2023 Global Health Engagement and Humanitarian Surgery Presentations

Andrea Lombardi, DO1; Nakkeya McGee, MSC1; Russel Wier, DO2; Jason Brill, MD1; 1Tripler Army Medical Center; 2United States Navy

Introduction: Exsanguinating hemorrhage was the most common preventable cause of death among US combat casualties in the last two decades. Whole blood is more efficacious than 1:1:1 therapy for hemorrhagic shock, and has a reduced logistical burden that is highly favorable in austere environments. According to recently published Joint Trauma System guidelines, a screened low-titer O whole blood (LTOWB) program should be a command priority prior to line unit deployment. We highlight system improvement progress within the INDOPACOM Combatant Command Trauma System regarding Military Treatment Facility (MTF) and unit-specific LTOWB capabilities.

Methods: As part of pre-deployment training, seven INDOPACOM units presented to their respective MTF for screening. Potential donors were split into two groups: those with group O blood, and those with other blood groups (A, B, and AB). Group O donors were further tested for Anti-A and Anti-B antibodies as well as the standard battery of transfusion transmissible diseases. Donors found to be low-titer (<1:256) were deemed eligible and registered for the emergency donor pool. Training for combat casualty care/pre-hospital transfusion protocols, such as the Army's Ranger O Low Titer (ROLO) and Marine Corps's Valkyrie Program, was provided to Medics and Corpsmen to allow line units to utilize fresh LTOWB in advance of Role II assets.

Results: Fifty-six servicemembers were trained in LTOWB pre-screening procedures as outlined in the Joint Trauma System Clinical Practice Guideline on Whole Blood Transfusions. Pre-screeners who demonstrated competency using DD form 572 and the Theater Medical Data Store were then tasked with screening various line units prior to deployment. Five hundred and seven servicemembers from seven line units in Okinawa and Hawaii were screened prior to deployment, resulting in 150 units of LTOWB collection.

Conclusion: In conjunction with prehospital fresh whole blood transfusion programs, the establishment of both walking and MTF-based cold-store LTOWB banks is a safe, feasible, and clinically superior supplement to the storage of large volumes of component therapy in austere environments. INDOPACOM MTFs and combat deployable units have taken important steps toward ensuring access to this critically important aspect of combat casualty care. Further priority, in terms of funding, policy-making, and commander support, should be given to these programs.