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Paediatric patients in mass casualty incidents: a comprehensive review and call to action. Br J Anaesth 2021; 128:e109-e119. [PMID: 34862001 DOI: 10.1016/j.bja.2021.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 12/16/2022] Open
Abstract
The paediatric population is disproportionately affected during mass casualty incidents (MCIs). Several unique characteristics of children merit special attention during natural and man-made disasters because of their age, physiology, and vulnerability. Paediatric anaesthesiologists play a critical part of MCI care for this population, yet there is a deficit of publications within the anaesthesia literature addressing paediatric-specific MCI concerns. This narrative review article analyses paediatric MCI considerations and compares differing aspects between care provision in Australia, the UK, and the USA. We integrate some of the potential roles for anaesthesiologists with paediatric experience, which include preparation, command consultation, in-field care, pre-hospital transport duties, and emergency department, operating theatre, and ICU opportunities. Finally, we propose several methods by which anaesthesiologists can improve their contribution to paediatric MCI care through personal education, training, and institutional involvement.
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2
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Song KH, Winebrenner HM, Able TE, Bowen CB, Dunn NA, Shevchik JD. Ranger O Low Titer (ROLO): Whole Blood Transfusion for Forward Deployed Units. Mil Med 2021; 188:usab473. [PMID: 34755846 DOI: 10.1093/milmed/usab473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/11/2021] [Accepted: 10/27/2021] [Indexed: 11/14/2022] Open
Abstract
First-time use of Ranger O Low Titer (ROLO) blood and implementation of a forward-walking blood bank using predetermined donors proved essential in the survival of a 33-year-old active duty soldier following a complex blast injury during combat operations. The patient sustained significant bone, soft tissue, and vascular damage and continued to deteriorate despite resuscitation with cold-stored whole blood (WB). Only after utilizing the ROLO battle drill and transfusing with fresh WB was the patient able to be stabilized and evacuated. In this case report, we discuss how ROLO walking blood bank takes the next step in aiding resuscitation, providing smaller, forward-deployed units with blood resupply without the administrative burden of storage, particularly in resource-scarce environments. We provide an overview of WB and contrast its use to that of component therapy. In conjunction with the Golden Hour, ROLO can be incorporated as the standard damage control resuscitation to reduce the risks of noncompressible hemorrhage. By taking precautionary steps in the pre-deployment setting, ROLO offers an invaluable alternative to conventional resuscitation.
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Affiliation(s)
- Kaoru H Song
- Department of Family Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Hans M Winebrenner
- Department of Anesthesia, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Ty E Able
- 1st Battalion, 75th Ranger Regiment, Hunter Army Airfield, Savannah, GA 31409, USA
| | - Charles B Bowen
- 1st Battalion, 75th Ranger Regiment, Hunter Army Airfield, Savannah, GA 31409, USA
| | - Noel A Dunn
- 2nd Battalion, 75th Ranger Regiment, Joint Base Lewis-McChord, WA 98327, USA
| | - Joseph D Shevchik
- 1st Battalion, 75th Ranger Regiment, Hunter Army Airfield, Savannah, GA 31409, USA
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3
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Grant SWJ, Heil KM. Practical limitations of emergency donor panels as a risk mitigation in small-scale short-term training team operations. BMJ Mil Health 2020; 169:e97-e99. [PMID: 32938711 DOI: 10.1136/bmjmilitary-2020-001529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022]
Abstract
Haemostatic resuscitation with blood products has become the expected standard of care for trauma casualties. As UK Defence increases its deployment of small-scale, short-term training teams (STTTs) in Defence Engagement and influence operations, ever greater reliance is being placed on emergency donor panels (EDP) as a source of whole blood. This paper outlines the practical limitations of using EDPs as a risk mitigation in conventional STTTs which must be considered prior to every deployment.
