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Gurney JM, Cap AP, Holcomb JB, Staudt AM, Tadlock MD, Polk TM, Davis C, Corley JB, Schreiber MA, Beckett A, Spott MA, Shackelford SA, Van Gent JM, Stallings JD, Martin MJ, Riggs LE. The thin red line: Blood planning factors and the enduring need for a robust military blood system to support combat operations. J Trauma Acute Care Surg 2024; 97:S31-S36. [PMID: 38996415 DOI: 10.1097/ta.0000000000004413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
ABSTRACT Battlefield lessons learned are forgotten; the current name for this is the Walker Dip. Blood transfusion and the need for a Department of Defense Blood Program are lessons that have cycled through being learned during wartime, forgotten, and then relearned during the next war. The military will always need a blood program to support combat and contingency operations. Also, blood supply to the battlefield has planning factors that have been consistent over a century. In 2024, it is imperative that we codify these lessons learned. The linchpins of modern combat casualty care are optimal prehospital care, early whole blood transfusion, and forward surgical care. This current opinion comprised of authors from all three military Services, the Joint Trauma System, the Armed Services Blood Program, blood SMEs and the CCC Research Program discuss two vital necessities for a successful military trauma system: (1) the need for an Armed Services Blood Program and (2) Planning factors for current and future deployed military ere is no effective care for wounded soldiers, and by extension there is no effective military medicine.
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Affiliation(s)
- Jennifer M Gurney
- From the Joint Trauma System (J.M.G., J.-M.V.G., J.D.S.), Defense Health Agency, Joint Base San Antonio-Fort, Sam Houston; US Army Institute of Surgical Research (J.M.G., A.P.C.), Fort Sam Houston, San Antonio, Texas; Department of Surgery, Trauma and Acute Care University of Alabama Medical Center (J.B.H.), Birmingham, Alabama; The Geneva Foundation at U.S. Army Institute of Surgical Research (A.M.S.), 3698 Chambers Pass, Joint Base San Antonio-Fort Sam Houston, Texas; Department of Surgery (M.D.T.), Naval Medical Center, San Diego; 1st Medical Battalion (M.D.T.), 1st Marine Logistics Group, Camp Pendleton, California; Director of Combat Casualty Care Research Program (T.M.P.), Medical Research and Development Command, Ft. Deetrick, MD; Armed Service Blood Program (C.D., M.A.S., L.E.R.), Falls Church, Virginia; Medical Capability Development Integration Directorate (J.B.C.), JBSA Fort Sam Houston, Texas; Donald D. Trunkey Center for Civilian and Combat Casualty Care (M.A.S.), Oregon Health & Science University, Portland, Oregon; Trauma and Acute Care Surgery, Faculty of Medicine (A.B.), St. Michael's Hospital, University of Toronto, Toronto; Canadian Forces Health Services (A.B.), Ottawa, Ontario, Canada; Defense Health Agency (S.A.S.), US Air Force Academy (S.A.S.), Colorado Springs, Colorado; and Department of Surgery (M.J.M.), Keck School of Medicine, University of Southern California, Los Angelos, California
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Tadlock MD, Gurney J, Tripp MS, Cancio LC, Sise MJ, Bandle J, Cubano M, Lee J, Vasquez M, Acosta JA. Between the devil and the deep blue sea: A review of 25 modern naval mass casualty incidents with implications for future Distributed Maritime Operations. J Trauma Acute Care Surg 2021; 91:S46-S55. [PMID: 34324471 DOI: 10.1097/ta.0000000000003199] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In the future, United States Navy Role 1 and Role 2 shipboard medical departments will be caring for patients during Distributed Maritime Operations in both contested and noncontested austere environments; likely for prolonged periods of time. This literature review examines 25 modern naval mass casualty incidents over a 40-year period representative of naval warfare, routine naval operations, and ship-based health service support of air and land operations. Challenges, lessons learned, and injury patterns are identified to prepare afloat medical departments for the future fight. LEVEL OF EVIDENCE Literature Review, level V.
