Providing blood for injured Soldiers during combat
operations is a complex task. A blood supply unit from Germany
overcame the challenges it encountered in Iraq to meet the needs of Soldiers there.
In January 2004, 10 Soldiers from the Blood Platoon, 226th
Medical Logistics Battalion (Forward), 30th Medical Brigade,
in Miesau, Germany, deployed to Balad, Iraq. Their mission
was to serve as the blood supply unit (BSU), supplying class
VIIIB (blood and blood products) for Operation Iraqi Freedom
(OIF) II. The dynamics of rapid-paced combat operations required
those in the blood supply chain to adapt quickly and make on-the-spot
The austere environment in Iraq presented unique challenges to blood distribution
operations. Many of these challenges resulted from a sporadic communications
capability and the exceptionally short shelf life of many of the blood products.
Additionally, insurgent activities increased during the months of April and November
2004, producing increased casualty rates for coalition forces and Iraqi civilians.
These increases in hostilities and subsequent injuries increased the need for
blood products exponentially.
During the first 6 months of the deployment, blood shipments to the BSU were
unpredictable and the average shelf life of packed red blood cells (PRBC) received
was about 12 days. The rapid expiration of PRBC supplies tested the blood distribution
chain by increasing the need to procure blood products, monitor blood products
on hand, and distribute them to meet needs. The limited PRBC storage capabilities
of forward support teams created additional problems. Many of the challenges
that the BSU faced were reduced when, later in the operation, it started receiving
PRBC with a shelf life of at least 14 days.
The 226th BSU supported nearly twice the medical treatment facilities (MTFs)
recommended for one BSU. The supported facilities included Army combat support
hospitals and forward support teams, Air Force expeditionary medical support
and expeditionary wings, Navy MTFs, and a Polish MTF. The BSU also provided emergency
support to the Allied hospital in the Spanish sector in April 2004, when operational
conditions exceeded the hospital’s blood supply capabilities. Because of
this additional demand and the increased use of blood for wounded coalition members,
insurgents, and civilians, the BSU functioned at a capacity well above normal
The 226th BSU received routine blood product shipments once a week from the blood
transshipment center in Qatar in quantities that were based on the requirements
of ongoing missions. The average weekly shipment contained 450 units of PRBC,
100 units of Cryoprecipitate, and 60 units of fresh frozen plasma.
The BSU initially used medical evacuation (MEDEVAC) assets to transport blood
from the BSU to the MTFs throughout Iraq. However, this presented a problem
for the MEDEVAC units because too much of their time was being used exclusively
transporting blood products rather than their primary mission—evacuating
casualties. To augment its means of transporting blood products and reduce
its use of the MEDEVAC system, the BSU established routine air shipments using
fixed- and rotary-wing aircraft.
The BSU monitored the blood products on hand at the different MTFs and their
projected rates of consumption to determine the quantity that should be shipped
routinely by air. Air movement requests were submitted 48 hours before the
stocks on hand in the MTFs were expected to be critically low. By working air
through the 1st Corps Support Command movement control cell, the BSU was able
to use opportune airlift, including C–23 Sherpa airplanes and CH–47
Chinook and UH–60 Black Hawk helicopters. (“Opportune airlift” refers
to aircraft that were scheduled for other missions and had space available
to transport the blood products.) In fact, nearly 90 percent of MTF blood shipments
were sent as routine shipments using opportune airlift rather than using MEDEVAC
flights. However, MEDEVACs were used extensively to transport emergency blood
specialist inventories packed red blood cells before
shipping them to one of the 22 medical treatment
facilities supported by the 226th Blood Supply Unit
during Operation Iraqi Freedom II.
The Joint Blood Program Office (JBPO) and the BSU used disposition and transfusion
reports to track the inventory of blood products. Each MTF sent the 226th BSU
a daily report indicating the quantities of blood products that were on hand,
used, and expired. These reports were sent by Internet to the BSU, where they
were compiled and sent to the JBPO using a secure Internet system.
The BSU relied on the Internet and telephone to communicate with its customers
and the blood transshipment center. Communications were adequate during most
operations. However, sometimes an installation or forward operating base shut
down Internet communications for security reasons. When this happened, telephones
became the primary means of communicating. At other times, the Internet service
went down because of technical problems with the service provider. Fortunately,
the BSU had access to multiple telephone systems, such as Army and Air Force
phone networks and an Iridium satellite phone, so that it could place orders
when the Internet was down. Disposition and transfusion reports were sent as
soon as the Internet came back on line.
Blood Product Disposition
It was extremely important to track every unit of blood product that moved through
the blood supply system. The daily blood report contained disposition information
as well as information on blood products on hand. Disposition information had
complete data on expired and transfused units, including information on the patients
receiving the transfused units. (Expired blood products were incinerated on location.)
JBPO maintained archives of all blood reports for future research.
The BSU used the Theater Defense Blood Standard System (TDBSS) to track which
MTF received each blood product. Although it was helpful in managing the overall
flow of products, the TDBSS was not helpful in tracking final disposition information
because supported MTFs did not use it.
The 226th BSU distributed over 20,000 blood products (2,500 gallons of blood)
throughout the Iraq area of operations during OIF II. In the end, the driving
enablers of success were the Soldiers, Sailors, and Airmen who made the system
work despite the austere environmental conditions, limited access to transportation,
short shelf life of blood products, and sporadic communications capability. ALOG
First Lieutenant Maria F. Johnson is the officer in charge of the Central
Processing Section at Landstuhl Regional Medical Center in Germany. She has a
degree in medical technology from Kean University in New Jersey and is a graduate
of the Army Medical Department Officer Basic Course.