Direct blood transfusion

kaja

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Hi guys

I read somewhere, that some SF 18D carry sets for direct blood transfusion in field. From my point of view, it looks like really good idea, since only blood can carry oxygen, and if you have few more guys on group with same blood type (or O neg .....) and there is minimal risk of their injury (like long firefight, IED hazard,...) they should tolerate donation of few hundred ml. IIRC, the set contained bag for blood with anti-coagulant , some tubing, cross-test and transfusion sets... Do you have any experience/ info on that?

Thanks

Kaja
 

TLDR20

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It is something that is possible, but I honestly would not be super comfortable with it. It is not in my aidbag and you have now effectively taken two guys out of the fight, also should there be a reaction your problems have gone from bad to much much worse in mins.
 

pardus

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Real, fresh, blood is the best thing you can give someone with blood loss. Sooner the better.
That said I'm not sure I'd be real comfortable doing a direct transfusion in the field unless it was under a certain set of circumstances.

It's not an option at my level anyway so it's a moot point for me.
 

policemedic

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I agree with all the above. Can it be done? Sure. The real question is one of risk vs. benefits and you have to take medical issues and tactical issues into account. Blood products should never be given blithely and without preparation for a SHTF scenario. In any case, there are better and safer options in use by other nation's SOF medics.
 

pardus

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Well, not an 18D but if you have a hemolytic reaction to the blood, well that can be really bad. Other volume expanders can benefit in the short term (hetastartch). Anybody using that stuff?

F.M.

We lost hetastartch. Too many retard CLS guys giving it to people who were dehydrated... yeah....
Loosing LRS as well, it's all saline now for us.
 

surgicalcric

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You guys are missing the point entirely.

It is not for times when the evac times are short -within reason; it is for times like the beginning of the Afghan invasion where the closest MH-47 was a 4 hour flight to the casualty. It came to be after several guys died who could have possibly benefited from receiving whole blood in the field. I say possibly because the guys died before getting to a MTF of non-compressible hemorrhage and it isn't known whether they would have lived or not had they received the transfusion. Shortly therafter a forward thinking Group Surgeon proposed the idea and it was widely adopted.

Furthermore, while permissive hypotension (PHPTN) is a good thing when there isnt a better option a patient can only be sustained in the field this way for a very finite amount of time. This time varies from patient to patient in the field and is based on a wide number of conditions from hydration level prior to insult to the ability of the medic to maintain the patients core temp greater than 96 degrees.

As for typing, I know all of my guys types - even the attachments to my team; it is stamped on their dogtags and is printed by me on their FCC's. That is the least of my concerns... Is it something I want to do, no. It is a procedure I am prepared to do though

...if you have a hemolytic reaction to the blood, well that can be really bad...

So can dying from hypovolemic shock.
 

Muppet

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You guys are missing the point entirely.

It is not for times when the evac times are short -within reason; it is for times like the beginning of the Afghan invasion where the closest MH-47 was a 4 hour flight to the casualty. It came to be after several guys died who could have possibly benefited from receiving whole blood in the field. I say possibly because the guys died before getting to a MTF of non-compressible hemorrhage and it isn't known whether they would have lived or not had they received the transfusion. Shortly therafter a forward thinking Group Surgeon proposed the idea and it was widely adopted.

A patient can only be sustained in permissive hypo-tension for a very finite amount of time. It varies from patient to patient and I have yet to read a study theorizing what that time may be as a general rule.

I know all of my guys types - even the attachments to my team; it is stamped on their dogtags and is printed by me on their FCC's. That is the least of my concerns... Is it something I want to do, no but it is a procedure I am prepared to do...



So can dying from hypovolemic shock.


I see your point Surgicalcric and once again, I learned something and I appreciate that brother.

F.M.
 

TLDR20

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You guys are missing the point entirely.
It is not for times when the evac times are short -within reason; it is for times like the beginning of the Afghan invasion where the closest MH-47 was a 4 hour flight to the casualty. It came to be after several guys died who could have possibly benefited from receiving whole blood in the field. I say possibly because the guys died before getting to a MTF of non-compressible hemorrhage and it isn't known whether they would have lived or not had they received the transfusion. Shortly therafter a forward thinking Group Surgeon proposed the idea and it was widely adopted.

Furthermore, while permissive hypotension (PHPTN) is a good thing when there isnt a better option a patient can only be sustained in the field this way for a very finite amount of time. This time varies from patient to patient in the field and is based on a wide number of conditions from hydration level prior to insult to the ability of the medic to maintain the patients core temp greater than 96 degrees.
. Is it something I want to do, no. It is a procedure I am prepared to do though

I agree with everything said, the highlighted portion especially, most young/less trained medics forget this part of their TCCC and ACLS codes. The blood transfusion is something I can do, and will do to save a life, I don't want to portray otherwise.

