title: Emergency whole-blood use in the field: a simplified protocol for collection and transfusion.
abstract: Military experience and recent in vitro laboratory data provide a biological rationale for whole-blood use in the treatment of exsanguinating hemorrhage and have renewed interest in the reintroduction of fresh whole blood and cold-stored whole blood to patient care in austere environments. There is scant evidence to support, in a field environment, that a whole blood-based resuscitation strategy is superior to a crystalloid/colloid approach even when augmented by a limited number of red blood cell (RBC) and plasma units. Recent retrospective evidence suggests that, in this setting, resuscitation with a full compliment of RBCs, plasma, and platelets may offer an advantage, especially under conditions where evacuation is delayed. No current evacuation system, military or civilian, is capable of providing RBC, plasma, and platelet units in a prehospital environment, especially in austere settings. As a result, for the vast minority of casualties, in austere settings, with life-threatening hemorrhage, it is appropriate to consider a whole blood-based resuscitation approach to provide a balanced response to altered hemostasis and oxygen debt, with the goal of reducing the risk of death from hemorrhagic shock. To optimize the successful use of fresh whole blood/cold-stored whole blood in combat field environments, proper planning and frequent training to maximize efficiency and safety will be required. Combat medics will need proper protocol-based guidance and education if whole-blood collection and transfusion are to be successfully and safely performed in austere environments. In this article, we present the Norwegian Naval Special Operation Commando unit-specific remote damage control resuscitation protocol, which includes field collection and transfusion of whole blood. This protocol can serve as a template for others to use and adjust for their own military or civilian unit-specific needs and capabilities for care in austere environments.
authors.affiliation: *Norwegian Naval Special Operation Commando; and; †Department of Immunology and Transfusion Medicine, Haukeland University Hospital, and Institute of Clinical Science, University of Bergen, Bergen, Norway; ‡Deployment Medicine International, Gig Harbor, Washington; §US Army Institute of Surgical Research, Fort Sam Houston, Texas; ∥Naval Special Warfare Command, San Diego, California; ¶Specialist Corps, US Army, Keller Army Community Hospital, West Point, New York; **Department of Transfusion Medicine, Örebro University Hospital, Orebro, Sweden; ††NSWDG US Navy, Virginia Beach, Virginia; ‡‡Medical Operations Royal Caribbean Cruises Ltd.; and §§Department of Pediatrics, Division of Critical Care, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Geir
authors.initials: G
authors.lastname: Strandenes
authors.forename: Marc
authors.initials: M
authors.lastname: De Pasquale
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Cap
authors.forename: Tor A
authors.initials: TA
authors.lastname: Hervig
authors.forename: Einar K
authors.initials: EK
authors.lastname: Kristoffersen
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickey
authors.forename: Christopher
authors.initials: C
authors.lastname: Cordova
authors.forename: Olle
authors.initials: O
authors.lastname: Berseus
authors.forename: Håkon S
authors.initials: HS
authors.lastname: Eliassen
authors.forename: Logan
authors.initials: L
authors.lastname: Fisher
authors.forename: Steve
authors.initials: S
authors.lastname: Williams
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
mesh_terms: D000017:ABO Blood-Group System; D001771:Blood Banks; D001788:Blood Grouping and Crossmatching; D001793:Blood Preservation / Q000379:methods*; D001803:Blood Transfusion; D003102:Colloids / Q000737:chemistry; D000077324:Crystalloid Solutions; D004635:Emergency Medicine / Q000379:methods; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D007552:Isotonic Solutions / Q000737:chemistry; D008889:Military Personnel; D009664:Norway; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000628:therapy*; D014857:Warfare
chemical_list: D000017:ABO Blood-Group System; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions