CCOP-01：在从受伤点撤离的战术中使用血液制品进行紧急抢救（英文）

VAMPIRE PROGRAM CCOP-01:URGENT RESUSCITATION USING BLOOD PRODUCTS DURING TACTICAL EVACUATION FROM POINT OF INJURY

![](/media/202412//1733383379.8728395.jpeg)**URGENT RESUSCITATION USING BLOOD PRODUCTS**

**DURING TACTICAL EVACUATION FROM POINT OF INJURY**

Original Release/Approval:10 February 2016

Note:CCOP-01 requires an annual review

Reviewed:28 September 2016

Supersedes:April 2012/June 2012

Version:CCOP-01:Version 1.6 with Appendices A-G

Minor Changes(or)

New Document That Requires Thorough Reading

Significant Changes

OPR:CCSG

**1.PURPOSE**

To provide essential instructions on urgent/life-saving resuscitation procedures using blood products during tactical evacuation (refers to both casualty evacuation and medical evacuation)from the point of injury (POI)for casualties suffering major blood loss/massive hemorrhage.Referred to as,

Vampire Program.All USCENTCOM clinical operating protocols (CCOPs)are posted to the CCSG SharePoint site at <https://intelshare.intelink.gov/sites/ccsg/SitePages/CCSG-CLINOPS.aspx> .

**2.APPLICABILITY**

This CCOP applies to all USCENTCOM Service Components,Combined and other Joint Task

Forces(CJTFs),and all U.S.military forces operating under Title 10 within the geographic area of responsibility(AOR)assigned or allocated to Commander,USCENTCOM by approved Global

Force Management(GFM)processes(e.g.,Command Plan)and Department of Defense (DoD)

civilian medical employees deploying with U.S.Forces (hereafter referred to as “DoD personnel”) consistent with DoD and Service specific guidance.

a.Medical and non-medical personnel (e.g.,flight medic,crew chief,registered nurse,enlisted medical personnel,physician,nurse practitioner,or physician assistant),assigned/attached or

allocated to perform tactical evacuation(CASEVAC and MEDEVAC)duties that involve direct or indirect patient care.

b.All operational units participating in the USCENTCOM Vampire Program will comply with quality assurance and patient safety reporting requirements IAW USCENTCOM Regulation (CCR) 40-1.

**3.REFERENCES**

a.Armed Services Blood Program(ASBP),“Joint Blood Program Handbook,”HQs Departments of the Army,Navy and the Air Force,(Army Technical Manual 8-227-12,NAVMED P-6530,AFH 44-152-IP),1 December 2011.

b.CCR 40-1,“Quality Management (QM)Programs in Healthcare Operations,”5 Feb 2016.

c.CCR 40-4,“Clinical Operations (CLINOPS)Program,”(Draft)30 Jan 2016.

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**4.RESPONSIBILITIES**

a.USCENTCOM Command Surgeon(CCSG)establishes and maintains the USCENTCOM Joint Blood Program consistent with DoD directives,instructions,and policies.

b.USCENTCOM Joint Blood Program Officer(JBPO)is the single manager for the CCSG on all blood products used within theater at treatment facilities and for patient evacuation.JBPO approves the implementation of this CCOP within US CENTCOM's Theater and maintains copies of signed review and approval forms (refer to Appendix A).

c.USCENTCOM Service Component and/or CJTF Command Surgeons have oversight on operational units performing pre-hospital blood/blood product transfusions.

d.Unit Flight Surgeon(FSO)/Senior Medical Officer(SMO)confirms by completing the review and approval form(refer to Appendix A)that individual and unit training has been fulfilled;and

mandatory equipment and supplies are in place to implement transfusion procedures.A copy of this form will be sent to the JBPO for final approval.

**5.FIELD INDICATIONS FOR TRANSFUSION DURING TACTICAL EVACUATION**

a.The following are indications for transfusion in the presence of **SEVERE** traumatic injury:

(1)Systolic BP<100 or absence of radial pulse;or

(2)Heart rate>100;or

(3)Any above knee amputation or double/triple/quadruple amputation (regardless of vital sign indication)

**WARNING:** The amputation patterns above are the only traumatic injuries that constitute a **STAND-ALONE IMMEDIATE FIELD INDICATOR** for transfusion that requires no

confirmation with vital sign parameters.

CAUTION:Control external bleeding before transfusion.

or simultaneously with

initiation

of blood product

**NOTE** :Amputation is defined as any severe trauma to a limb that involves complete or partial loss of the limb (this includes limbs that are severely mangled but not completely severed).

b.Traumatic Arrest:patient with exsanguination who had signs of life when received from

ground forces and has since become pulseless should receive immediate transfusion**(transfusion is**

***more important than chest compressions in cases of exsanguination and should take priority).***

(1)Traumatic injuries where early blood transfusions are most likely to be needed:

(a)Penetrating thoracic/abdominaljunctional (junctional includes axilla/inguinal/cervical)

injury.

