A Descriptive Analysis of Blood Products Utilized by a Forward Deployed Surgical Team in Syria

Abstract

ABSTRACT Introduction Traumatically injured combat casualties urgently need both blood and surgery. Forward Surgical Teams (FSTs) or Role 2 (R2) surgical teams were created to minimize the time-space distance from point of injury to damage control surgery. Our goal is to describe the use of blood products from a Split FST deployed to Green Village from July 2018 to April 2019. Materials and Methods A retrospective review of a collection of patients treated by a single R2 was conducted following institutional regulatory approval. De-identified data were input into the study database and were then retrospectively reviewed for patients who presented to and received treatment at the R2 facility. Results Of the 470 total patients treated in 10 months: 226 (48%) received blood products and 132 (28%) underwent operative procedures. The patients were 98% male; 74% Host Nationals (HN), 24% North American Treaty Organization members. Mechanism of injury was 75% explosive and 98% penetrating. Documented Injury Severity Scores (n = 214) were: <9 (n = 57/27%), 9 to 15 (n = 34/16%), 16 to 25 (n = 64/30%), and >25 (n = 59/28%). In total 1,052 units of blood products were administered: whole blood (n = 495), red blood cells (n = 200), fresh frozen plasma (n = 109), and liquid plasma (n = 248). HN whole blood used was 337/495 (68%) units for 78 patients; walking blood bank was mobilized six times for HN patients. Of the patients seen, >99% who arrived with a pulse survived to be discharged to a higher level of care. Conclusions This analysis describes blood usage associated with one high volume forward deployed operative team and demonstrates the vital importance of the R2 split FST to provide coalition forces with surgical care in proximity to the point of injury. Over time, the supply chain has improved with more component therapy available at R2s; however, the need for walking blood bank and innovative solutions to care for all casualties must be part of small team capabilities. Liquid plasma use should be expanded as soon as it is feasible.