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Affiliation(s)
| | - K M Heil
- 42 Commando, Royal Marines, Plymouth, UK
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4
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Doughty H, Strandenes G. Whole blood in disaster and major incident planning. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/voxs.12503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Heidi Doughty
- NHS Blood and Transplant Birmingham UK
- College of Medical and Dental Sciences University of Birmingham Birmingham UK
| | - Geir Strandenes
- Department of Immunology and Transfusion Medicine Haukeland University Hospital Bergen Norway
- Department of War Surgery and Emergency Medicine Norwegian Armed Forces Medical Services Oslo Norway
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5
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Vitalis V, Carfantan C, Montcriol A, Peyrefitte S, Luft A, Pouget T, Sailliol A, Ausset S, Meaudre E, Bordes J. Early transfusion on battlefield before admission to role 2: A preliminary observational study during "Barkhane" operation in Sahel. Injury 2018; 49:903-910. [PMID: 29248187 DOI: 10.1016/j.injury.2017.11.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/10/2017] [Accepted: 11/22/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Haemorrage is the leading cause of death after combat related injuries and bleeding management is the cornerstone of management of these casualties. French armed forces are deployed in Barkhane operation in the Sahel-Saharan Strip who represents an immense area. Since this constraint implies evacuation times beyond doctrinal timelines, an institutional decision has been made to deploy blood products on the battlefield and transfuse casualties before role 2 admission if indicated. The purpose of this study was to evaluate the transfusion practices on battlefield during the first year following the implementation of this policy. MATERIALS AND METHODS Prospective collection of data about combat related casualties categorized alpha evacuated to a role 2. Battlefield transfusion was defined as any transfusion of blood product (red blood cells, plasma, whole blood) performed by role 1 or Medevac team before admission at a role 2. Patients' characteristics, battlefield transfusions' characteristics and complications were analysed. RESULTS During the one year study, a total of 29 alpha casualties were included during the period study. Twenty-eight could be analysed, 7/28 (25%) being transfused on battlefield, representing a total of 22 transfusion episodes. The most frequently blood product transfused was French lyophilized plasma (FLYP). Most of transfusion episodes occurred during medevac. Compared to non-battlefield transfused casualties, battlefield transfused casualties suffered more wounded anatomical regions (median number of 3 versus 2, p = 0.04), had a higher injury severity score (median ISS of 45 versus 25, p = 0,01) and were more often transfused at role 2, received more plasma units and whole blood units. There was no difference in evacuation time to role 2 between patients transfused on battlefield and non-transfused patients. There was no complication related to battlefield transfusions. Blood products transfusion onset on battlefield ranged from 75 min to 192 min after injury. CONCLUSION Battlefield transfusion for combat-related casualties is a logistical challenge. Our study showed that such a program is feasible even in an extended area as Sahel-Saharan Strip operation theatre and reduces time to first blood product transfusion for alpha casualties. FLYP is the first line blood product on the battlefield.
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Affiliation(s)
- V Vitalis
- French Medical Unit, Medical Centre of Lyon, France
| | - C Carfantan
- French Military Medical Service, Operational Headquarters, France
| | - A Montcriol
- Sainte Anne Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Toulon, France
| | - S Peyrefitte
- French Medical Unit, Naval Special Operations Commandos Command, Lanester, France
| | - A Luft
- French Military Medical Service, Operational Headquarters, France
| | - T Pouget
- French Military Blood Institute, Clamart, France
| | - A Sailliol
- French Military Blood Institute, Clamart, France
| | - S Ausset
- Percy Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Clamart, France & Val de Grâce Military Academy, Paris, France
| | - E Meaudre
- Sainte Anne Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Toulon, France
| | - J Bordes
- Sainte Anne Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Toulon, France; 7th Paratrooper Forward Surgical Unit, France.
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6
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Howard M, Bakker-Dyos J, Gallagher L, O'Hara JP, Woods D, Mellor A. Power supplies and equipment for military field research: lessons from the British Service Dhaulagiri Research Expedition 2016. J ROY ARMY MED CORPS 2017; 164:41-45. [PMID: 29279321 DOI: 10.1136/jramc-2017-000767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/17/2017] [Accepted: 06/19/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The British Service Dhaulagiri Research Expedition (BSDMRE) took place from 27 March to 31 May 2016. The expedition involved 129 personnel, with voluntary participation in nine different study protocols. Studies were conducted in three research camps established at 3600, 4600 and 5140 m and involved taking and storing blood samples, cardiac echocardiography and investigations involving a balance plate. Research in this remote environment requires careful planning in order to provide a robust and resilient power plan. In this paper we aim to report the rationale for the choices we made in terms of power supply, the equipment used and potential military applicability. METHODS This is a descriptive account from the expedition members involved in planning and conducting the medical research. RESULTS Power calculations were used to determine estimates of requirement prior to the expedition. The primary sources used to generate power were internal combustion engine (via petrol fuelled electric generators) and solar panels. Having been generated, power was stored using lithium-ion batteries. Special consideration was given to the storage of samples taken in the field, for which electric freezers and dry shippers were used. All equipment used functioned well during the expedition, with the challenges of altitude, temperature and transport all overcome due to extensive prior planning. CONCLUSIONS Power was successfully generated, stored and delivered during the BSDMRE, allowing extensive medical research to be undertaken. The challenges faced and overcome are directly applicable to delivering military medical care in austere environments, and lessons learnt can help with the planning and delivery of future operations, training exercises or expeditions.
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Affiliation(s)
- Matt Howard
- Defence Medical Services Whittington, Lichfield, UK
| | | | - L Gallagher
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - J P O'Hara
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - D Woods
- Defence Medical Services Whittington, Lichfield, UK.,Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - A Mellor
- Defence Medical Services Whittington, Lichfield, UK.,Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
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7
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Doughty H, Maguire A, Fitchett G, Parker P. Group O low titre only emergency donor panels for small combat teams. J ROY ARMY MED CORPS 2017; 163:401-404. [PMID: 28883026 DOI: 10.1136/jramc-2017-000830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military elements increasingly operate in small teams in remote areas with no immediate blood product support. Planners and operators may endorse collection of fresh whole blood from pretested donors in emergency situations. The biggest risk of transfusion is the accidental use of ABO incompatible blood which can be fatal. The risk may be mitigated by using only group O LOw (OLO) titre donors with plasma containing low levels of the naturally occurring antibody to group A and B red cells. This paper reviews the ABO blood group distribution in potential blood donors from a high readiness UK medical regiment and explores the feasibility of using only group OLO donors in small teams. METHODS A retrospective review of routine volunteer blood donor samples was undertaken at 6 monthly intervals during a 2-year period. Personnel were tested in groups when available during training to create multiple donor panels to simulate small teams. RESULTS 206 donation samples were collected from 157 potential donors. All donors were acceptable based on the lifestyle questionnaire, serology and microbiology screen. Of the 206 samples reviewed, 85 (41%) were group O (D pos and D neg). 14 group O (16.5%) were shown to have high titre of anti-A or B. Therefore, 71, that is, 34% overall were suitable as OLO donors. The donor panel size varied from 15 to 44. The absolute number of OLO donors in each panel ranged from 4 to 17 and the number of O neg donors was 0-3. CONCLUSION A third of samples were suitable as OLO donors; however, there were insufficient 'universal' donors within smaller subgroups (<10). In this situation, we recommend the careful use of both group O and group A donors or the use of a buddy-buddy blood group matrix.
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Affiliation(s)
- Heidi Doughty
- NHS Blood and Transplant, Birmingham, UK.,Academic Department of Military Anaesthesia and Critical Care, Birmingham, UK
| | - A Maguire
- The Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - G Fitchett
- The Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - P Parker
- The Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK.,Senior Lecturer in SOF Medicine, University College Cork, Cork, Republic of Ireland
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Affiliation(s)
- Mike Smith
- Royal Centre for Defence Medicine, Birmingham, UK
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9
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Parker P, Doughty H. Commentary: Parachute group O LOw titre (POLO) Program. J ROY ARMY MED CORPS 2017:jramc-2017-000834. [PMID: 28794009 DOI: 10.1136/jramc-2017-000834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Paul Parker
- Royal Centre for Defence Medicine, Birmingham, UK
| | - H Doughty
- NHS Blood and Transplant, Birmingham, UK
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10
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Deployed skills training for whole blood collection by a special operations expeditionary surgical team. J Trauma Acute Care Surg 2017; 82:S96-S102. [PMID: 28333831 DOI: 10.1097/ta.0000000000001433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Noncompressible hemorrhage is the leading cause of potentially preventable battlefield death. Combining casualty retrieval from the battlefield and damage control resuscitation (DCR) within the "golden hour" increases survival. However, transfusion requirements may exceed the current blood component stocks held by forward surgical teams. Warm fresh whole blood (WFWB) is an alternative. We report WFWB transfusion training developed by and delivered to a US Golden Hour Offset Surgical Treatment Team and the resulting improvement in confidence with WFWB transfusion. METHODS A bespoke instructional package was derived from existing operational clinical guidelines. All Golden Hour Offset Surgical Treatment Team personnel completed initial training, reinforced through ongoing casualty simulations. A record of blood types and donor eligibility was established to facilitate rapid identification of potential WFWB donors. Self-reported confidence in seven aspects of the WFWB transfusion process was assessed before and after training using a five-point Likert scale. Personnel were analyzed by groups consisting of those whose operational role includes WFWB transfusion ("transfusers"), clinical personnel without such responsibilities ("nontransfusers") and nonclinical personnel (other). Comparisons within and between groups were made using appropriate nonparametric tests. RESULTS Data were collected from 39 (89%) of 44 training participants: 24 (62%) transfusers, 12 (31%) nontransfusing clinicians, and 3 (8%) other personnel. Transfusers and nontransfusers reported increased comfort with all practical elements of WFWB transfusion. The confidence of other personnel also increased, but (likely due to small numbers) was not statistically significant. CONCLUSION WFWB transfusion is an integral part of modern deployed military remote DCR. Our in-theater training program rapidly and reproducibly enhanced the comfort in WFWB transfusion in providers from a range of backgrounds and skill-mixes. This model has the potential to improve both safety and effectiveness of WFWB remote DCR in the far-forward deployed setting. LEVEL OF EVIDENCE Therapeutic/care management study, level IV.
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11
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Woolley T, Badloe J, Bohonek M, Taylor AL, Erik Heier H, Doughty H. NATO Blood Panel perspectives on changes to military prehospital resuscitation policies: current and future practice. Transfusion 2017; 56 Suppl 2:S217-23. [PMID: 27100759 DOI: 10.1111/trf.13489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022]
Abstract
The North Atlantic Treaty Organization (NATO) Blood Panel exists to promote interoperability of transfusion practice between NATO partners. However, it has served as an important forum for the development of prehospital transfusion and transfusion in the austere environment. There are synergies with the trauma hemostasis and oxygen research community especially in the areas of innovation and research. Four presentations are summarized together with a review of some scientific principles. The past decade has already seen significant changes in early transfusion support. Sometimes practice has preceded the evidence and has stretched regulatory and logistic constraints. Ethical and philosophical issues are also important and require us to question "should we" and not just "could we." The challenge for the combined communities is to continue to optimize transfusion support underpinned by evidence-based excellence.
