Emergency Whole-Blood Use in the Field

## Emergency Whole-Blood use in the Field: A Simplified Protocol for Collection and Transfusion

Geir Strandenes, Marc De Pasquale, Andrew P. Cap, Tor A. Hervig, Einar K. Kristoffersen, Matthew Hickey, Christopher Cordova, Olle Berseus

#### Description:

Combat medics need proper protocol-based guidance and education if whole-blood collection and transfusion are to be successfully and safely performed in austere environments. This article presents the Norwegian Naval Special Operation Commando unit specific remote damage control resuscitation protocol, which includes field collection and transfusion of whole blood as an example that can be used as a template to develop unit specific protocols.

#### Key Points:

- Resuscitation in the field with a full complement of RBCs, plasma, and platelets may offer an advantage, especially under conditions where evacuation is delayed.

- No current evacuation system, military or civilian, can provide RBC, plasma, and platelet units in a prehospital environment, especially in austere settings.

- Military experience and laboratory data provide a rationale for whole-blood use in the treatment of massive hemorrhage.

- As a result, for the vast majority of casualties, in austere settings, with life-threatening hemorrhage, it is appropriate to consider a whole blood based resuscitation approach to reduce the risk of death from hemorrhagic shock.

emergency Whole-Blood Use in the Field: A Simplified Protocol for Collection and Transfusion
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Key Flowchart:

## Take Home Message

Whole blood is perhaps the most appropriate product for hemostatic resuscitation.
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 is required.
Unit specific protocol should be implemented and trained if whole-blood collection and transfusion are to be successfully and safely performed in austere environments.