The Trauma Hemostasis and Oxygenation Research (THOR) Network including  the 75th Ranger Regiment, NORNAVSOF, and others have led the way in  re-implementing type-O, low titer fresh whole blood far forward with the  Ranger type-O Low titer(ROLO) program. In 2015 the Ranger medical  leadership along with founders of the ROLO program published the paper,  “Tactical Damage Control Resuscitation” outlining in detail why they  chose to bring back fresh whole blood at the point of injury. Since that  time further studies have strongly suggested that the earlier fresh  whole blood was transfused, the greater the benefit to the patient.  Shackleford et al. demonstrated that the greatest benefit to a patient  receiving fresh whole blood occurred within 36 minutes of injury. After  36 minutes no decrease in 24-hour mortality was found.   

Blood must be replaced as soon as possible. The Committee on Tactical  Combat Casualty Care also recommends FWB as the first line intervention  for patients in hemorrhagic shock with blood products in both second and  third place. We cannot ignore whole blood any longer if we wish to  deliver the best possible battlefield care possible. Excuses citing  logistical difficulty, concerns about safety or lack of information are  unfounded. There are multiple ways to ensure our casualties are  receiving fresh whole blood. The first is through the Armed Services  Blood Program (ASBP) delivering cold stored O-Low titer blood to a Role 2  facility where it is picked up and pushed forward from there.  Refrigeration is necessary in order to keep it below 4°C. If going out  on mission insulated containers such as the Golden Hour or Golden Minute  containers can be used to keep the blood within temperature specs for  24 hours, 72 hours or longer. If dismounted, a transfusion can occur at  or near the point of injury with pre-typed, screened and titered  ROLO/SOLO donors. Other non-Ranger Special Operations units have since  followed suit and have tweaked the name to suit them, hence the new SOLO  (Special Operations Low-O) acronym.   

www.prolongedfieldcare.org