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Affiliation(s)
- Tom Woolley
- Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - John Badloe
- Commander, Netherlands Military Blood Bank, SBB (ASCP), Consultant in Transfusion Medicine, Amsterdam, the Netherlands
| | - Milos Bohonek
- Main Consultant for Hematology and Blood Transfusion, Military Medical Service, Army of Czech Republic, Prague, Czech Republic
| | - Audra L Taylor
- Director, US Army Blood Program, JBSA Fort Sam Houston, Texas
| | | | - Heidi Doughty
- NHS Blood and Transplant, Birmingham, UK and Centre of Defence Pathology, RCDM, Queen Elizabeth Hospital, Birmingham, UK
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12
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Daniel Y, Sailliol A, Pouget T, Peyrefitte S, Ausset S, Martinaud C. Whole blood transfusion closest to the point-of-injury during French remote military operations. J Trauma Acute Care Surg 2017; 82:1138-1146. [PMID: 28328685 DOI: 10.1097/ta.0000000000001456] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To improve the survival of combat casualties, interest in the earliest resort to whole blood (WB) transfusion on the battlefield has been emphasized. Providing volume, coagulation factors, plasma, and oxygenation capacity, WB appears actually as an ideal product severe trauma management. Whole blood can be collected in advance and stored for subsequent use, or can be drawn directly on the battlefield, once a soldier is wounded, from an uninjured companion and immediately transfused.Such concepts require a great control of risks at each step, especially regarding ABO mismatches, and transfusion-transmitted diseases. We present here the "warm and fresh" WB field transfusion program implemented among the French armed forces. We focus on the followed strategies to make it applicable on the battlefield, even during special operations and remote settings, and safe for recipients as well as for donors.
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Affiliation(s)
- Yann Daniel
- French Medical Unit, Naval Special Operations Commandos Command, Lanester, France (Y.D., S.P.); French Military Blood Institute, Clamart, France (A.S., T. P., C.M.); Anaesthesia and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France (S. A.); and Department of Biology, Laveran Military Teaching Hospital, Marseille, France (C.M.)
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13
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Daniel Y, Habas S, Malan L, Escarment J, David JS, Peyrefitte S. Tactical damage control resuscitation in austere military environments. J ROY ARMY MED CORPS 2016; 162:419-427. [PMID: 27531659 DOI: 10.1136/jramc-2016-000628] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite the early uses of tourniquets and haemostatic dressings, blood loss still accounts for the vast majority of preventable deaths on the battlefield. Over the last few years, progress has been made in the management of such injuries, especially with the use of damage control resuscitation concepts. The early application of these procedures, on the field, may constitute the best opportunity to improve survival from combat injury during remote operations. DATA SOURCES Currently available literature relating to trauma-induced coagulopathy treatment and far-forward transfusion was identified by searches of electronic databases. The level of evidence and methodology of the research were reviewed for each article. The appropriateness for field utilisation of each medication was then discussed to take into account the characteristics of remote military operations. CONCLUSIONS In tactical situations, in association with haemostatic procedures (tourniquet, suture, etc), tranexamic acid should be the first medication used according to the current guidelines. The use of fibrinogen concentrate should also be considered for patients in haemorrhagic shock, especially if point-of-care (POC) testing of haemostasis or shock severity is available. If POC evaluation is not available, it seems reasonable to still administer this treatment after clinical assessment, particularly if the evacuation is delayed. In this situation, lyophilised plasma may also be given as a resuscitation fluid while respecting permissive hypotension. Whole blood transfusion in the field deserves special attention. In addition to the aforementioned treatments, if the field care is prolonged, whole blood transfusion must be considered if it does not delay the evacuation.
