title: The Armed Services Blood Program: blood support to combat casualty care 2001 to 2011.
abstract: BACKGROUND
  The Armed Services Blood Program (ASBP) provides the farthest-reaching blood supply in the world. This article provides statistics and a review of blood operations in support of combat casualty care during the last 10 years. It also outlines changes in blood doctrine in support of combat casualty care.
  
  
  METHODS
  This is a descriptive overview and review of blood product use and transfusions used by ASBP personnel to support combat operations in Iraq and Afghanistan between October 2001 and November 2011.
  
  
  RESULTS
  The ASBP initiated major changes in blood availability and age of blood in theater. In support of data published by physicians in theater, showing improved patient survival when a higher ratio of fresh frozen plasma and red blood cells (RBCs) is achieved, plus the use of platelets, the ASBP increased availability of plasma and established platelet collection facilities in theater. New capabilities included emergency collection of apheresis platelets in the battlefield, availability and transfusion of deglycerolized red cells, rapid diagnostic donor screening, and a new modular blood detachment. Forward surgical facilities that were at one time limited to a blood inventory consisting of RBCs now have a complete arsenal of products at their fingertips that may include fresher RBCs, fresh frozen plasma, cryoprecipitate, and platelets. A number of clinical practice guidelines are in place to address these processes. Changes in blood doctrine were made to support new combat casualty care and damage-control resuscitation initiatives.
  
  
  CONCLUSIONS
  Despite the challenges of war in two theaters of operation, a number of improvements and changes to blood policy have been developed during the last 10 years to support combat casualty care. The nature of medical care in combat operations will continue to be dynamic and constantly evolving. The ASBP needs to be prepared to meet future challenges.
  
  
  METHODS
  Epidemiologic study, level IV.
authors.affiliation: Armed Services Blood Program Office, Falls Church, Virginia, USA. frank.rentas@us.army.mil
authors.forename: Francisco
authors.initials: F
authors.lastname: Rentas
authors.forename: David
authors.initials: D
authors.lastname: Lincoln
authors.forename: Aaron
authors.initials: A
authors.lastname: Harding
authors.forename: Peter
authors.initials: P
authors.lastname: Maas
authors.forename: Joseph
authors.initials: J
authors.lastname: Giglio
authors.forename: Ronny
authors.initials: R
authors.lastname: Fryar
authors.forename: Kathleen
authors.initials: K
authors.lastname: Elder
authors.forename: Roland
authors.initials: R
authors.lastname: Fahie
authors.forename: Kathleen
authors.initials: K
authors.lastname: Whitlock
authors.forename: Jerome
authors.initials: J
authors.lastname: Vinluan
authors.forename: Richard
authors.initials: R
authors.lastname: Gonzales
mesh_terms: D055826:Afghan Campaign 2001-; D001771:Blood Banks / Q000458:organization & administration* / Q000600:supply & distribution; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003422:Critical Care / Q000379:methods; D005260:Female; D006772:Hospitals, Military / Q000458:organization & administration*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D054527:Mass Casualty Incidents / Q000401:mortality / Q000706:statistics & numerical data; D008887:Military Medicine / Q000458:organization & administration*; D008889:Military Personnel / Q000706:statistics & numerical data; D016730:Program Development; D015397:Program Evaluation; D012151:Resuscitation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014857:Warfare; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*