On our first day in charge of the Role 2, we had three combat casualties. doi: 10.1097/TA.0b013e31827546e4. This work was prepared as part of our official duties. Response Rates to Drills and WBB Activations over Time. We created 30+ signs and posted them throughout the camps to encourage people to come to the Role 2 for screening. This case demonstrates how the US Navy used the WBB to provide blood replacement in a hemorrhaging patient when no other source of . Bookshelf (U.S. Navy photo by Mass Communication Specialist 3rd Class Kendra. Although the CPG recommends the use of pretitered low-titer O (LTO) donors, their use is by no means mandated. To our knowledge, this is the first description of a Role 2 developing and running a WBB with a focus on LTO fresh whole blood. This case demonstrates how the US Navy used the WBB to provide blood replacement in a hemorrhaging patient when no other source of blood was available and ultimately returned a sailor to his ship. % to 95%, blood bank authorize medical allowance list from ? e. The DoD will adhere to current good manufacturing practices and standards published by the FDA and the Centers for Medicare and Medicaid Services, and sustain regulatory compliance Our country depends upon navy medicine's unique expeditionary medical. TACOMA, Wash. - For a few Sailors assigned to Navy Medicine Readiness and Training Command (NMRTC) Bremerton, their duty is away from a nautical setting., For these drills, we utilized a communication application for all confirmed donors and contacted them directly for any drills. With 50 reliable donors, we could likely massively transfuse two to four patients. In many cases, we issued additional CSWB to forward operating units and dipped below our own recommended levels. 200330-N-FK318-1017 LOS ANGELES (March 30, 2020) Hospital Corpsman 3rd Class Deja Blandino, a native of Miami, draws blood from Hospital Corpsman 2nd Class Mikael Peters, a native of Laport, Ind., during a walking blood bank evolution aboard the hospital ship USNS Mercy (T-AH 19) March 30. Solution 3: The walking blood bank (WBB) clinical practice guideline (CPG)6 has a detailed sample SOP for running a WBB. An official website of the United States government. All of the efforts we describe above yielded only 60 additional donors at a great cost in man hours. . Background: The aim of our work was to show how a "walking blood bank" could provide a sufficient supply. From donor to patient in 20 minutes: emergency resuscitation with whole blood during operation Iraqi Freedom. Changing to type-specific after O blood has been started could result in a major ABO mismatch because of circulating O blood.10 Type testing after transfusion of O-type blood is not reliable.6 If a pretransfusion blood sample is not available, the CPG recommends continuing O-type blood for up to a month. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that persons official duties. Today's Navy and Marine Corps team is engaged in a global power competition. Problem 3: Base turnover is high especially considering how many units are present and how disparate the rotations are. We identified and trained six personnel to work the WBB for all mass casualty situations. PMC We gained 56 donors via units that completed testing before arrival in theater. Our unit would then either store the blood or distribute it to more forward units. The theater Role 3 had enough reagents to check a limited number of titers, but we had no reliable way of shipping frozen specimens. Using an LTO blood bank requires more work up front to identify donors, get titer and TTD testing complete, etc., but it decreases required tasks on the day of a mass transfusion.16 Prescreened members can donate to any patient. Proper training teaches you the steps leading up to, actions on, and corrective actions in case of a transfusion reaction. Cvoky, an Air Force working dog, received blood from a Navy working dog and quickly recovered, Stars & Stripes reported. We collected blood samples from volunteer O-type donors throughout deployment. We found that after we spent the manpower and time to enroll donors into our pool, they would often leave without warning, either for redeployment or other undisclosed reasons. USS Theodore Roosevelt's (CVN 71) walking blood bank is composed of Sailors who volunteer to donate blood to injured shipmates. At least one unit attempted to get titers completed before travel to theater, but was not permitted to do so because of concerns about costs, equipment, and the lack of a strict requirement. Monday, November 8, 2010. Blue: donors with titers completed, point-of-care transfusion transmissible disease (TTD) testing complete,+/- definitive TTD testing, Orange: number of samples stored for shipment, Grey: Number pending testing CONUS Armed Services Blood Program (ASBP) (the stored samples were shipped via the role 3 in month 4 and arrived in month 5 of the deployment). Sometimes it worked, but often patients had fatal reactions. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. We have found a workaround through a mutually beneficial relationship with the local Armed Services Blood Program (ASBP). The red blood cells carry oxygen to the bodys organs and tissues. The https:// ensures that you are connecting to the Their crucial responsibility is conducted in a tri-service environment marked with tank crossing signs and echoes of artillery practice in the near distance. We conducted internal training on the WBB to improve our efficiency. A walking blood bank is based on urgency, where blood can be timely drawn from those already pre-tested and designated as a 'walking' donor pool if suddenly required in responding to any. Because of the large number of potential donors in the theater of operations, the risk of blood shortage was quite low and we did not face blood shortage despite significant transfusion requirements. Titer testing. Author links open overlay panel Olle Bersus a Command Blood Program. Therapeutic study, level V. MeSH Limited (one to three units) supplies of CSWB and CT including platelets are usually available at our location. Cold chain shipment is difficult in theater, dry ice may not be available, and these samples need to remain frozen throughout the shipping process. Copyright Statement: We are military service