TRIAGE CONSIDERATIONS

DCBI casualties require massive amounts of blood products and can stress any surgical team given the intensive resources required. Walking Blood Bank initiation is common for casualties with this MOI. These casualties can potentially overwhelm a small Role 2 surgical team, whose goal is further stabilization and movement along the continuum of care. Role 2 surgical teams exist to bridge the gap between point of wounding and higher levels of battlefield care, but faced with one or two DCBI patients simultaneously, these teams will quickly exhaust all their resources. Mass casualty planning and ensuring small teams are augmented with base resources to support the WBB are necessary force multipliers.

Secondary to this MOI, DCBI events usually produce multiple casualties – but because of tactics (space on patrols) only 1-2 are critically injured and the rest, while they likely have injuries requiring surgery, do not require the immediate, resource-intensive interventions that the casualty closest to the blast requires. While this was the scenario most likely seen during U.S. Central Command operations with buried IEDs – further conflicts using artillery or drones could result in the same devastating injury patterns. Triage considerations for LSCO may require a different calculus; however, it is important to 'take care of the patient in front of you’ and maintain situational awareness of the operational environment and constantly track blood and other life-saving resources. REBOA and AAJT may be adjuncts to facilitate hemorrhage control if there are casualties from multiple DCBI events. If more than one patient with this injury pattern is set to arrive to a Role 2 or Role 3 MTF, then it is pragmatic to activate the WBB for (previously) prescreened Low Titer Group O donors.