Everyone is familiar with blood transfusions and donations. Typically, these types of activities are envisioned taking place in sterile operating rooms or at least in controlled environments. Well, imagine conducting blood donations and transfusions on the battlefield. This has become a standard training and operating practice for special operations combat medics.

Not too long ago, a wounded patient would not receive a blood transfusion until they would arrive at a medical unit or, at minimum, until they would be loaded onto a medevac helicopter with highly qualified medics. Medics would carry IV bags containing Hextend and Tranexamic acid (TXA), used for fluid resuscitation and blood loss mitigation for patients in hemorrhagic shock (i.e. for someone who had lost a lot of blood). Even with high-speed life-saving capabilities, there were operators still dying from wounds that they may have otherwise survived if they had received supplemental blood sooner. According to the Army Blood Program, it is estimated that 90 percent of preventable deaths in combat are due to blood loss.

The Limits of Blood Transfusions in Combat

A successful blood transfusion on the battlefield requires the documentation of the troops' blood type.
U.S. Navy Hospital Corpsman 1st Class Bryan Pascacio, with I Marine Expeditionary Force, seeks a vein to insert a needle during Valkyrie Emergency Whole Blood Transfusion Training program at Camp Pendleton, California, May 14, 2020. (Photo by Cpl. Anabel Abreu Rodriguez/USMC)

It is no secret that the fundamental way to save the life of a person who has lost a lot of blood is to first stop the bleeding and then give them more blood. This basic reality is why the Special Operations Combat Medic course now trains operators on how to conduct a blood transfusion in the field.

In any special operations unit, it is critical for the medic to document the blood type of each team member. Of course, in cool guy pictures and movies, you often see guys’ blood types velcroed to their helmets, kits, and shoulder patches. This isn’t just to look “cool.” It is a life-saving technique used by medics on the ground, medevac aircrews, and surgeons.

A good medic will have conducted blood type compatibility testing and documented the results for all members on his team prior to deployment. Blood type compatibility testing can be complicated. The donor’s and the recipient’s blood should always be tested before donating/transfusing takes place. It’s not ideal trying to conduct this kind of testing in a combat zone, while a guy is bleeding out.

A special operations medic in the field cannot carry blood bags for each individual guy, some will carry a few bags of whole blood, but this blood will run out quickly with a severely wounded trauma patient. Medics carry ready-to-go donation/transfusion kits. If an operator sustains a critical wound, the medic can immediately start filling a blood bag from another team member who has compatible blood. Once the blood bag is filled, the medic can start transfusing this blood to the patient, while another donor bag is being filled.

The Rangers Come Up With a Great Idea

Rangers come up with an ingenious approach to blood transfusions on the battlefield.
A soldier performs first aid unto a life-size training doll during a medical focused exercise at the Day Stakes event at the 2021 Best Ranger Competition in Fort Benning, GA, April 17, 2021. (Photo by Pfc. Matthew Mackintosh/28th Public Affairs Detachment)

For larger units or joint teams that are consistently changing members, an ingenious solution for readily available blood transfusion was created and implemented by the 75th Ranger Regiment. It’s called ROLO — Ranger O Low Titer Whole Blood Program. This program calls for individuals with O type blood, to be tested for low anti-A and anti-B titers prior to deployment. If donors have these low titers, they are true universal donors and can be called upon during a combat trauma emergency. In the Ranger Regiment, operators that are on the ROLO list, carry their own blood transfusion bags. If the medic makes a request for blood, these Rangers can retreat back to the casualty collection area, fill their blood bags with their own blood with the assistance of another trained operator, hand it to the medic, and return to the fight. This ROLO protocol was put into action last year in Afghanistan during a fierce firefight; it saved the lives of two Rangers.

Of course, other team members cannot give away all their blood. A patient with critical wounds needs to be evacuated to a higher echelon of care as quickly as possible. This is why the enforcement of the “Golden Hour” and having dedicated medevac crews on alert is so important for the survival of critically wounded military personnel.