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(b)Pelvic fracture.

(c)Multiple injuries.

(d)Proximal amputations (above knee or elbow).

c.Initiate transfusion with 1 unit of blood product.Give additional units if clinically

indicated.Avoid over-resuscitation with crystalloid which may increase bleeding,particularly from non-compressible torso hemorrhage.

d.Refer to Appendix B for list of clinical indicators for hemorrhagic shock.

**6.PROCEDURE**

a **.Blood Component Therapy Approved for Transfusion during Tactical Evacuation**

(1)Red blood cells (RBCs)increase the recipient's oxygen-carrying capacity by increasing the mass of circulating red cells.Plasma and platelets work together to improve blood clot formation and clot stability.On average a unit of whole blood contains a volume of 500-600 mL and a unit of

RBC's contains a volume of 300-400 mL.In an exsanguinating patient,a unit of blood can be given quickly.Ensure good blood flow through IV or IO access before initiating transfusion.

**CAUTION:** Rapid infusion against resistance **CAN CAUSE** mechanical shearing of RBCs and should be avoided.

(a)Blood products will be administered in the following priority depending on availability and according to Tactical Combat Casualty Care Guidelines:

1.Low titer Group O whole blood (LTGOWB),or,if not available

NOTE:Low Titer Group O Whole Blood has been screened for anti-A and anti-B antibodies;these units contained a low titer of anti-A and anti-B and are therefore considered a universal donor

product that may be given to recipients of any blood type with a minimum risk for a minor ABO

incompatibility(typically minor and most often subclinical clinical consequences).The whole blood supplied to MEDEVAC units will be exclusively drawn in the United States from the ASBP-

approved sites and distributed in theater by the ASBP blood distribution system.The LTGOWB units will be fully tested following FDA current guidelines.

2.Plasma,RBCs,and platelets in a 1:1:1 ratio,or,if not available 3.Plasma and RBCs in 1:1 ratio,or,if not available

4.Reconstituted dried plasma,liquid plasma,or thawed plasma alone or RBC's alone

(b)O POS(either low titer Group O whole blood or Type O RBCs)is the standard for transfusion during evacuation.

![](/media/202412//1733383379.9130168.png)**NOTE:** Patients requiring blood can safely receive uncrossmatched low titer Group O whole blood or Type O RBC's until type-specific products are available.

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(c)If available,use O NEG on females of childbearing potential age <50 years old.Inform receiving facility regarding female given O POS blood for documentation in the

medical record

CAUTION:Whole Blood collected in theater will NOT be supplied for use onboard MEDEVAC aircraft.

**NOTE:** If a minimal amount (just a few milliliters)is given,consider Rhogam therapy.The

immunologic consequences of administration of an entire unit of O POS whole blood or RBC to an O NEG female of child-bearing potential cannot safely be reversed with Rhogam. **Treatment of**

***exsanguination takes precedence over potential future pregnancy outcomes.***

(2)Plasma is recognized as an important component in preventing and treating coagulopathy in trauma.On average a unit contains a volume of 200-250 mL and is transfused rapidly.

(a)Type A or AB thawed plasma is the current standard for transfusion during evacuation.

**CAUTION:** Thawed plasma only has a shelf life of 5 days and may not be available for the pre- hospital mission.Liquid plasma(never frozen)has a shelf life o**f 26 days**.Check with issuing

facility or blood supply unit for availability.

(3)The recommended mission loads for tactical evacuation are based on OPTEMPO and determined by the theater or JTF surgeon.

**NOTE:** Golden Hour Container (GHC)maximum capacity is four (4)units RBC/FFP or 2 units of whole blood.

(c)Specific missions may require additional blood products,units will refer to the JBPO.

**NOTE:** If whole blood or plasma is **UNAVAILABLE,** evacuation personnel will fly with RBCs exclusively

![](/media/202412//1733383379.9403365.png)**WARNING:** Unused blood products(i.e.,Whole Blood and Freeze Dried Plasma)furnished by

forward U.S.or Coalition Forces **WILL NOT** be used by evacuation personnel.***Recommend products be left with forward forces.Blood products (WB and FDP)spiked by forward forces and transfusing at time of pick up will be continued during evacuation.

![](/media/202412//1733383379.95205.png)**NOTE** :Emergency transfusion of pediatric patients relies on clinical assessment rather than specific vital signs,since normal heart rate and blood pressure are age-dependent.Clinical signs of shock are the same as in adults (cool,pale,weak or absent radial pulse,delayed capillary refill,decreased

mental status).Pediatric fluid resuscitation related to trauma begins with 10 mL/kg of first blood product,then repeat as needed based on response.

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**CAUTION:** After removal of the blood product from the storage container,begin transfusion

immediately.The transfusion must be completed within **4 hours** after the start of the transfusion.If the transfusion is delayed,blood products that are removed from storage and exceed the proper

storage temperature range will be returned to issuing facility or delivered to the MTF per local policy for proper disposal.

**b.Receiving Blood Components from an Issuing Facility (U.S.and Coalition)**

(1**)U.S.issuing facility personnel from the Blood Support Detachment (BSD),MTF (Role 2/3)or Laboratory (LAB)will:**

(a)If requested and available,thaw frozen plasma IAW local procedures and label products (A or AB)with 5 day expiration date.

(b)Ensure Golden Hour Container(GHC)is properly charged and removed from freezer 25-30 minutes prior to loading blood products.

(c)Ensure all blood products issued have a Safe-T-VUE (NSN 6515-08-T00-3056) attached and activated for temperature monitoring (Refer to Appendix G).

CAUTION:Ensure thawed plasma is at refrigerated temperature(1-6°C)before placing Safe-T-VUE

on unit.

![](/media/202412//1733383379.969443.png)**NOTE:** Evacuation personnel will follow Appendix G for Safe-T-VUE procedures when required.

(d)Document in Theater Medical Data Store (TMDS)the issuance of blood products to an evacuation team(e.g.,DUSTOFF;Pararescue;Tactical Critical Care Evacuation Team).

(e)Complete appropriate sections of the SF518 Blood or Blood Component Transfusion Record for issuing blood products(Appendix E);place inside GHC pocket or attach form to each unit of blood product issued.

(f)Verify the blood information on the SF518 against the blood product label with receiving evacuation unit personnel.

**(2)Non-U.S.Issuing Facility:**

(a)When U.S.blood products are to be issued from a Coalition facility,send email to the JBPO at centcom.macdill.centcom-hg.mbx.ccsg-joint-blood-program@mail.mil ,to coordinate

issuing requirements and documentation of units received.

(3**)Receiving unit (Evacuation Unit)personnel will:**

(a)Prior to sealing GHC,ensure each blood product loaded into the GHC has an activated Safe-T-VUE attached (Appendix G)and an SF518 Form.

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(b)Accept blood products into receiving unit's TMDS inventory.

**NOTE:** If receiving unit is unable to access TMDS,the issuing facility will access account and receive the products under the receiving unit's TMDS inventory.

(c)Unit FSO/SMO will track and monitor unit's compliance with issuing and receiving requirements.

**c.Storage,Transportation and Monitoring of Blood Products**

(1)All blood and blood components must be maintained in a controlled environment and stored under appropriate conditions.

(2)Blood products carried outside a BSD/MTF/Lab will only be transported in an approved storage container(e.g.,Golden Hour Container NSN 6530-01-505-5301;OCP/5306;Desert)for a maximum of 48 hours.

**CAUTION:** Units will monitor containers and document status (e.g.,dry/no leaking noted)at a minimum of every **24 hours.**

(3)Once loaded and sealed,container will remain closed and intact at all times until blood product is required for patient care.

**NOTE** :Notify the issuing facility (BSD/MTF/Lab)as soon as possible when blood products have been used

![](/media/202412//1733383379.989005.png)**WARNING:** At no time will container or its contents (blood products)be placed in a refrigerator or other cooling device outside a blood bank.

(4)GHC is only approved for **48 hours** use;prior to expiration end users will contact issuing

facility (BSD/MTF/LAB)to coordinate the return and exchange of a container and blood products per mission requirements.

**WARNING:** If issuing facility lacks capacity to condition containers,the unit FSO/SMO can

apply for an Exception to Policy (ETP)from JBPO to recondition their own containers.Refer to

***CCOP-01A*** *Reconditioning Blood Product Storage Containers for Tactical Evacuation for policy*

and procedures,which can be found on the CCSG SharePoint site at

<https://intelshare.intelink.gov/sites/ccsg/SitePages/CCSG-CLINOPS.aspx> .

***The ETP **WILL NOT** authorize units to hold blood products beyond 48 hours.Units approved to recondition containers will continue to return and exchange blood products with their issuing

facility.

(5)Unit FSO/SMO will track and monitor compliance of GHC storage and transport performed by unit personnel.

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**WARNING:** Blood products will not be used if container is leaking;or the temperature indicator (Safe-T-VUE)on the blood product is out of standard (refer to Appendix G).***Notify the

issuing facility and return container and products for replacement.

**d.Individual and Unit Training Requirements**

(1)At a minimum,medical personnel who participate in the administration of blood products during evacuation will be trained in the following topics:

(a)Indications for transfusion(Appendix B);transfusion procedures (Appendix C);

documentation(Appendices E&F);PEARLS for transfusion(Appendix D)and when required, submission of a patient safety report (PSR)

(2)At a minimum,non-medical personnel who assist will be trained in the following:

(a)Transfusion procedures;equipment/supplies;and documentation requirements for the

SF518.

(3)Units who implement this CCOP will train appropriate personnel on the following:

(a)Emergency procedures for in-flight complications.

(b)Storage container/blood product exchange requirements.

**e.Essential Items Required for Implementing a Vampire Program**

(1)Approved blood component transport container.

