Joint Theater Blood Program Update by wuy61796

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									                                               UNCLASSIFIED




    Joint Theater Blood Program Update

               Major Molly Sloan, MSC, USA
                LCDR Mike Roth, MSC, USN
               LTC Rick McBride, USAF, BSC


                                         SAFMLS
                                         March 2009
UNCLASSIFIED
                                                           UNCLASSIFIED




                             Agenda
• OIF Theater Initiatives
    – Historical Transfusions
    – Calculation of MTF Inventories
       • 6- σ training utility in a combat environment
    – Quality Health Assistance Visits (Q-HAVs)
       • Whole Blood Collection Capabilities
       • More utility for 6- σ (for smarter people)
• OEF Historical Transfusions
• CENTCOM Initiatives
    –   Age of Blood
    –   Frozen Blood
    –   Donor/Transfusion Records Standardization and Consolidation
    –   Platelet Golden Hour Boxes

UNCLASSIFIED
               UNCLASSIFIED




UNCLASSIFIED
                                         UNCLASSIFIED




       OIF HISTORICAL TRANSFUSIONS

• Overall product transfusions are on a downward
  trend
• Between Jan 2008 and Jan 2009 there was a 84%
  reduction in the monthly average for all blood
  products transfused in OIF
   – RBC transfusions were 21,411 and 11,116 for
     2007 and 2008 respectively
• Low Period:     January 2009      414 Products
• Peak Period: March 2008         3610 Products
• January 2009 had the lowest blood product
  usage in OIF since July 2004
UNCLASSIFIED
                                                                                                               1-Feb-09
UNCLASSIFIED




                                                           Transfusions
                                                           Decrease in




                                                                                                               18-Jan-09
                                                             Jan 2009
                                                             AVG RBC


                                                             Jan 2008
                                                             Monthly
                                                     83%



                                                               from




                                                                                                               4-Jan-09
                                                                 to




                                                                                                               21-Dec-08
               OIF RBC TRANSFUSIONS PAST 12 MONTHS




                                                                                                               7-Dec-08
                                                                                                               23-Nov-08
                                                                                                               9-Nov-08
                                                                                                               26-Oct-08
                                                                                                               12-Oct-08
                                                                                                               28-Sep-08
                                                                                                               14-Sep-08
                                                                                                               31-Aug-08
                                                                                                               17-Aug-08




                                                                                                                           Date
                                                                                                               3-Aug-08
                                                                                                               20-Jul-08
                                                                                                               6-Jul-08
                                                                                                               22-Jun-08
                                                                                                               8-Jun-08
                                                                                                               25-May-08
                                                                                                               11-May-08
                                                                                                               27-Apr-08
                                                                                                               13-Apr-08
                                                                                                               30-Mar-08
                                                                                                               16-Mar-08




                                                                                                                           UNCLASSIFIED
                                                                                                               2-Mar-08
                                                                                                               17-Feb-08
                                                                                                               3-Feb-08




                                                                                                           0
                                                     700



                                                             600



                                                                   500



                                                                             400



                                                                                     300



                                                                                               200



                                                                                                     100
                                                                         # of RBC Transfused
                                                          UNCLASSIFIED




             Quarterly Analysis of MTF Inventories
               OIF MTF   Bld Types   Target Inv #   JUN   JUL


MTF                       Mixed         200         665   636

week 1                                              246   143

daily high                                          119    37

daily low                                           2      1

week 2                                              124   159

daily high                                          38     38

daily low                                           8      8

week 3                                              197   120

daily high                                          54     36

daily low                                           9      5

week 4                                              98    214

daily high                                          27     57

daily low                                           4      8




UNCLASSIFIED
                                                                    UNCLASSIFIED




               Calculation of 99% C.I.
     Confidence Intervals: Estimate of the amount of error in our estimates;
     precision of statistical estimates. We are 99% sure the interval contains the
     True Population mean.


                        Z-score for 95% CI= 1.96
                        Z-score for 99% CI = 2.58



                                        Standard Deviation
          Mean +/-      Z –score x
                                        √N

                             Solution = MINITAB!!



UNCLASSIFIED
                                                                                                                                                                     UNCLASSIFIED




                                   Minitab Calculations
                                                                   332 AFTH Transfusions
                   225                                      215
                                                                                                             205
                                     198
                   200
                                                                  182
                                                                                         176
                   175
                                           160                                                                                161                               170 Target
    Transfusions




                               152
                   150                                                             142                                                   143                    151 UI
                                                      138
                                                                        134
                         128
                                                                                                                                                          124   133 AVG
                   125                                                                                 115              117                         117
                                                                                                                                                                115 LI
                   100                           90                           92                                   89
                                                                                               85 83                                86

                   75
                                                                                                                                               56

                   50
                         1     2     3     4     5    6     7     8     9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
                                                            OCT 07 - MAR 08 Weekly Totals

UNCLASSIFIED
                                                                                             UNCLASSIFIED


                   PRBC Target Review Process
                                       Memo with Data to MED
                                       BDE HQs and MNC-I                          Brief to
                             NO        w/No Changes                               MNC-I
End of Month                                                                      Surgeon
                                       Recommended
Production        Target
Review            Level
                  Changes?                                                         Concur?
                                       Staff to TF MED BDE              NO                      YES
Quarterly                    YES       units with blood
Blood Target                           capabilities
                                                                   Resolve with               Execute
Review
                                                                   MNC-I SURG                 Proposed
*Next review is                                                    Section                    Target Levels
                                       Brief Data with
APR (will cover                        Proposed Changes to
JAN-MAR)
                                       MED BDE HQs


                                             Concur?
                                  NO                         YES


                              Resolve                  Staff to
                              with BSU,                remaining
                              BDE G/S-4                MNC-I
                              and CLIN                 customers
                              OPS




       UNCLASSIFIED
               UNCLASSIFIED




UNCLASSIFIED
                                                                                     UNCLASSIFIED




                              Blood Services
•   Packed Red Blood Cells
    Transfused
     –   April—7
                                     45
     –   May— 12
                                                 April         May   June   July      August
     –   June— 40                    40


     –   July--- 10                  35
     –   Aug--- 10
•   Fresh Frozen Plasma Transfused   30


     –   April—2                     25

     –   May— 6
     –
                                     20
         June— 11
     –   July--- 0                   15

     –   Aug--- 0
                                     10

•   Other Products Transfused
     –   April---0                   5


     –   May---0                     0

     –   June---2 (Whole Blood)           PRBC           FFP         Cryo      PLT             WB


     –   July--- 0
     –   Aug--- 0



    UNCLASSIFIED
                                                                                        UNCLASSIFIED



                       Blood Services
•   Packed Red Blood Cells
    Transfused                     MASCAL Jun 07

     – Sep --- 9
                              45                                          April
                                          Multiple Traumas                May

     – Oct --- 35             40          Oct & Nov 07
                                                                          June


     – Nov --- 30             35
                                                                          July

                                                                          August

•   Fresh Frozen Plasma       30                                          September

    Transfused                25
                                                                          October

                                                                          November
     – Sep --- 0
     – Oct --- 6
                              20




     – Nov --- 1              15




• Other Products Transfused   10



     – Sep --- 0              5


     – Oct --- 0              0

     – Nov --- 0
                                   PRBC         FFP          Cryo   PLT            WB




    UNCLASSIFIED
               UNCLASSIFIED




UNCLASSIFIED
                                                              UNCLASSIFIED




       Quality Healthcare Assessment Visits
• December 2007: UK Whole Blood recipients identified
• 11 United Kingdom Patients were identified as receiving emergency
  non-FDA licensed blood products throughout OEF/OIF
    – 5 Military
    – 6 Contractor
• 51 non-FDA licensed products were transfused from a total of 47
  donors
• 20 of 47 donor collections had traceable retrospective (EIA) results
• 7 of 11 recipients products were negative for all required EIA tests
  (HIV, HCV, HBsAg, HBc, HTLV)
• Four recipients had varying levels of testing on donor samples (see
  later slides)