As for the permissive hypotension, it is gaining a lot of traction in the Pre-hospital setting. However if it is my buddy I am prolly going to go ahead and give him the hetastarch.
 

surgicalcric

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...As for the permissive hypotension, it is gaining a lot of traction in the Pre-hospital setting...

And I am glad to see it...

Having been a paramedic for 14 years prior to going to the SFQC I have seen far too many paramedics/EMT-Is, who could/can only treat patients according to an algorithm with no thought to or idea about what is actually going on at the cellular level in a patient, bring trauma patients in leaking raspberry cool-aid, with their standard (2) 14-16 ga caths running NS or LR WAO (Wide Assed Open.) This is unsat for a myriad of reasons too lengthy to discuss here. Suffice to say hem-control must be gained, in those with compressible bleeds, before fluid resuscitation should be a consideration. It is also good to see civilian EMS/Emer Med picking up on our lessons learned.

I am a big supporter of PHPTN and utilize it to the fullest but I know it has a point of diminishing return(s) and prepare accordingly, as I know you do.

Crip
 

pardus

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It is not for times when the evac times are short -within reason; it is for times like the beginning of the Afghan invasion where the closest MH-47 was a 4 hour flight to the casualty. It came to be after several guys died who could have possibly benefited from receiving whole blood in the field. I say possibly because the guys died before getting to a MTF of non-compressible hemorrhage and it isn't known whether they would have lived or not had they received the transfusion. Shortly therafter a forward thinking Group Surgeon proposed the idea and it was widely adopted.

Furthermore, while permissive hypotension (PHPTN) is a good thing when there isnt a better option a patient can only be sustained in the field this way for a very finite amount of time. This time varies from patient to patient in the field and is based on a wide number of conditions from hydration level prior to insult to the ability of the medic to maintain the patients core temp greater than 96 degrees.

As for typing, I know all of my guys types - even the attachments to my team; it is stamped on their dogtags and is printed by me on their FCC's. That is the least of my concerns... Is it something I want to do, no. It is a procedure I am prepared to do though

Agreed 100%

(who the fuck am I to disagree anyway? lol)
 

x SF med

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Crip-
Do you do pre-mission titering for reactive proteins for the entire team so you know who can't take the same type blood? It's not a perfect system, but it could keep guys alive when you have to go the direct transusion route without the ability to spin down and filter the blood to plasma, packed cells and garbage.
 

surgicalcric

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Crip-
Do you do pre-mission titering for reactive proteins for the entire team so you know who can't take the same type blood? It's not a perfect system, but it could keep guys alive when you have to go the direct transusion route without the ability to spin down and filter the blood to plasma, packed cells and garbage.

P:

I have had them done in the past but don't do them prior to every rotation. I had the idea sold to our Group Surgeon at one time -because someone has to pay for the titers right...- but there has been a change in the Med Section and our current Group SGN isn't the person we need in that position. I have recently been pushing buttons again and am hoping to make some head way on the topic -as well as a few others which I believe are important in planning for sustained operations where med support comes from my aidbag and not a CSH or FST down the road by air...

That is another topic for another time though...
 

policemedic

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We lost hetastartch. Too many retard CLS guys giving it to people who were dehydrated... yeah....
Loosing LRS as well, it's all saline now for us.

Yet more proof of why the CLS program overreaches it's capability to train people to competency. I routinely removed Hextend from the CLS bags because none of my CLS trained soldiers understood how it worked.
 

policemedic

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You guys are missing the point entirely.

It is not for times when the evac times are short -within reason; it is for times like the beginning of the Afghan invasion where the closest MH-47 was a 4 hour flight to the casualty. It came to be after several guys died who could have possibly benefited from receiving whole blood in the field. I say possibly because the guys died before getting to a MTF of non-compressible hemorrhage and it isn't known whether they would have lived or not had they received the transfusion. Shortly therafter a forward thinking Group Surgeon proposed the idea and it was widely adopted.

Furthermore, while permissive hypotension (PHPTN) is a good thing when there isnt a better option a patient can only be sustained in the field this way for a very finite amount of time. This time varies from patient to patient in the field and is based on a wide number of conditions from hydration level prior to insult to the ability of the medic to maintain the patients core temp greater than 96 degrees.

As for typing, I know all of my guys types - even the attachments to my team; it is stamped on their dogtags and is printed by me on their FCC's. That is the least of my concerns... Is it something I want to do, no. It is a procedure I am prepared to do though



So can dying from hypovolemic shock.

These are all good points, and I don't disagree. I just think we need to push for the approval of treatment options like lyophilized plasma, such as French SOF have available (and which some injured US troops have received).
 
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