(a)Recommend between 4 and 6 each GHCs for a Vampire Program (NSN 6530-01-505- 5301 (OCP)/5306(Desert)).

(b)Hemacool (NSN 4110-01-506-0895)or other freezer with temp check to ensure a temperature≤to (-)18°C to support reconditioning of GHC.

(2)Safe-T-VUE (NSN 6515-08-T00-3056)for temperature monitoring (Refer to Appendix F).

(3)Theater Medical Data Store (TMDS)accounts for an issuing facility (BSD/MTF (Role2/3) and LAB);and receiving unit (evacuation unit):

(a)Personnel will notify the JBPO at centcom.macdill.centcom-hq.mbx.ccsg-joint-blood program@mail.mil ,for account requests.

(b)When directed by the JBPO,requesting personnel will go to the TMDS website at:

https://tmds.tmip.osd.mi/portal/sec/portal/default ;select ACCEPT and on next page select "NEEDS ACCESS”and complete the registration form and select "REGISTER USER ACCOUNT".

**f.Warming Devices for Blood Transfusion**

(1)Use of infusion warming devices is **HIGHLY** recommended.These will be FDA approved

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for the actual use in transfusion of blood products (examples of devices include:Belmont@Buddy- liteTM,EnFlow or Thermal Angel).

WARNING:Warming devices will have safety mechanisms built in that prevents the output

temperature from exceeding 42°C.Unit personnel will be familiar with safety mechanisms for the device used.

NOTE:Warming devices must have an airworthiness release (AWR)or other appropriate certification for use within rotary and/or fixed wing.Contact robert.e.eshelman.civ@mail.mil U.S.Army Aeromedical Research Laboratory (USAARL)for copies and updates of AWRs.

at the

**NOTE:** Units will ensure regular medical maintenance is performed on warming devices IAW CENTCOM Medical Logistics policy/procedures.

**g.Tranexamic Acid (TXA)**

(1)Patients receiving blood transfusion within three hours of injury should also receive TXA. Refer to the Tactical Combat Casualty Care(TCCC)guidelines for administration of TXA.

**i.Record Keeping and Documentation Requirements**

(1)Transfusions will be documented into TMDS by evacuation personnel.

**NOTE:** Issuing facility personnel may also enter transfusions into TMDS if evacuation unit lacks TMDS access.

(2)Personnel will refer to the Theater Blood Application Training Guide for directions or Inventory Management and for Transfused Products.

(3)Complete SF518 documentation and turn over at the destination MTF for placement in the patient's medical record.

6.The proponent for CCOP-01 is the USCENTCOM Command Surgeon.

![](/media/202412//1733383380.0260599.png)

DARIN K.VIA

CAPT,MC,USN

Command Surgeon

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Appe**ndix A-REVIEW AND APPROVAL FOR UNIT**:

1.Blood product administration is always physician directed.This CCOP is considered a

USCENTCOM clinical operating protocol that is approved and implemented under the direction of the unit's FSO/SMO by qualified personnel once signed below by the unit FSO/SMO,Senior Training NCO,Unit Commander,and by the USCENTCOM JBPO.

2.It is the responsibility of the FSO/SMO,Senior Training NCO,and Unit Commander to ensure all personnel implementing CCOP-01 remain current for the length of the units deployment in all required skills to safely implement urgent blood resuscitation during tactical evacuation within

USCENTCOMs Theater.

a.FSO/SMO Signature of Approval

(1)Name/Rank Date

(2)Unit Email

b.Senior Training NCO Signature of Approval

(1)Name/Rank Date

(2)Email

c.Unit Commander Signature of Approval

(1)Name/Rank Date

(2)Email

d.FSO/SMO will forward a signed copy to the JBPO office at centcom.macdill.centcom:

hg.mbx.ccsg-joint-blood-program@mail.mil

3.JBPO has reviewed and approved implementation of CCOP-01 for:

(Insert Unit Name)

a.JBPO Signature of Approval

(1)Name/Rank Date

b.JBPO will forward a signed copy to the requesting unit FSO/SMO.

c.JBPO will maintain a copy of approval record for length of the unit's deployment.

4.Once signed by JBPO,this protocol will be in effect the length of deployment but not to exceed 12 months.For deployments scheduled beyond 12 months,protocol will be reviewed prior to the end of 12 months and resigned by the FSO/SMO,Senior Training NCO,Unit

Commander and the JBPO.

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**PRE-TRANSFUSION GUIDELINES**

**TACTICAL COMBAT CASUALTY CARE**

**PATIENT STABILIZATION REQUIREMENTS**

![](/media/202412//1733383380.0483704.jpeg)**HEMORRHAGE**

AIRWAY

**RESPIRATIONS**

CIRCULATION

**HYPOTHERMIA**

**MONITOR**

Bleeding is CONTROLLED by use of pressure

dressing,tourniquet or fibrin bandage

Secured and patent (Follow TCCC Guidelines)

Assess,apply oxygen,diagnose/decompress tension pneumothorax

IV/1O access obtained;place at least 2 large bore IV(18G minimum;14G preferred).If unable to establish IV in 90 seconds -place an lO.

