To ensure that U.S. Soldiers and coalition forces have the best chance of survival during traumatic event where blood loss is a concern, the lab team of Joint Task Force Med 374 (JTF MED 374) stands ready and remains diligent in ensuring they have adequate supplies of blood products on hand, as well as a contingent plan to acquire additional blood if needed using a stand-up walking blood bank.
Fresh whole blood is a vital component in increasing the survivability of trauma patients in the combat environment. A U.S. military report estimates that 15 percent to 20 percent of traumatic deaths are preventable, and 66 percent to 80 percent of these deaths occur from hemorrhage. In another study conducted by The Journal of Trauma and Acute Care Surgery, fresh whole blood was independently proven to increase the 24-hour and 30-day survival rate in such patients. The Role III hospital in Iraq is currently staffed by Soldiers from the 801st Field Hospital out of Fort Sheridan, Illinois.
"Not only are we charged with running the lab in the Role III hospital, but we are also in charge of blood supply for the Combined Joint Task Force which consists of 35 separate down trace units throughout eastern Syria, northeastern Jordan and all of Iraq," said Staff Sgt. Emily French, lab noncommissioned officer in charge (NCOIC).
French co-leads the Operation Inherent Resolve (OIR) lab mission with Maj. Rodrick Clayton, lab officer in charge (OIC). Additionally, Clayton directly manages the Area Joint Blood Program Office (AJ-BPO), an essential blood program that coordinates all blood products in-theater.
While Clayton and French are co-located at the Role III hospital with the 801st Field Hospital, they are strategically aligned under Central Command (CENTCOM) and supply blood products to the multiple Department of State locations and the immediate surrounding Department of Defense units. They also provide OIR with emergency whole blood resupply if a down trace unit's blood supply is depleted.
Looking back on how the role of the blood supply has changed over the years with the drawdown of forces Clayton shared that the task force is a primary supplier of blood products for CJTF-OIR with a blood supply similar to a detachment.
To ensure blood supplies meet the demands of the OIR mission, the lab team is tasked with operating and maintaining a walking blood bank--a program that collects blood from Soldiers working in their area of operations. The lab maintains an accurate personnel roster of blood types and Rh factors. A walking blood bank can occur anytime the current supply of blood products is depleted, such as during a mass casualty event or during a life-saving surgery where large amounts of blood are needed to counteract hemorrhagic shock. The program is a last resort effort of funneling fresh blood to where it is required in order to sustain life.
To maintain a current emergency whole blood donor list in the immediate area, periodic blood pre-screenings are conducted every 90 days. These pre-screenings compensate for the number of units deploying into theater and those re-deploying from theater. Once the new units have their blood samples drawn, the samples are put through a rigorous testing regime to determine blood type, Rh factor, and ensure the samples are disease free. The four major blood types are type A, type B, type A.B., and type O. Each blood type also has a corresponding Rh factor expressed as either positive or negative. Blood testing of the samples is completed and specifications of the Food and Drug Administration (FDA), ensuring that all units used are safe to use by U.S. Soldiers and Coalition Forces. This blood testing procedure is being replicated in all JTF MED 374 units in CENTCOM's area of responsibility under OIR.
"Low titer O blood donors are sought after because their blood is less likely to cause a hemolytic transfusing reaction from patients that are in need of emergency blood," said Spc. Patricio Clavel, 68K, CJTF Lab technician. Clavel is tasked with overseeing the collection and testing of blood samples between coalition forces and Department of State personnel the Role III serves.
"If a patient receives blood from another blood type that is not compatible, it can cause more harm. Low titer O whole blood is important because it is compatible and universally accepted blood type. In addition, having low titer O whole blood on hand during emergencies drastically reduces the time from the doctor's request for blood to the time it is administered as compared to giving traditional component therapy. During times of hemorrhagic shock, time is of the essence, and every second counts," he said.
So far, the Role III lab staff has successfully resupplied outlying units with emergency blood 12 times since the unit entered theater. This is one of the Task Force's primary functions, ensuring the units that report directly to the Role III have viable supplies of blood, especially whole blood. Meeting this capability ensures that the teams that fall under JTF MED 374 can provide life-saving blood products to coalition forces in a timely manner while also meeting the other subtasks of the mission of OIR of advising, assisting, and enabling the Iraqi military and the stabilization of Iraq. To complete these objectives requires developing and maintaining relationships with many units in more isolated locations and support from other support units such as Dust Off (helicopter medical evacuation unit) and other transportation units.
Communication between the lab staff within the Role III, and the direct reporting units is critical in maintaining the visibility of the theater blood supply. To support the 72 nations that comprise the CJTF-OIR, the Role III lab team stocks over 50 units of whole blood at any given time. Since blood products have a limited shelf life, they are constantly replenished to meet the ever-increasing needs of the Coalition Force and partners.
The lab team has also extended its knowledge and experience in collecting and storing life-saving blood products by hosting a blood screening event with approximately 100 Iraqi special forces soldiers.
“A majority of the soldiers we worked with had never had their blood drawn or have been properly blood typed,” said Sgt. Samantha Smith, JTF MED 374 Lab NCO. “Many of them showed up with these generic medical cards that all had the same blood typing on them. Spc. Clavel and I were tasked with properly typing each of the specimens which is important, or a transfusion can be lethal. Blood typing enables them to provide the same level of life-saving fresh whole blood to their forces that we provide for our troops.”\
Smith said she valued working with the Iraqi forces and the positive impact her team was making with the host nation. She also shared her appreciation for what she had learned from her lab training and the prevalence of certain blood types in different regions, which she observed in testing.