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Affiliation(s)
- Yann Daniel
- Antenne médicale spécialisée, Base des Fusiliers Marins et des Commandos, Lanester, France
| | - S Habas
- Antenne médicale spécialisée, Base des Fusiliers Marins et des Commandos, Lanester, France
| | - L Malan
- Antenne médicale spécialisée, Base des Fusiliers Marins et des Commandos, Lanester, France
| | - J Escarment
- Hôpital d'Instruction des Armées Desgenettes, Lyon, France.,Direction Régionale du Service de Santé des Armées, Lyon, France
| | - J-S David
- Service d'Anesthésie Réanimation, Hôpital Edouard Herriot, Lyon, France.,Université Claude Bernard, Lyon, France
| | - S Peyrefitte
- Antenne médicale spécialisée, Base des Fusiliers Marins et des Commandos, Lanester, France
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14
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Doughty H, Glasgow S, Kristoffersen E. Mass casualty events: blood transfusion emergency preparedness across the continuum of care. Transfusion 2016; 56 Suppl 2:S208-16. [DOI: 10.1111/trf.13488] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Heidi Doughty
- NHS Blood and Transplant UK; Birmingham UK and Centre of Defence Pathology, RCDM, Queen Elizabeth Hospital, Birmingham, UK
| | - Simon Glasgow
- Centre for Trauma Sciences, the Blizard Institute, Queen Mary University of London; London UK
| | - Einar Kristoffersen
- Department of Immunology and Transfusion Medicine; Haukeland University Hospital and the Institute of Clinical Sciences, University of Bergen; Bergen Norway
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15
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Doughty H, Thompson P, Cap AP, Spinella PC, Glassberg E, Skogrand Eliassen H, De Pasquale M, Strandenes G. A proposed field emergency donor panel questionnaire and triage tool. Transfusion 2016; 56 Suppl 2:S119-27. [DOI: 10.1111/trf.13487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Heidi Doughty
- NHS Blood and Transplant; Birmingham UK and Centre of Defence Pathology, RCDM, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Andrew P. Cap
- US Army Institute of Surgical Research; JBSA-FT Sam Houston Texas
| | - Philip C. Spinella
- Division of Critical Care, Department of Pediatrics; Washington University in St Louis; St Louis Missouri
| | | | - Håkon Skogrand Eliassen
- Norwegian Naval Special Operations Commando, and the Department of Immunology and Transfusion Medicine, Haukeland University Hospital; Bergen Norway
| | | | - Geir Strandenes
- Norwegian Naval Special Operations Commando, and the Department of Immunology and Transfusion Medicine, Haukeland University Hospital; Bergen Norway
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16
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Aye Maung N, Doughty H, MacDonald S, Parker P. Transfusion support by a UK Role 1 medical team: a 2-year experience from Afghanistan. J ROY ARMY MED CORPS 2015; 162:440-444. [PMID: 26400976 DOI: 10.1136/jramc-2015-000489] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/28/2015] [Accepted: 08/30/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION This paper describes the clinical governance, training, equipment and infrastructure developed to enable a UK Role 1 medical team to deliver forward transfusion in Southern Afghanistan. The aim was to explore the utility and feasibility of forward blood transfusion by a Role 1 medical team in an austere military environment. METHODS An audit of prospectively collected transfusion regulatory and cold chain data using standard-issue equipment and governance systems. TempIT tags were read before and after each mission to record blood storage temperature. Two years' data were analysed to review the use of blood products, cold chain compliance and equipment issues. RESULTS Over 24 months, blood products were carried on over 1000 mission hours. Two clinical cases required transfusion and were successfully resuscitated. The team was able to correctly transport, store and deploy red cells and plasma on missions using standard Ministry of Defence (MOD) issue equipment. There were seven cold chain failures, all of which were addressed locally. Current cold chain and diagnostic equipment would require further optimisation for use at Role 1. CONCLUSIONS An isolated Role 1 medical team can safely deliver blood transfusion on vehicle, helicopter or foot patrols. The transport and storage of blood created a large logistical burden for a relatively small clinical output. However, with further developments, this capability may have utility in contingency operations especially for isolated teams.
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Affiliation(s)
- Niall Aye Maung
- MOD A Block Regents Park Barracks, Ministry of Defence, London, UK
| | - H Doughty
- Transfusion Medicine, NHS Blood and Transplant, Birmingham, UK
| | - S MacDonald
- SO2 Responsible Person Blood, DMS Blood Supply Team, Birmingham Research Park, Birmingham, UK
| | - P Parker
- Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, UK
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