California Army Base First to Receive Pre-Hospital Whole Blood Transfusion Capability – JEMS: EMS, Emergency Medical Services

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(L-R) Bonnie Taylor, Dr (Maj.) Nicholas Studer, Captain Devon Haggie holding a whole blood unit and Dean Ross. (Photo/Amy Phillips)

By Amy Phillips

The remoteness of U.S. Army Garrison Fort Hunter Liggett and the sustained efforts of Fire Captain Devon Haggie allowed the installation to be the first in the Army and Department of Defense to receive the vital capability to transfuse whole blood through its emergency medical service (EMS). Additionally, no EMS system in California currently provides this capability, making the FHL program the first in the state. Prehospital whole blood programs are the aspiration of many EMS systems nationwide.

“Having this system and the ability to deliver whole blood to wounded soldiers and civilians at Fort Hunter Liggett is life changing,” said Haggie, EMS coordinator. He witnessed the importance of this program during a visit with San Antonio Fire Department EMS in Texas last year.

“They told me stories of people who were completely unresponsive and likely to die. And with a unit of whole blood being administered, patients are actually sitting and talking while being transported to the trauma center. That alone is hugely eye-opening to me, and being so remote was one of the reasons I pursued that ability for the facility,” Haggie said.

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“There are several other facilities that have this requirement but don’t have the motivated staff like Mr. Haggie, or the infrastructure to support this program,” said Dr. (Maj.) Nicholas Studer, physician-scientist at the ‘US Army Institute of Surgical Research (USAISR) at Joint Base San Antonio-Fort Sam Houston, Texas and medical director of the Army EMS program. “Mr. Haggie almost single-handedly enabled this ability for Fort Hunter Liggett.

The garrison commander’s emphasis on pre-hospital medicine, the survivability of soldiers in training areas, and the austere environment of the installation were crucial factors that played into FHL’s selection as the as the Army’s first pre-hospital whole blood site. The Army EMS program, USAIR, and the Armed Services Blood program worked together to overcome logistical, equipment, and training barriers to bring whole blood to the FHL.
FHL’s whole blood program uses components that were developed for battlefield use by the USAIR, as well as proven technologies from the Army’s civil-military integration programs in the San Francisco region. Antonio in particular.

The military increasingly recognized the need for rapid pre-hospital blood infusions for soldiers injured on the battlefield. In 2019, Studer contacted the latest “trauma tube” producer and modified the “TraumaFlow” tube product to meet military requirements. In partnership with the San Antonio Fire Department, this agency has made the first purchases of a new tubing product that can support both military and civilian patients.

“You can expect blood tubes to typically deliver fluid twice as fast as regular IV tubes, and TraumaFlow is three times faster than regular blood tubes,” Studer said. He added that TraumaFlow is more compact and much less expensive than several other products available for rapidly transfusing blood on the battlefield or on the streets of American cities.

FHL also received a QinFlow Warrior blood/fluid warmer and a Peli Biothermal CREDO blood storage chiller. Both developed for military use and proven with the San Antonio Metro Area Whole Blood Program under the direction of the Southwest Texas Regional Advisory Council. Studer provided initial training on these components, including the TraumaFlow tubing, to FHLEMS personnel on June 22, 2022.

Accompanying Studer on his visit to the FHL, Dean Ross and Bonnie Taylor of the Office of the Army Surgeon General (OTSG) helped answer questions and provide advice. Ross is the Army’s EMS Program Director and is responsible for standardizing EMS care Army-wide.

“My goal is to develop a sustainable strategy for the 117 EMS program in the military,” Ross said. Austere environments, like FHLs, are more urgently needed than those stationed in urban settings. “Fort Hunter Liggett is the beta site and our first opportunity to implement the program which could have very substantial benefits for those who are injured,” Ross said. He adds, “Blood administration is not new, but it applies to the pre-hospital environment, so we are adapting the skills that the military and the civilian sector already have to the installation environment.”

“The Army’s standard of care for trauma patients is to provide whole blood in the field,” said Taylor, EMS paramedic and OTSG systems program evaluator. “Additionally, the military and facilities like Fort Hunter Liggett are in a unique position to easily access blood banks, when most civilian pre-hospital care providers lack this capability. There are no state protocols for the use of blood.
FHL is once again leading the way for the Army’s efforts to provide a safe and sustainable environment for troops, as well as those who work and live at the installation. In addition to this new capability, FHL is also recognized by the Army and Army Reserve as a leader in energy resilience and sustainability efforts.

“Working and living in a remote and isolated facility is a challenge,” said Colonel Lisa Lamb, commanding officer of U.S. Army Garrison Fort Hunter Liggett. “And we are very grateful and honored to receive the Army’s continued support to provide enhanced services and improve the quality of life at Fort Hunter Liggett.”

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