UNCLASSIFIED
                                                                                          UNCLASSIFIED




          Quality Healthcare Assessment Visits

                                       Total
                              Total  Products
                            Products Requiring Total      %      Rapid                       EIA
Patients FWB         Plts   Received  Testing Resulted Complete Testing                    Testing
   SC         15      4          19           19        4           21%           Y            Y
   CH          1      0           1            1        1          100%                        Y
   MR*         0      7           7            5        5          100%                        Y
    BS         0      1           1            1        1          100%           Y            Y
   RS          0      1           1            1        1          100%           Y            Y
   DR          0      1           1            1        1          100%           Y            Y
   VM          0      2           2            2        2          100%                        Y
   PH          0      1           1            1        1          100%           Y            Y
   WY          6      0           6            6        0           0%
   PN*         0      6           6            5        1           20%                        Y
   DW*         3      3           6            5        3           60%                        Y
  Total      25       26        51            47       20          43%

MR = received 2 sets of double platelets           See specific patient comments on upcoming slides
PN and DW = received one set of double platelets




UNCLASSIFIED
                                                                                                                    UNCLASSIFIED




             Quality Healthcare Assessment Visits
Process Audited            ISBT-128     Testing    Shipping      Collection   Release   Storage   Disposition   Look-back    Totals
                            Label       of Whole   Specimens                                                    Procedures
                           Procedures   Blood      for Testing
                                                   of Whole
                                                   Blood



Total Applicable Points        10          62           24            68          8        10          6            12            200
Total Survey Points
Obtained
Percentage
Rating
Total Critical Points           6          32           18            42          8         6          2            12            126
Total Critical Points
Obtained
Percentage Critical Area
Compliance
Commendable       100%         10          62           24            68          8        10          6            12            200
Trained           80-99%       8-9        50-61       19-23         54-67        6-7       8-9         5            8-9         160-199


Practiced         65-79%        7         40-49       16-18         44-53         5         7          4             7          130-159


Untrained         <64%         <6          <39         <15           <43         <4        <6         <3            <6            <129
Critical Tasks                  5          26           14            34          6         5          1            10            100



UNCLASSIFIED
                                                                                                        UNCLASSIFIED




            Quality Healthcare Assessment Visits

100%




95%




90%




85%




80%




75%
       ISBT 128     Testing of     Shipping      Collection   Release   Storage   Disposition   Lookback     Totals
        labeling   Whole Blood   Specimens for                                                  Procedures
                                   Testing of
                                 Whole Blood




  UNCLASSIFIED
                                         UNCLASSIFIED




      OEF HISTORICAL TRANSFUSIONS

• Overall product transfusions are on an upward
  trend
• Between Jan 2008 and Jan 2009 there was a 36%
  increase in the monthly average for all blood
  products transfused in OEF
   – RBC transfusions were 5,178 and 6,613 for
     2007 and 2008 respectively
• Low Period:     February 2008     404 Products
• Peak Period: August 2008        1282 Products
• August 2008 had the highest blood product
  usage in Afghanistan to date
UNCLASSIFIED
                                                                                                                1-Feb-09
                                                                             RBC Transfusions
                                                                             from Jan 2008 to
UNCLASSIFIED




                                                                               Monthly AVG




                                                                                                                18-Jan-09
                                                                                Increase in



                                                                                 Jan 2009
                                                                       31%




                                                                                                                4-Jan-09
               OEF RBC TRANSFUSIONS PAST 12 MONTHS




                                                                                                                21-Dec-08
                                                                                                                7-Dec-08
                                                                                                                23-Nov-08
                                                                                                                9-Nov-08
                                                                                                                26-Oct-08
                                                                                                                12-Oct-08
                                                                                                                28-Sep-08
                                                                                                                14-Sep-08
                                                                                                                31-Aug-08
                                                                                                                17-Aug-08




                                                                                                                            Date
                                                                                                                3-Aug-08
                                                                                                                20-Jul-08
                                                                                                                6-Jul-08
                                                                                                                22-Jun-08
                                                                                                                8-Jun-08
                                                                                                                25-May-08
                                                                                                                11-May-08
                                                                                                                27-Apr-08
                                                                                                                13-Apr-08
                                                                                                                30-Mar-08
                                                                                                                16-Mar-08




                                                                                                                               UNCLASSIFIED
                                                                                                                2-Mar-08
                                                                                                                17-Feb-08
                                                                                                                3-Feb-08




                                                                                                            0
                                                     700



                                                           600



                                                                 500



                                                                               400



                                                                                        300



                                                                                                200



                                                                                                      100
                                                                       # of RBC Transfused
                                              UNCLASSIFIED




