1. You need authorization. Before starting down the road of doing a field blood transfusion you have to have authorization from your medical director and higher command. This battle can be tricky, especially on the conventional side, or places where the good news hasn't spread yet (Whole Blood is the resuscitative fluid of choice, and recommended by the overall authority on the matter; the Committee on Tactical Combat Casualty Care). There's a bunch of retards out there... which brings us to our next point:
2. Proper training. Anytime you are working with putting blood from one person to another it is a high-risk endeavor. The reason it is allowed in a field situation within our line of work is a very simple Risk vs. Reward equation. What is the worst thing that can happen if I don’t give the patient blood? He dies. The same answer goes for the question, what is the worst thing that can happen if I do give him blood?
When giving blood, if it is done improperly, or done without knowing 100% without a doubt the blood types of both donor and recipient, you stand a chance of having a life-threatening event. Proper training teaches you the steps leading up to, actions on, and corrective actions in case of a transfusion reaction. You have to have a thorough knowledge of the s/s of hemolytic reactions, anaphylactic reactions, and so on and so forth, as well as the drugs used to counteract these potential complications as they happen.
**Remember to use your resources. A great one is the Whole Blood Toolkit, by Next Generation Combat Medic.
3. You’ll need appropriate supplies. At the minimum, you’ll need:
- Donor bags
- Filtered tubing
- Large bore catheters (16 preferred)
- Saline locks
- Fluid warmers
- Hemolytic/Anaphylaxis drugs
4. Titer testing. The Army and the Air Force have the ability to run specific titer testing for your O type blood. The Navy and Marine Corps team does not have the ability to pull blood tubes and send them in for testing. We have found a workaround through a mutually beneficial relationship with the local Armed Services Blood Program (ASBP). For those that do not know the ASBP, they are an organization that is organic to MTFs that holds blood drives around military bases and other government installations, and provide blood to all MTFs and deploying Units. We have worked a relationship here that works like this: We give them full units of blood to increase their stock, they turn around and test the blood for their titer level, blood type, and all pertinent blood born pathogens. After testing the OIC of the ASBP provides us with a list of all results including titer level for all units collected. We turn around and use that list as our primary donor list in the case we need to activate our walking blood bank. LTOWB (Low-titer group O) is the preferred universal donor, due to its low probability of hemolytic and anaphylactic reaction.
5. IMPORTANT: titers must be verified no more than 90 days prior to deployment. While deployed titer results are considered valid for 1 year.
6. If you have run through all of your pre-identified donors (Low-titer group O) it is possible to go type to type specific (A to A, B to B). If you haven’t done a full type-drive prior to deployment, you will need to use Eldon cards to type both donor and recipient prior to beginning transfusion.
Nobody should be doing this without authorization. Blood transfusions are a great tool for keeping a patient alive that otherwise wouldn’t survive, they are also potentially dangerous.
There are no cutting corners, if you have a program in place, or are in the process of building one, you have to be thorough and follow the protocols, to a “T.”
Our titer drives (that’s what we call when we send all of our O type guys in to give a unit and have their blood tested) might not work at alternate facilities, it will be up to you the medic/corpsman to create and nurture that relationship.
If you are unsure of something and don’t have the ability to ask or find out DO NOT DO IT!