Apply Blanket;Consider Fluid Warmer

Place casualty on cardiac monitor IF possible (minimum HR,B/P and SpO2)

![](/media/202412//1733383380.0620644.jpeg)**CLINICAL INDICATIONS OF HEMORRHAGIC SHOCK**

Clinical Evidence Hemorrhagic Shock is Present

H

**HYPOTENSION**

Systolic Blood Pressure<100mmHg

T

**TACHYCARDIA**

>100 BPM;Unresponsive to a 250-500cc fluid bolus (NS/LR

R

**RESPIRATIONS**

Rapid/Shallow

P

**PULSE** **(POOR** **CHARACTER**

Weak and Thready (ineffective

M

**MENTAL** **STATUS**

Decreased (excluding head injury

S

**SKIN** **COLOR**

Pale/Cyanotic

C

**CONTINUED** **BLEEDING**

From Non-Compressible Wound

**TRANSFUSION** **PROCEDURES**

**MAINTAIN** **UNIVERSAL** **PRECAUTIONS(Gloves** **&Eye** **Protection)**

**STEP** **1:ESSENTIAL** **BLOOD** **ADMINISTRATION** **ITEMS**

1. “Y”Type Filtered Blood Administration Set (**UNDER** **NO** circumstances should non-filtered tubing be used

2. Blood Product to Transfuse**(Universal** **Donor** **is** **approved** **for** **Pre-Hospital** 3.0.9%N**S(Dedicated** **Line** **Only** **for** **Blood** **Products**)

4. Blood Pressure Cuff/Monitor

5. Blood Warmer Device

6.Pressure bag (if available)

**STEP** **2:PRE-TRANSFUSION** **TASK**

**Two** **Person** **Verification** **Process**

Verify Blood Label and completed SF 518 for the 5 items listed here or transcribe items from Blood Label onto blank SF518

(1)Unit#;(2)Type of Product;(3)Donor ABO/Rh **(Must** **be** **O** **for** **RBCs;and** **A** **or** **AB** **for** **Plasma)**;(4)Expiration Date;and (5)Temperature Indicator (RED =NOT ACCEPTABLE

1. CLOSE all 3 clamps on Y tubing

2. NOTE:When using blood/fluid warming device,attach line to fluid warmer cartridge and fluid warmer extension line a. Ensure warming device is functioning IAW manufacturers guidelines

3. Insert 1st spike into NS bag and hang;**OPEN** clamp and prime only the"Y"section;**CLOSE** clamp

4.Insert 2nd spike into blood product and hang;**OPEN** clamp and run the length of the tubing

5.Attach line to IV or IO site ****Ensure** **good** **flow** **through** **IV/IO** **before** **initiating** **transfusion*** 6. Ensure all clamps are **CLOSED**

7.Note/document pre-transfusion vitals-at a minimum BP and HR

**8.Medical** **person** **will** **visually** **inspect** **blood** **product** **if** **possible** **for** **gas,discoloration,clots,foreign** **objects,or** **sedim**ent; **and** **ensure** **no** **cracking** **of** **the** **plastic** **bag** **that** **has** **led** **to** **leaking**

a. Visually inspect the Temperature Indicator (RED =NOT ACCEPTABLE)

9. Non-Medical person can assist with documentation on the SF518 for Pre and Post transfusion informatior

**STEP** **3:TRANSFUSION** **TASK**

1. OPEN main line clamp for blood product to begin infusion

**a.** **ENSURE** **CLAMP** **to** **NS** **REMAINS** **CLOSE**D

**b.UNDER** **NO** **CIRCUMSTANCES** will other medications or IV fluid (including 3%NS)be introduced through transfusion line -this will cause hemolysis/clotting of blood products

**2.Blood** **products** **must** **be** **transfused** **within** **4** **hours** **of** **removal** **from** **a** **storage** **cont**ainer-if not,the product(s)will be returned to issuing facility or delivered with patient to MTF to be discarded

3. If using pressure infuser set pressure to 300 mmHg

4. Monitor vitals IAW TCCC guidelines

5.When blood product has been infused,**CLAMP** blood product line and **OPEN** NS line to deliver residual blood product 6. If 2nd Unit required -**CLOSE** NS clamp

7.Spike 2nd Unit-**OPEN** blood product and main line clamps to begin 2nd infusion

8. Monitor closely and continue VS assessment

9. VSgoal:SBP>100mmHg;and/or Pulse<100;MAP 70-80 mmHg

**STEP** **4:DOCUMENTATION** **TASK**

**1.** **Pre-Transfusion** **Data**

a. Unit Number

b. Type of Blood Product (RBC/Plasma c.Donor ABO/Rh

d. Expiration Date

e.Vital Signs (HR and B/P)

**1.Post** **Transfusion** **Data**

a.Vital Signs

b.Date/Time started/completed

c. Note if interrupted and reason for interruption

d.Patient Identification (as much as possible)

**PEARLS** **FOR** **TRANSFUSIONS**

**PRE-TRANSFUSION** **PEARLS**

1.Use of 2%Lidocaine(2-3ml)with 0.9%NS is permitted to flush any IO site prior to blood product transfusion

2.Consider pain control measures to reduce tachycardia resulting from uncontrolled pain

3.Once removed from storage container blood products will be transfused in under 4 hours

4. ONLY USE"Y"filtered blood administration sets

5.If directly involved in patient care,1st Verifier (Medical Person)can direct a non-medical person to be the 2nd Verifier and record data on the SF518

6. **DO** **NOT** use blood product if storage container is leaking or temperature indicator is **RED**

7.**If using enFLow fluid warmer-add IV extension tubing

8.DO NOT allow blood warmer to be placed directly on patients skin as this may cause burning 9. If Thawed plasma is available it should be given prior to RBC;normal ratio is 1:1

**DURING** **TRANSFUSION** **PEARLS**

1.Transfusion infusion rates can be titrated to slower rates if VS parameters move to appropriate levels (SBP>100 HR<100;MAP 70-80)

2.Special attention should be paid to non-compressible injuries (chest;abdominal;and pelvis)so as to NOT raise the SBP over 90mmHg

3.Once transfusion is initiated,decrease all other fluids to KVO rate

4. **In-flight** **emergencies**

a. Contact unit FS or tactical operation center for medical direction;or

b**.Divert** **to** **nearest** **MTF(Do** **not** **delay** **divert** **waiting** **on** **medical** **direction)**

5.If transfusion is interrupted,record date/time and reason for interruption on SF518 if not able to resume within 5

min

6. Under **NO** **CIRCUMSTANCES** will other medications or IV fluids (to include 3%NS)be introduced through

transfusion line

7.Blood output temperature from a warmer device **WILL** **NOT** **EXCEED** 42℃(107°F

**EMERGENCY** **ACTION** **PEARLS**

1. Suspected /confirmed

TRANSFUSION

**2.Disconnect** **tubing** **from** **with** **NS**

transfusion reaction:STOP

**infusion** **site;flush** **IV** **site**

3.Keep IV Line OPEN with NS

4.Re-initiate transfusion only if it is deemed clinically

essential

5.Document on SF518 date/time and actions taken

**POST** **TRANSFUSION** **PEARLS**

1.After 1st transfusion,re-evaluate casualty and initiate 2ndunit ONLY if criteria is still met (Appendix A)

2.If 1st unit is initiated based on "Stand-Alone"injury (Double/Triple/Quadruple Amputation);subsequent units wil be based on VS parameters

3. Complete documentation on SF518

4.Consider Tranexamic Acid (TXA)-follow TCCC Guidelines for Administration

**PATIENT** **HAND-OFF** **(COMMUNICATION)**

1.Provide receiving MTF with completed SF518s for patients record

2.Report any adverse events;transfusion reactions;and actions taken en route

3.Report interrupted transfusions and provide explanation

4.Report O POS blood given to female patients between the age of 10-50

![](/media/202412//1733383380.0974638.png)![](/media/202412//1733383380.1110692.png)![](/media/202412//1733383380.1231115.jpeg)![](/media/202412//1733383380.1336782.png)![](/media/202412//1733383380.1425707.png)![](/media/202412//1733383380.1530924.png)![](/media/202412//1733383380.1620514.png)![](/media/202412//1733383380.171529.png)![](/media/202412//1733383380.183667.png)![](/media/202412//1733383380.194161.png)518-123 **ISSUING FACILITY(BSD/MTF/LAB)**

NSN 7540-00-8344158

SEX

2 .Notty Physician and Transfusion Servioe.

informason identfying the container with the intended reapient matches item by item.

|3.Follow Transhusion Reaction Prooedures.

The reepient is the same person named on this Blood Companent Transtusion Fom

2na VERIFIERSgatu

BLOOD OR BLOOD COMPONENT TRANSFUSION

**MEDICAL RECORD**

SECTIONI·REQUISITION

COMPONENT REQUESTED (Check ane)

RED BLOOD CELLS

FRESH FROZEN PLASMA

PLATELETS (Pool af une

CRYOPRECIPITATE (Poo/of unt)

Rh IMMUNE GLOBULIN

OTHER (Specf)

VPE OF RECUEST (Check ONLY if Red Blood Cal

Rddycts are requeated)

TME AND SCREEN

***

]CROSGATCH

REQUESTING PHYSICIAN (Print)

DIAGNOSIS OR OPERATIVE PROCEDURE

DATE REGUESTED

I have ollected a biood specimen on the below named pafent verifed the name and ID No.df the pabent and verihed the specimen tube label to be correct

DATE AND HOURqUE

VOLUME REOUESTED (If appficabie

ML

KNONN ANTRY GRMATIONRANSFUSION

REACTION (Spec

SIGNATURE OF VERIFIER

PENARKS

IF PATIENTIS FEMALE,IS THERE HISTOACF

RhIG REATMENT7 DATE GIVEN

HEGOLYTIC DISEASE OF NEWBORN?