               Age of Blood Initiative

• Develop course of action for improved red
  cell manufacture and CENTCOM
  distribution
    – Provide fresher blood for trauma patients
    – Adding at least 7 days shelf life to CENTCOM
      inventories should theoretically reduce RBC
      requirements by ~10%
    – Off-set a potential increase in expiring ―older‖
      unused blood

UNCLASSIFIED
                                                   UNCLASSIFIED




                 Age of Blood Initiative

• Conference held in Sep 2008
    – Develop action plan to improve blood product
      manufacture, labeling, storage and
      distribution to CENTCOM AOR

    – Attendees included:
         •   Armed Service Blood Program Office (ASBPO)
         •   CENTCOM Joint Blood Program Office
         •   TRANSCOM Medical Planners
         •   Directors of Service Blood Program Offices


UNCLASSIFIED
                                              UNCLASSIFIED




               Age of Blood Initiative

• Recommendations
    – Improve blood manufacturing process to
      insure blood is prepared for distribution NLT
      48 hours post collection and arrives at
      ASWBPL NLT 4 days post collection

    – Identify and eliminate choke points

    – Have RBCs arrive in theater by 7th day post
      collection

UNCLASSIFIED
                                                                                UNCLASSIFIED




                              Choke Points

• Turn around time for testing
    – Change: Use a combination of regional military/civilian test centers

• Only one dedicated mission from ASWBPL to Al Udeid each week
    – Change: Add a second channel flight on Tuesday (started on 28
      October 2008

• Work schedule for 379th Blood Transshipment Center (BTC) Al
  Udeid
    – In September 2008, BTC shift hours switched from days to nights to
      maximize throughput of blood upon arrival at Al Udeid to theater
      distribution.
    – In the same 12 hour shift:
         • Plane delivering blood arrives at Al Udeid
         • BTC receives, processes and packages the shipment
         • Outgoing shipment delivered to cargo handling for intra-theater distribution




UNCLASSIFIED
                                   Inter-modal Distribution Lanes (IDL)
RBC Tracking:
Days of shelf-life                    CENTCOM – Blood Shipments
remaining
      42-36                            37-29               32-25       24-18                                                                    30-0

                                          RBC Tracking: Days of shelf-life remaining
     BDC                          ASWBPL                   BTC                     BSD                                                         *MTF
                                   East

              RBCs must arrive                                                           2-3 opportunities/week             2-3 opportunities/week
                                               Channel Mission:
              at ASWBPL                        Once/week opportunity
              NLT Day 7                                                                      Sun/Wed              BSD
                                                                                                                  Iraq                     *MTFs
                                                                                                 JMR
                                                    EUCOM          As




                                                                          Needed
                                                    ASBBC

                                                                   JMR
                                                                                            Mon/Thurs         BSD
                                                                                                              Afghan                        MTFs
                                                                                                 JMR

                   FEDEX          ASWBPL              TCN              BTC
      BDCs                                                                                              As Needed                           Kuwait
                   24 hrs         East               48 hrs            Qatar
                                                                                                             JMR
                                                                                                       Mondays Only                          HOA
                                                                                                             JMR
* Note: BSD Iraq facilitates the
rotation of RBCs with ~ 7 days
                                                                                           As Needed              Bahrain                    Ships
shelf-life from E:II MTFs to major                                                              JMR               NSA
E:III MTFs; it’s difficult to rotate
inventory in Afghanistan due to
remote locations and aircraft                        IDL #1                                  IDL #2
availability.
                                                                                                                                          Jan 2008/ajh
                                Inter-modal Distribution Lanes (IDL)
RBC Tracking:
Days of shelf-life                 CENTCOM – Blood Shipments
remaining
     42-36                       37-29               32-25       24-18                                                      30-0

                                    RBC Tracking: Days of shelf-life remaining
    BDC                         ASWBPL               BTC                 BSD                                               *MTF
                                 East

             RBCs must arrive                                                  2-3 opportunities/week   2-3 opportunities/week
                                         Channel Mission:
             at ASWBPL                   Once/week opportunity
             NLT Day 7




       CHANGE - 1               CHANGE - 2              CHANGE - 3



   REQUIREMENT: Fresher blood needed for optimal care of surgical patient.