members. We decided on an LTO WBB based on our available resources and a review of the literature. and transmitted securely. Level of evidence: Study type: case series, level V. Clipboard, Search History, and several other advanced features are temporarily unavailable. Crit Care Nurse. This site needs JavaScript to work properly. Other experiments: sheep's blood transfusions occasionally seemed to help, and briefly in the 1800s, milk! The intent is to deliver personalized, dynamic learning using the most current and accessible technology, enabling a self-directed and continuous study of . The US military experience with fresh whole blood during the conflicts in Iraq and Afghanistan. Makin Island is currently homeported in San Diego. The NEMU plan for massive transfusions was organized around using O-type whole blood. This differs from the risk of an ABO-specific mismatch that carries a high risk of often fatal hemolytic reactions. There was an activation in month 6 for a massive upper gastro-intestinal bleed. Other WBBs in the literature generally utilize type-specific whole blood for the WBB.11,14,15 We decided on LTO blood for multiple reasons. government site. The .gov means its official. Mod thirteen to USCENTCOM individual protection and individual-unit deployment policy, Risk associated with autologous fresh whole blood training, Red tides: mass casualty and whole blood at sea, The use of fresh whole blood in massive transfusion, Emergency whole-blood use in the field: a simplified protocol for collection and transfusion. CRO Medical, Click For End of Year Government Ordering Contracts, **Remember to use your resources. These major ABO mismatch errors generally occur because of human error at a rate of 1:80,000.8 This rate is likely even higher in a severely resource-limited environment. From donor to patient in 20 minutes: emergency resuscitation with whole blood during operation Iraqi Freedom. We conducted monthly base-wide drills and blood drives to increase our donor pool and improve coordination between the multiple units on base. In addition, there is no reliable means of communication between units on base. We were able to collect samples from 108 military members during our deployment. Methods: We gathered the blood-group types of military personnel deployed to the theater of operations to evaluate our "potential walking blood bank," and we compared these data with our needs. The goal is always to get blood products to those who need it in the fastest manner possible, said Lake, leading petty officer, and Washington native who grew up in the area and has worked at the center for approximately five years. 105 provides that Copyright protection under this title is not available for any work of the United States Government. Title 17 U.S.C. serological test for syphilis. 2008 Jul;36(7 Suppl):S340-5. Oxford University Press is a department of the University of Oxford. The aim of our work was to show how a "walking blood bank" could provide a sufficient supply. We also sent rosters of these individuals to the base camps monthly and required that they too reach out to the donors during activations. Available for both RF and RM licensing. Bethesda, MD 20894, Web Policies Its primary mission is to provide damage control resuscitation and damage control surgery for the base and surrounding areas. This article details some of our units experiences instituting and developing a robust blood management program and WBB in a combat theater. Please enable it to take advantage of the complete set of features! Because of complexities beyond the scope of this article, these donors were not identified in the theater medical data server (TMDS). Disclaimer, National Library of Medicine Free for commercial use, no attribution required. This work is written by (a) US Government employee(s) and is in the public domain in the US. After testing the OIC of the ASBP provides us with a list of all results including titer level for all units collected. 1). This also allowed the Role 2 to get blood products with a longer effective shelf life (shown in Table I). Bookshelf Internally, frequent practice was required to maintain administrative and clinical skills. Walking Blood Banks. This left the Role 2 with an average of 1 unit of CSWB available for use and no platelets. Titers and TTD testing are recommended predeployment in the Joint trauma system whole blood transfusion clinical practice guideline (JTS whole blood transfusion CPG),6 but not required by CENTCOM,12 and almost none of the units present had them completed before arrival. Problem 2: The donor pool for LTOWB was small, and all were leaving shortly after our arrival. Our country depends upon Navy Medicine's unique expeditionary medical. Unable to load your collection due to an error, Unable to load your delegates due to an error. IMPORTANT: titers must be verified no more than 90 days prior to deployment. In addition, we were able to contact a special operations unit and the MEDEVAC platform on base and use their CSWB. A single casualty could easily wipe out all the CSWB and components.15,16 As an example, we had a patient with a massive upper gastro-intestinal (GI) bleed who required 13 units of blood. Disclaimer, National Library of Medicine In different operational conditions such as near-peer fights, needs will be higher. Joint Trauma System Clinical Practice Guideline, 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, The state of the science of whole blood: lessons learned at Mayo Clinic. Micah J Gaspary, MC, USN, Adrianna I Kyle, MC, USN, Scott M Lawson, MC, USN, James Birkla, NC, USN, Elisha D Bolton, NC, USN, Kyle P Bergeron, USN, Michael M Tiller, MC, USN, Obstacles to an Effective Low-Titer O Walking Blood Bank: A Deployed Units Experience, Military Medicine, Volume 186, Issue 1-2, January-February 2021, Pages e137e142, https://doi.org/10.1093/milmed/usaa236. As far as we knew, no unit on the base had officially activated or drilled the WBB and there was no formal written process. We identify the needs, make the appropriate needed products and send off. It is an element of care that is greatly complicated by logistics and available equipment . At the minimum, youll need: 4. We activated the WBB after transfusing the first four units of CSWB that had no effect on the resuscitation.