DATE VERIFIEO

TIME VERIFIED

**SECTIONII-PRE-TRANSFUSION** **TESTING**

UNIT NO

TRANSFUSION NO

PATIENT NC

l TEBPRETATION

PREVIOUS RECORD CHECK

NO RECORC

RECORC

4

ANTIBODYSC

IREL

* 米 *

SIGNATURE OR PERSON PERFORMING TEST

DONOR

ABO

Rh

RECIPIENT

ABO

Rh

JCROSSMATCH NOT REQUIRED FOR THE COMPONENT REQUESTED

DATE

BFMARKS

**Unit** **Expires:**

**SECTION** **II-RECORD** **OF** **TRANSFUSION**

FRE.TRANSFUSION DATA POST-TRANSFUSION DATA

INSPECTED AND ISSUED BY SPuT AMOUNT GVEN TTIMEDATE COMPLETEDINTERRUPTED

REACTION TENPERATURE PULSE 「BLOOD PRESSURE

]NONE[ ]SUSPECTED

ON (Date)

AT (Heu?

![](/media/202412//1733383380.2106931.png)If reacion issuspeced -IMMEDIATELY:

IDENTIFICATION

![](/media/202412//1733383380.220367.png)and on the pabent identifcaion tag 4.Do NOT discard unt Reun Blood Baa.Fiter Set and LV.Soutions to the Blood Banl

hock if present.keep intravenous Iine open.

I have examined the Blood Component container label and this fomm and I fnd all

DESCRIPTION OF REACTION

1*VERIFIER (Signahre)

PAIN

FEVER

□URTICARIA ]cHu

]OTHER (Speaty

OTHER DIFFICULTIES (Equipmens,dot,ete.

PRE.TRANSFUSiON ]NO YES (Soecy

leutsE IBP 」SIGNATURE OF PERSON NOTING ABOVE

TENP

DATE OF TRANSFUSION TIME STARTED

![](/media/202412//1733383380.2352662.png)

PATIENT IDENTFICATION-USE EMBOSSER (For yped or wniten entnes gve Name-Last frst,middle:grade:rank

WARD

BLOOD OR BLOOD COMPONENT TRANSFUSION

Medical Record

CTANDARD FORM 518(REV.992)

PrWrbAd Dy GSACMR.ARVR(41 CFR)2014.202-1

rate:hosptsl or mediasl facity)

*****Pre-Hospital Mission-T&S and Crossmatch Not**

**Required -Only Universal Donor Products Used**

**Complete Only The Blue Highlighted Boxes**

![](/media/202412//1733383380.2517624.jpeg)![](/media/202412//1733383380.2645829.jpeg)![](/media/202412//1733383380.274994.jpeg)

**RECEIVING UNIT (Tactical Evacuation Unit)**

518-122 NSN 7540-00-6344158

BLOOD OR BLOOD COMPONENT TRANSFUSION

**MEDICAL RECORD**

SECTIONI-REQUISITION

KE OF REQUEST (Chek ONLY fRad Bood Cef

REQUESTING PHYSICIAN (Print)

COMPONENT REQUESTED (Check one)

Proddt are requeeted.

RED BLOOD CELLS

□NPEKNDSCREE***

**BIAGNCSISORTOPERATIVE** **PRCCEDURE**

PLASMA

of\_ unt

FRESH FROZEN

PLATELETS (Pool

CRYOPRECIPITATE

CROSSMAKCH

DATE REQUESTED

(Pool af

un)

|I have colleced a blood specimen on the below named patient verifed the name and ID No.of the patient and vertfied the specimen tube label to be cormect

Rh IMMUNE GLOBULIN

DATE AND HOUR RECUIRF

OTHER (Sp*cfy)

SIGNATURE OF VERIFIER

VOLUME REQUESTED (If apPlicabie)

ML

REMARKS

ION

ANTIBODY

FBRMATONTA

KNOWN

REACTON

(Spec

IF PATIENT S FENALE.IS THERE HISTORTF

OATE VERIFIED

RhIG TREATMENT?DATE GIVEN:

TIME VERIFIED

HFHGLYTC DI3EASE OF NEWBORN?

