Podcast Episode 36: ROLO to SOLO: The Logistics of Fresh Whole Blood Transfusion
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.
This is the program discussed in this quick episode.
Eric was a Special Operations Battalion Surgeon who listened to his medics and what they needed to make the decision to empower them to save lives.
He then read the emerging and existing research realizes the importance of limiting the dose of shock and oxygen debt as early as possible.
He engaged his chain of command in order to educate them on the dire need for them to adopt this existing program.
He did the legwork of ensuring his type-Os were titered ahead of deployment through the Armed Services Blood Program who brought the donation bus to the unit area.
He ensured all of his medics were educated through NTM (Non-Trauma Module) classroom sessions.
He ensured that they were further trained during the course of scenario training before deploying.
Now on to the podcast:
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Practice will highlight limitations. Just reading about FWB transfusion and the CPG is not equal to physically doing it.
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