One of the unique aspects of trauma care in a combat zone relative to that in the US is the administration of blood. It is an element of care that is greatly complicated by logistics and available equipment and trained personnel.
In the US, blood is taken from a donor and immediately divided into its components which include red blood cells, plasma, and platelets. These components are refrigerated and stored until used. They are ordered individually for patients depending on that person's needs. One of the reasons for the division of blood into its parts is that blood supplies are scarcer than demand. Component therapy, thus, increases efficient use of the resource.
In cases of massive transfusion, all of the components are usually given in rough proportion to their ratios in blood. In effect, blood is reconstituted to its original form. Unfortunately one of the drawbacks to this system is that the processing and storage of blood products lessens their effectiveness. Old red cells, plasma, and platelets are not as good as the "fresh" blood that circulates in our arteries and veins.
Here at the FST "blood banking" presents certain challenges. We keep a store of red blood cells and plasma. However, we are limited as to the blood types that we have on hand because our storage capacity is smaller than that of a hospital in America. When our supply gets low, we require a resupply by helicopter to maintain our mission capability. Additionally, we do not carry platelets, in spite of their crucial role in forming clot, due to their very short shelf life.
|The Blood Cooler. (No diet Cokes please.)|
One of the solutions to these problems is the maintenance of a "walking blood bank." Specifically, American service members willing to give blood are screened so that we can take blood in its whole form directly from the donor and transfuse it into a patient. This fresh whole blood is in many ways superior to the components used at home because it is not processed, frozen, and stored to the same extent. It seems to have better oxygen-carrying capability and better ability to restore proper clotting function. The main limitation is that tests that we use to screen for viruses and infection are not quite as accurate as those used in American blood banks such as the Red Cross. Fortunately all service members are prescreened for most of these agents as part of routine military health care.
When a patient is brought for care and it is apparent that their transfusion needs will exceed our supply, the walking blood bank is activated. The loudspeaker on the FOB calls for volunteers who share the patient's blood type to report to the tent maintained by the tenant army regiment's medical company. The volunteers are processed, poked, and prodded just like at the bloodmobile back home. Their donated units are then walked up the hill to the FST and brought into the OR where they are transfused immediately into the patient. We have already had numerous patients that have required up to ten units of fresh whole blood in surgery. That is in addition to the other blood components that we administer.
As the FST's anesthesiologist and, therefore, the prime user of blood, I wanted to recognize this unique contribution that our service members on the base make to each other. What better way to do that than a T-shirt. Here is that T-shirt, which I ordered and am happy to report is being handed out on the FOB.
|Linda, one of our OR techs, crosstrained as a model.|
|Don't worry, they get a juice box too.|