SECTIONN-PRE-TRANSFUSION TESTING

UNIT NO

TRANSFUSION NO

PATIENT NO

ST INTERPRETATION

PREVIOUS RECORD CHECK RECORC

NO RECORD

ANTiBODYV

S

H

***

SIGNATURE OR PERSON PERFORMING TEST

DONOR

ABO

Rh

RECIPIENT

ABO

Rh

CROSSMATCH NOT REQUIRED FOR THE COMPONENT REQUESTED

DATE

w****Pre-Hospital** **Mission-T&S** **and** **Crossmatch** **Not**

**Required-Only** **Universal** **Donor** **Products** **Used**

SECTION II -RECORD OF TRANSFUSION

I PRE-TRANSFUSION DATA

POST-TRANSFUSION DATA

NSPECTED AND ISSUED BY (Signatre

AT (Hour

AMOUNT GIVEN

TIME/DATE COMPLETEDIINTERRUPTED

PEACTION

NONE |SUSPECTED

TEMPERATURE

PULSE

BLOOD PRESSURE

ON /Datt

FTATT

I have examined the Blood Component container label and this fom and I find a infomaton identfing the container wth the intended reapient matches item by iten The recpient is the same person named on this Blood Companent Transfusion Fon and on the patent identification tag

If reaction is suspeded -IMMEDIATELY:

1.Discontinue transtusion.treat shock if present.keep intravenous line ope 2.Notfy Physician and Transfusion Servioe

3.Folow Transfusion Reaction Procedures

4.Do NOT discard unt.Retum Blood Bag,Filter Set.and I.V.Solutions to the Blood Bank

1#VERIFIER (Signature)

DESCRIPTION OF REACTICN

URTICARIA CHILL FEVER PAIN

OTHER (Speafy

2nd VERIFIER (S/gnature

OTHER DIFFICULTIES (Equipment,dote,ete.

NO VES (Specy

PRE.TRANSFUSION

TEMP

PULSE

BP

SIGNATURE OF PERSON NOTING ABOVE

DATE OF TRANSFUSION

TIME STARTED

FATIENT IDENTIFICATION-USEENEOSSER(FCr typed or Wnten enres ove Name L3st frst,mode,gade.rank rate,hospital or medical facility

SEX

WARID

**Document As Much As Possible for Patient**

**ldentification**

BLOOD OR BLOOD COMPONENT TRANSFUSION

Medcal Record

STANDARD FORM 518(REV.9-92)

PresrDAd Dy GSAACVR,FIRNR(41 CFR)201-9202-1

Complete Only the Purple Highlighted Boxes

**SAFE-T-VUE TEMPERATURE INDICATOR**

![](/media/202412//1733383380.2974186.jpeg)**ISSUING FACILITY INSTRUCTIONS**

![](/media/202412//1733383380.3102002.png)![](/media/202412//1733383380.3188982.png)![](/media/202412//1733383380.331672.png)![](/media/202412//1733383380.3407829.jpeg)![](/media/202412//1733383380.3494751.jpeg)

1.Safe-T-VUE10 is a temperature sensitive indicator that easily adheres directly to blood bags during transport and changes color from WHITE to RED when the 10°C indication temperature has been reached or exceeded.

a.Safe-T-VUE is non-reversible and indicates that a high temperature condition existed,even if temperature

returns to a lower level.As long as indicator remains WHITE,blood may be stored for future use. 2.Prepare the Safe-T-VUE temperature indicator by refrigerating for a minimum of 24 hours at 1-6℃ .

3.Remove the blood product and one Safe-T-VUE indicator from the refrigerator at the same time and place on a clean dry surface.

**NOTE:**Remove excess moisture from the blood product bag by using a dry wipe/paper towel on the surface where the Safe-T-VUE is to be applied.

**NOTE:**Use of cold pack on the surface below the blood product will help to maintain temperature

4.Hold Safe-T-VUE against the blood product with fingertips.Peel off the "REMOVE"label to expose the adhesive.

NOTE:Be careful to only handle around the edge of the indicator to expose RED DOT and WHITE DOT.

![](/media/202412//1733383380.362803.jpeg)

5.Attach Safe-T-VUE directly to the lower third of the blood product bag where there is a large volume of product.

![](/media/202412//1733383380.3719707.jpeg)

CAUTION:Ensure thawed plasma is at refrigerated temperature (1-6℃)before placing Safe-T-VUE on unit

NOTE:Be certain the Safe-T-VUE indicator is in complete contact with the blood component bag being monitored.No air pockets should be under the indicator(e.g.,fold in the bag;over any labels;or any other obstruction).

6.Fold WHITE DOT onto the RED DOT and press firmly together to activate.

CAUTION:Be careful to ONLY press on the GREEN color-coded end to activate properly.

**CAUTION:**It is important to place pressure on the outer edge of the WHITE DOT,and not the center,when pressing onto the RED DOT to prevent false activation.

7.Issuing facility will complete documentation on SF518 for each blood product unit (Refer to Appendix E/H ),place inside GHC pocket and secure container.

8.Receiving personnel will understand color change temperature indication:

a.When WHITE DOT turns solid RED,temperature has reached ≥10℃

· Return blood product to issuing facility (BSD/MTF/LAB)

b.Appearance of SMALL RED DOTS is an indication blood product requires cooling or immediate refrigeration.

Return product to issuing facility (BSD/MTF/LAB)for appropriate cooling/refrigeration C. WHITE DOT-product is acceptable for transfusion

![](/media/202412//1733383380.3856757.jpeg)

**<9℃**

**≥10℃**

**≈9.5℃**