JTS) recommends stored whole blood (SWB) for prehospital resuscitation of battlefield casualties.
• Clinical data from OIF and OEF indicate SWB is safe, effective, and superior to crystalloid/colloid fluids.
• SWB presents logistical challenges for Special Operations Forces (SOF) in austere environments due to shelf-life and cold-chain requirements.

Purpose of the Study:

• To outline the protocols and strategies US SOF employ to mitigate challenges in delivering SWB to battlefield casualties.
• To highlight the importance of donor pool management, medical education, and specialized equipment for tactical blood transfusion.

Main Methods:

• Pre-deployment screening of soldiers for blood type to establish a donor pool.
• Provision of 'blood kits' for medics to carry SWB for point-of-injury transfusion.
• Implementation of specialized storage and transport equipment (e.g., powered coolers, tactical blood coolers, IV infusion warmers).

Main Results:

• SOF have developed logistical frameworks, training programs, and equipment to deliver SWB at the point of injury.
• Protocols include donor identification, medic training, and use of advanced cooling and warming devices for SWB transport.

Conclusions:

• SOF possess the necessary support, framework, training, and equipment for prehospital SWB delivery.
• Widespread implementation requires expanded distribution and standardization of 'blood kits' and increased emphasis on SWB education.
• Continuous reassessment and refinement of procedures, incorporating new evidence and technology, are crucial for optimizing battlefield SWB delivery.