Blood Deployment in Natural Disasters and a Military in Conflict

After the terrorist attacks on the World Trade Center on 9/11/2001, the public health sector increased focus on emergency or disaster preparedness. This includes the preparedness of the health care system to respond and manage a sudden, large influx of patients that may be severely injured or critically ill. Blood transfusion emergency preparedness is integral to the ability of the health care system to respond to such an event. Trauma care has changed dramatically over the last 15 years, informed by the U.S. military experience in Iraq and Afghanistan. The translational research made possible by the Joint Trauma System Trauma Registry has changed civilian trauma practice especially in the area of resuscitation and hemorrhage control. Most hospitals now have massive transfusion protocols to guide resuscitation in hemorrhaging patients with shock that incorporate both blood component transfusion ratios of 1:1:1 and use of non-blood products to minimize coagulopathy such as tranexamic acid. This chapter reviews the challenges of maintaining adequate blood supply and distribution of that blood supply in a mass casualty event and solutions for those challenges.