Ranger O Low Titer (ROLO): Whole Blood Transfusion for Forward Deployed Units 

A 33-year-old active duty man conducting combat operations in Afghanistan sustained a right-sided complex blast injury. The injury pattern included: massive soft tissue injury from right costal margin to right knee.

Written by:

Kaoru H Song, MC, USA,  Hans M Winebrenner, MC, USA,  Ty E Able, MSC, USACharles B Bowen, MSC, USA,  Noel A Dunn, MC, USA,  Joseph D Shevchik, MC, USA

Over the course of the wars in Iraq and Afghanistan, the military prehospital system has seen a drastic decrease in the mortality of combat trauma due to the tourniquet, the “Golden Hour” policy, and the use of whole blood. Unfortunately, hemorrhage, specifically noncompressible hemorrhage, continues to be a significant cause of mortality on the battlefield accounting for more than a third of military deaths. The National Trauma Care System and the Committee on Tactical Combat Casualty Care (TCCC) have prioritized the research and development of strategies to mitigate mortality from noncompressible hemorrhage with the overall goal of achieving zero preventable deaths.

In 2018, the idea of Advanced Resuscitative Care (ARC) was introduced as a way to begin to overcome the death rates associated with noncompressible hemorrhage. ARC’s standard of practice is early administration of whole blood and the use of interventions such as the resuscitative endovascular balloon occlusion of the aorta (REBOA) or the abdominal aortic junctional tourniquet (AAJT). While the potential benefit of REBOA and AAJT is still being determined, the early use of whole blood 2,3 transfusion has already shown mortality benefit in studies.

The 75th Ranger Regiment has successfully implemented the Ranger O Low Titer (ROLO), a far forward -walking blood bank, using predetermined donors for use at point of injury (POI). Until recently, there has never been a walking blood bank transfusion performed at POI. This case demonstrates the first documented use of a POI walking blood bank on a U.S. casualty who survived a massive noncompressible abdominopelvic hemorrhage related to a complex blast injury.

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