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Episode 3: Throw out your colloids, it’s time to get bloody!
In this episode, we get bloody. We talk FWB, ROLO, LTOWB, and Autologous FWB transfusion training. When you're done, go find all the colloids in your aid station and put them in the trash where they belong. Wait, maybe don't be that aggressive, but the window for colloids on the battlefield is a narrow one, and its probably razor thin below the Role 2/3.
Here is the article from Next Gen Combat Medic that we talked about in the show: https://nextgencombatmedic.com/2017/09/03/whole-blood-toolkit/
Here are the case reports mentioned in the PAdcast - think about you or your medics in these situations and whether you're ready:
2009 Case Report - FWB transfusion in Afghanistan Role 1 BAS: Cordova CB, Cap AP, Spinella PC. Fresh Whole Blood Transfusion for a Combat Casualty in Austere Combat EnvironmentJournal of Special Operations Medicine. 14(1):9-12.
2019 Case Report - SWB & FWB transfusion at PoI by a medic: Lewis CL, Nilan M, Srivilasa C, Knight R, Shevchik J, Bowen B, Able T, Kreishman P. Fresh Whole Blood Collection and Transfusion at Point of Injury, Prolonged Permissive Hypotension, and Intermittent REBOA. Journal of Special Operations Medicine. 20(2):123-126.
Here is the 2013 Norwegian SOF study on physical capacity after blood donation: Strandenes G, Skogrand H, Spinella PC, Hervig T, Rein EB. Donor performance of combat readiness skills of special forces soldiers are maintained immediately after whole blood donation: a study to support the development of a prehospital fresh whole blood transfusion program. Transfusion. 53(3):526-30.
Also: GrumPA mentioned a memorandum from the ISR to TCMC in Aug 2019 about changes coming to the JTS CPG. As of April 2021, the old recommendations persist in the DCR CPG dated July 2019. However, the TCCC CPG dated Nov 2020 is updated IAW with this memo for a single dose of 2g IV/IO TXA and Calcium dosing up front and every 4th unit. If you need/want a copy of the memo, an example Deliberate Risk Assessment Worksheet for Autologous FWB transfusion training, or any of the articles above (and you can't find them through your local medical library), just email [email protected] and he'll shoot it to you. Please include your work/global email address so I know I'm emailing a colleague.
Notes on meds from above:
-TXA is now 2gm IV ASAP but at least within 3 hours of wounding, instead of the old guidance of 1gm slow IV over 10 minutes followed by another 1gm in the first 8 hours.
- Calcium is recommended as soon as you identify the need for blood transfusion, probably after TXA is on board if you have to choose one up front. Dose is 1g, then an additional 1g every 4 units of blood. Calcium Gluconate is 30cc of 10% CaGlu, Calcium Chloride is 10cc of 10% CaCl, best through a central line because it scleroses peripheral vessels/causes injection site pain/risks tissue damage if it infiltrates.
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By GrumpePA
5
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In this episode, we get bloody. We talk FWB, ROLO, LTOWB, and Autologous FWB transfusion training. When you're done, go find all the colloids in your aid station and put them in the trash where they belong. Wait, maybe don't be that aggressive, but the window for colloids on the battlefield is a narrow one, and its probably razor thin below the Role 2/3.
Here is the article from Next Gen Combat Medic that we talked about in the show: https://nextgencombatmedic.com/2017/09/03/whole-blood-toolkit/
Here are the case reports mentioned in the PAdcast - think about you or your medics in these situations and whether you're ready:
2009 Case Report - FWB transfusion in Afghanistan Role 1 BAS: Cordova CB, Cap AP, Spinella PC. Fresh Whole Blood Transfusion for a Combat Casualty in Austere Combat EnvironmentJournal of Special Operations Medicine. 14(1):9-12.
2019 Case Report - SWB & FWB transfusion at PoI by a medic: Lewis CL, Nilan M, Srivilasa C, Knight R, Shevchik J, Bowen B, Able T, Kreishman P. Fresh Whole Blood Collection and Transfusion at Point of Injury, Prolonged Permissive Hypotension, and Intermittent REBOA. Journal of Special Operations Medicine. 20(2):123-126.
Here is the 2013 Norwegian SOF study on physical capacity after blood donation: Strandenes G, Skogrand H, Spinella PC, Hervig T, Rein EB. Donor performance of combat readiness skills of special forces soldiers are maintained immediately after whole blood donation: a study to support the development of a prehospital fresh whole blood transfusion program. Transfusion. 53(3):526-30.
Also: GrumPA mentioned a memorandum from the ISR to TCMC in Aug 2019 about changes coming to the JTS CPG. As of April 2021, the old recommendations persist in the DCR CPG dated July 2019. However, the TCCC CPG dated Nov 2020 is updated IAW with this memo for a single dose of 2g IV/IO TXA and Calcium dosing up front and every 4th unit. If you need/want a copy of the memo, an example Deliberate Risk Assessment Worksheet for Autologous FWB transfusion training, or any of the articles above (and you can't find them through your local medical library), just email [email protected] and he'll shoot it to you. Please include your work/global email address so I know I'm emailing a colleague.
Notes on meds from above:
-TXA is now 2gm IV ASAP but at least within 3 hours of wounding, instead of the old guidance of 1gm slow IV over 10 minutes followed by another 1gm in the first 8 hours.
- Calcium is recommended as soon as you identify the need for blood transfusion, probably after TXA is on board if you have to choose one up front. Dose is 1g, then an additional 1g every 4 units of blood. Calcium Gluconate is 30cc of 10% CaGlu, Calcium Chloride is 10cc of 10% CaCl, best through a central line because it scleroses peripheral vessels/causes injection site pain/risks tissue damage if it infiltrates.