Scientific aspects of supplying blood to distant military theaters

Abstract

Reduction in combat zone morbidity and mortality requires rapid delivery of safe blood products as an integral element of advanced trauma surgical care. This review of the current literature presents scientific aspects of supplying blood for rapid delivery to enhance survival and patient outcome in the combat zone. Most deaths due to hemorrhage can be averted by transfusion during the first hour from injury; therefore, maintaining a dependable inventory of blood products in combat support hospitals is essential. Current casualty care in distant geographic locations involves rapid air evacuation to combat support hospitals or fleet hospitals, where massive transfusions may be required. Resuscitation by forward surgical teams utilizing red blood cells before air evacuation or in-flight has also been reported. To improve survival, these massive transfusions should be composed of not only red blood cells but also other blood components and plasma factors. Rapid on-site combat casualty transfusion support requires specialized blood transport containers and transfusion practices not observed in noncombat settings, such as the mobile walking blood bank and a frozen blood program. Additionally, technology for improved transport containers, cell-free hemoglobin-based oxygen carriers, freeze-dried blood, and recombinant activated coagulation factor has attracted focused interest.