title: Fresh whole blood transfusions in coalition military, foreign national, and enemy combatant patients during Operation Iraqi Freedom at a U.S. combat support hospital.
abstract: BACKGROUND
  United States military doctrine permits the use of fresh whole blood (FWB), donated by U.S. military personnel on site, for casualties with life-threatening injuries at combat support hospitals. U.S. Military Medical Department policy dictates that all patients treated at military facilities during combat (coalition military personnel, foreign nationals, and enemy combatants) are to be treated equally. The objectives of this study were to describe admission vital signs and laboratory values and injury location for patients transfused with FWB, and to determine if FWB was employed equally among all patient personnel categories at a combat support hospital.
  
  
  METHODS
  This retrospective cohort study evaluated admission vital signs and laboratory values, injury location, and personnel category for all patients receiving FWB at a U.S. Army combat support hospital in Baghdad, Iraq, between January and December 2004.
  
  
  RESULTS
  Eighty-seven patients received 545 units of FWB. Upon admission, the average (+/-S.D.) heart rate was 144 bpm (+/-25); systolic blood pressure, 106 mmHg (+/-33); base deficit, 9 (+/-6.5); hemoglobin, 9.0 g/dl (+/-2.6); platelet concentration, 81.9 x 10(3)/mm(3) (+/-81); international normalized ratio (INR), 2.0 (+/-1.1); and temperature 95.7 degrees F (+/-2.6). The percentages of intensive care patients who received FWB by personnel category were as follows: coalition soldiers, 51/592 (8.6%); foreign nationals, 25/347 (7.2%); and enemy combatants, 11/128 (8.5% (p = 0.38). The amount of FWB transfused by personnel category was as follows: coalition soldier, 4 units (1-35); foreign national, 4 units (1-36); and enemy combatant, 4 units (1-11) (p = 0.9).
  
  
  CONCLUSIONS
  Fresh whole blood was used for anemic, acidemic, hypothermic, coagulopathic patients with life-threatening traumatic injuries in hemorrhagic shock, and it was transfused in equal percentages and amounts for coalition soldiers, foreign nationals, and enemy combatants.
authors.affiliation: U.S. Army Institute of Surgical Research, San Antonio, Texas, USA.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Perkins
authors.forename: Kurt W
authors.initials: KW
authors.lastname: Grathwohl
authors.forename: Thomas
authors.initials: T
authors.lastname: Repine
authors.forename: Alec C
authors.initials: AC
authors.lastname: Beekley
authors.forename: James
authors.initials: J
authors.lastname: Sebesta
authors.forename: Donald
authors.initials: D
authors.lastname: Jenkins
authors.forename: Kenneth
authors.initials: K
authors.lastname: Azarow
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D001803:Blood Transfusion; D016009:Chi-Square Distribution; D006772:Hospitals, Military; D006801:Humans; D007493:Iraq; D008889:Military Personnel; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014481:United States; D014857:Warfare; D014947:Wounds and Injuries / Q000628:therapy*