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Affiliation(s)
- Matthew D Tadlock
- From the Navy Medicine Readiness & Training Command (M.D.T., J.B., M.C., M.V.), San Diego, California; US Army Institute of Surgical Research (J.G.), Fort Sam Houston; Joint Trauma System, Defense Health Agency (J.G.), San Antonio, Texas; Bureau of Medicine and Surgery (M.S.T.), Falls Church, Virginia; Division of Trauma (M.J.S.), Scripps Mercy Hospital, San Diego, California; Uniformed Services University of the Health Sciences (J.L.), Bethesda, Maryland; and Veterans Administration Loma Linda Healthcare System (J.A.A.), Loma Linda, California
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Gurney J, Staudt A, Cap A, Shackelford S, Mann-Salinas E, Le T, Nessen S, Spinella P. Improved survival in critically injured combat casualties treated with fresh whole blood by forward surgical teams in Afghanistan. Transfusion 2020; 60 Suppl 3:S180-S188. [PMID: 32491216 DOI: 10.1111/trf.15767] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective of this study was to assess transfusion strategies and outcomes, stratified by the combat mortality index, of casualties treated by small surgical teams in Afghanistan. Resuscitation that included warm fresh whole blood (FWB) was compared to blood component resuscitation. STUDY DESIGN AND METHODS Casualties treated by a Role 2 surgical team in Afghanistan from 2008 to 2014 who received 1 or more units of red blood cells (RBCs) or FWB were included. Patients were excluded if they had incomplete data or length of stay less than 30 minutes. Patients were separated into two groups: 1) received FWB and 2) did not receive FWB; moreover, both groups potentially received plasma, RBCs, and platelets. The analysis was stratified by critically versus noncritically injured patients using the prehospital combat mortality index. Kaplan-Meier plot, log-rank test, and multivariable Cox regression were performed to compare survival. RESULTS In FWB patients, median units of FWB and total blood product were 4.0 (interquartile range [IQR], 2.0-7.0) and 16.0 (IQR, 10.0-28.0), respectively. The Kaplan-Meier plot demonstrated that survival was similar between FWB (79.1%) and no-FWB (74.5%) groups (p = 0.46); after stratifying patients by the combat mortality index, the risk of mortality was increased in the no-FWB group (hazard ratio, 2.8; 95% confidence interval, 1.2-6.4) compared to the FWB cohort. CONCLUSION In forward-deployed environments, where component products are limited, FWB has logistical advantages and was associated with reduced mortality in casualties with a critical combat mortality index. Additional analysis is needed to determine if these effects of FWB are appreciable in all trauma patients or just in those with severe physiologic derangement.
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Affiliation(s)
- Jennifer Gurney
- US Army Institute of Surgical Research, San Antonio, Texas, USA.,Joint Trauma System, San Antonio, Texas, USA
| | - Amanda Staudt
- US Army Institute of Surgical Research, San Antonio, Texas, USA
| | - Andrew Cap
- US Army Institute of Surgical Research, San Antonio, Texas, USA.,Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Tuan Le
- US Army Institute of Surgical Research, San Antonio, Texas, USA
| | - Shawn Nessen
- Uniformed Services University, Bethesda, Maryland, USA
| | - Philip Spinella
- Washington University School of Medicine, St. Louis, Missouri, USA
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Vanderspurt CK, Spinella PC, Cap AP, Hill R, Matthews SA, Corley JB, Gurney JM. The use of whole blood in US military operations in Iraq, Syria, and Afghanistan since the introduction of low-titer Type O whole blood: feasibility, acceptability, challenges. Transfusion 2018; 59:965-970. [PMID: 30548277 DOI: 10.1111/trf.15086] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hemorrhage is the leading cause of preventable death in military and civilian traumatic injury. Blood product resuscitation improves survival. Low-titer Type O Whole Blood (LTOWB) was recently re-introduced to the combat theater as a universal resuscitation product for hemorrhagic shock. This study assessed the utilization patterns of LTOWB compared to warm fresh whole blood (WFWB) and blood component therapy (CT) in US Military Operations in Iraq/Syria and Afghanistan known as Operation Inherent Resolve (OIR) and Operation Freedom's Sentinel (OFS) respectively. We hypothesized LTOWB utilization would increase over time given its advantages. STUDY DESIGN AND METHODS Using the Theater Medical Data Store, patients receiving blood products between January 2016 and December 2017 were identified. Product utilization ratios (PUR) for LTOWB, WFWB, and CT were compared across Area of Operations (AORs), medical treatment facilities (Role 2 vs. Role 3), and time. PUR was defined as number of blood products transfused/(number of blood products transfused + number of blood products wasted). RESULTS The overall PUR for all blood products was 17.4%; the LTOWB PUR was 14.3%. Over the study period, the total number of blood products transfused increased 133%. Although the total whole blood (WB) increased from 2.1% to 6.6% of all products transfused, WFWB use remained at 2% while LTOWB transfusions increased from 0.5% to 4%. Transfusion of LTOWB occurred more in austere Role 2 facilities compared to Role 3 hospitals. CONCLUSIONS LTOWB transfusion is feasible in austere, far-forward environments. Further investigation is needed regarding the safety, clinical outcomes, and drivers of LTOWB transfusions.
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Affiliation(s)
- Cecily K Vanderspurt
- Division of Emergency Medicine, Martin Army Community Hospital, Fort Benning, Georgia
| | - Philip C Spinella
- Division of Critical Care, Department of Pediatrics, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Andrew P Cap
- Joint Trauma System, U.S. Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas
| | - Ronnie Hill
- Department of Pathology, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Sarah A Matthews
- Department of Pathology, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - Jason B Corley
- Armed Service Blood Program, Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas
| | - Jennifer M Gurney
- Armed Service Blood Program, Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas.,Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland
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