Blood lifeline on the frontline

28 March 2024

In a first for the ADF health system, 2nd Health Battalion (2HB) medics simulated giving patients blood at the point of injury as part of early treatment during Exercise Viper Walk.

This is a change from the current system, where patients only receive blood when they arrive at the Role 2E hospital, which is traditionally deployed at great distances from the frontline. 

2HB used the exercise to showcase the ability to use fresh whole blood – transfusing directly from donor to patient – to increase survivability of the casualty. 

Commanding Officer 2HB Lieutenant Colonel Kelly Dunne emphasised the importance of delivering forward blood on the battlefield to save lives.

“Giving blood to critically wounded soldiers within 30 minutes is crucial for casualty survival,” Lieutenant Colonel Dunne said.

“As part of our readiness culture, we need things to change, and ensuring we have pre-screened our eligible donors is a critical part of preparing for the next fight. 

“We need a blood solution for the pre-hospital space, particularly if we know that we are likely to experience capacity challenges in the casualty evacuation space.”

Currently, blood groups A, B, O and AB are held in fridges at the deployable hospital, and while this is ideal for casualties who make it back to the R2E for treatment, it doesn’t provide a solution for the many casualties who need blood replacement on the battlefield. 

“In being able to transfuse from one arm directly to another on the battlefield, we reduce the cold chain burden on the logistics system and increase the survivability of our fighting forces by ensuring casualties receive life-saving blood earlier,” Lieutenant Colonel Dunne said.

2HB also aims to demonstrate that about 30-35 per cent of eligible blood donors across the ADF could safely transfuse their blood to casualties, regardless of their blood type.

To develop an exercise on this scale, Lieutenant Colonel Dunne applied the 2-30-1 planning metric, which represents the medical and physiological needs of a combat casualty.

“Two minutes is time to initial treatment via tactical combat casualty care; 30 minutes is time to blood replacement through advanced resuscitation by medic or Role 1; and, one hour is time to damage-control surgery,” Lieutenant Colonel Dunne said.

“When it comes to blood, if combat commanders cannot get their casualties back to the preferred cold-stored blood option at the deployable hospital, then 2nd Health Battalion wants to provide warfighters with a forward blood solution to reduce their risk.

“The raising of the 2HB has been a key leap forward in enabling this cultural shift and focus on supporting the combat brigades across Army.”

Lieutenant Colonel Dunne said pre-screening volunteer donors was necessary to identify 0+ and 0- blood types to enable whole blood transfusion. The method, used by the US military, forms part of emergency donor panel and walking blood bank protocols.

To date, the ADF doesn’t provide specific training for this, however, the battalion has developed a two-day military transfusion course for clinical staff training.

If approved, the course may be used across the brigade and wider ADF in future. 

Lance Corporal Kalista Prince, a medic who participated in the exercise, has trained with the US Marine Corps on walking blood bank protocols. 

“Hopefully in the future this incredibly simple and lifesaving capability can be officially trained, so that ADF clinicians can continue progressing with skills in accordance with the most up-to-date research,” Lance Corporal Prince said.



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