From battlefield to community: Simulation-based education for walking blood bank whole blood transfusion

Field transfusion of whole blood is vital for patients in hemorrhagic shock, particularly in austere or resource-limited environments. Military use of warm fresh whole blood (WFWB) has inspired civilian interest in walking blood banks (WBBs) for rural, prehospital, and mass casualty settings where blood product access is limited. However, standardized training and proficiency benchmarks are lacking. This project developed a checklist and established validity evidence to assess provider proficiency in WFWB collection and transfusion.

A multidisciplinary panel created a checklist and modified an existing training video for WFWB collection and transfusion. Using simulation, medical students, nurses, nurse practitioners, physicians, and emergency medical service providers were evaluated to validate the checklist and define proficiency thresholds. Participants (n = 41) were categorized as novice (n = 12), intermediate (n = 13), or expert (n = 16) based on experience. After reviewing the video, participants performed simulated procedures graded by independent evaluators. The maximum score was 47 points, with competency defined by expert performance.

Analyses of variance revealed significant differences between novice and intermediate (p <.01) and novice and expert (p<.01) groups, but not between intermediate and expert (p = .09). Mean rubric scores and completion times were: novice (31/47; 41 min 17 s), intermediate (38/47; 33 min 7 s), expert (41/47; 29 min 19 s). The competency threshold was set at 41/47 and 33 min 27 s.

The validated checklist and training video provide a foundation for standardized WFWB education and proficiency assessment, supporting safe WBB implementation in military and civilian settings.