The Use of Whole Blood, Blood Plasma and Plasma Expanders by the Armed Forces

Abstract

The word "shock" and its clinical implications are well known to the modern surgeon and internist. Medical shock as the result of overwhelming toxemia and bacteremia was frequently seen as a terminal event in severe infections, before the advent of antibiotics. Surgical shock at the operating table and during the immediate post operative period has always been a serious potential complication of major surgery, but is becoming less frequent as the result of adequate blood replacement during surgery, better surgical techniques, and improved anesthesia. Wound shock and hemorrhagic shock as the result of traffic and industrial accidents, however, are commonly seen in any large hospital emergency service and will always present a serious problem to the young interne and resident on duty. The emergency room, however, has proved to be an invaluable training ground for the physician who is to be called to duty with the Armed Services, for it is in the emergency room that he first becomes familiar with the management of the various kinds of trauma to which modern man is exposed : knifings, gunshot wounds, severe fractures, crushing injuries, burns, elc.When the young medical officer arrives at the battlefield, he will find his experiences in the emergency room magnified many times, and yet his facilities for treating these cases reduced to a minimum. He will find that he must direct his efforts to the relief of suffering and the dressing of wounds, and to assure that the victim of battle will be in sufficiently good physical condition to make the trip back to a surgical hospital safely. One of his most serious problems will be the prevention and treatment of shock, under adverse conditions of weather, inadequate shelter, noise, and with rudimentary supplies. He will have to rely upon his clinical judgment in the diagnosis of shock, and upon his past experience for its treatment.Great strides have been made since World War I in the treatment of shock in battle casualties. It was not until the latter part of that war that 0. H.Robertson' demonstrated the effectiveness of blood transfusion in combating shock. By 1940, the use of small quantities of type specific whole blood for transfusion was a safe and routine procedure in most hospitals. With the onset of the second World War, the British, in anticipation of air raids, established an elaborate system of blood collection centers, blood, plasma, and serum banks throughout Great Britain. These efforts were justified, afid their ability to provide whole blood, liquid plasma, and serum to casualty collection stations and hospitals on short notice saved the lives of many an air raid victim.The campaigns of the British and American armies in Africa in 1942 and 1943 clearly established the imperative need for whole blood for the replacemept of Lieutenant Colonel M C., U. S. Army t Colonel, M.c., u. S. Amy, F.A.C.S. 529

Remote damage control resuscitation and the Solstrand Conference: defining the need, the language, and a way forward

“…The severely injured patient with UMH is likely to experience massive blood loss normally incompatible with survival beyond a brief period, an absent hemostatic intervention, or an as‐yet undefined strategy to stave off coagulopathy and hemorrhagic shock while en route to the operating table . If the patient or casualty is to survive in such a situation, an out‐of‐hospital resuscitation strategy including blood component transfusion becomes a practical necessity . In theory, modern blood banks working in concert with sophisticated clinical laboratories can provide carefully calibrated component‐based therapeutic bundles for transfusion, based upon laboratory investigations of a patient's physiologic status and immunophenotypic profile .…”

“…Nevertheless, these hard lessons were rapidly re‐assimilated, and assurance of the availability of whole blood, as well as plasma, at the Anzio beachhead in January 1944 was a major factor in Allied operational planning . From that point until the end of the Vietnam era, whole blood and plasma were the main pillars of trauma resuscitation in the US military, although freeze‐dried plasma was abandoned during the Korean conflict due to the high rates of transmission of viral hepatitis …”