   Course of Action: Identify and Eliminate Chokepoints.

   Change 1: RBCs must arrive at ASWBPL within 4 calendar days of collection

   Change 2: Add second weekly flight from ASWBPL. RBCs arrive at Al Udeid (AUAB) within 7 days
   post collection.

   Change 3: 379th Expeditionary Blood Transshipment Center (EBTC) AUAB switches work scheduled
   for facilitate throughput of shipments to theater Blood Support Detachments (BSD).

                                                                                                                      Jan 2008/ajh
                            Inter-modal Distribution Lanes (IDL)
RBC Tracking:
Days of shelf-life             CENTCOM – Blood Shipments
remaining
     42-36            35     34-31           28-21                                               30-0

                                 RBC Tracking: Days of shelf-life remaining
    BDC      ASWBPL        BTC       BSD             *MTF                                        *MTF
              East

     RBCs must                   Fresh Blood (≤14 Days Old)
     arrive                                                     Remaining Shelf Life 3-4 Weeks
     at ASWBPL
     NLT Day 4

              Channel Mission:
                Twice/week




   OUTCOMES

   -Provides a window (~7 days) where fresher blood is available at three Level III MTFs
   (Trauma Centers)

   -Provides longer dated blood for remote FOBs; easing the resupply mission
UNCLASSIFIED




                                                                                                                                                                                                              31-Jan-09
                                                                                                                                                                                                              24-Jan-09
                                                                                                                                                                                                              17-Jan-09
                                                                                                                                                                                                              10-Jan-09
                                                                                                                                                                                                              3-Jan-09
                                                                                                                                                                                                              27-Dec-08
                                                                                                                                                                                                              20-Dec-08
                                                                                                                                                                                                              13-Dec-08
                                                                                                                                                                                                              6-Dec-08
                                                                                                                                                                                                              29-Nov-08
                                                                                                                                                                                                              22-Nov-08
                                                                                                                                                                                                              15-Nov-08
               AVERAGE AGE OF BLOOD (in Days)
               UPON ARRIVAL at Al Udeid Air Base




                                                                                                                                                                                                              8-Nov-08
                                                                                                                                                                                                              1-Nov-08
                                                                                                                                                                                                              25-Oct-08
                                                                                                                                                                                                              18-Oct-08
                                                                                                                                                                                                              11-Oct-08
                                                                                                                                                                                                              4-Oct-08
                                                                                                                                                                                                              27-Sep-08
                                                                                                                                                                                                              20-Sep-08
                                                                                                                                                                                                              13-Sep-08




                                                                                                                                                                                                                          SHIPMENT ARRIVAL DATE
                                                                                                                                                                                                              6-Sep-08
                                                                                                                                                                                                              30-Aug-08
                                                                                                                                                                                                              23-Aug-08
                                                                                                                                                                                                              16-Aug-08
                                                                                                                                                                                                              9-Aug-08
                                                                                                                                                                                                              2-Aug-08
                                                                                                                                                                                                              26-Jul-08
                                                                                                                                                                                                              19-Jul-08




                                                                                                                                                                                 31 Jan 2009 - 6.5 Days
                                                                                                                                                                                 28 Jan 2009 - 8.8 Days
                                                                                                                                                                                                              12-Jul-08
                                                                                                                                                                                                              5-Jul-08
                                                                                  Highest Average Age: 17.0 Days (03 Jan 2009)



                                                                                                                                     Multi-Shipment Weeks Began on 28 Oct 2008
                                                                                                                                                                                                              28-Jun-08


                                                                                  Lowest Average Age: 5.6 Days (17 Jan 2009)
                                                                                                                                                                                                              21-Jun-08
                                                                                                                                                                                                              14-Jun-08




                                                                                  Average Age past 12 Months: 11.5 Days
                                                                                                                                                                                                              7-Jun-08
                                                                                                                                                                                                              31-May-08
                                                                                                                                                                                                              24-May-08
                                                                                                                                                                                                              17-May-08
                                                                                                                                                                                                              10-May-08
                                                                                                                                                                                                              3-May-08
                                                                                                                                                                                                              26-Apr-08




                                                                                                                                                                                 Most Recent Shipments:
                                                                                                                                                                                                              19-Apr-08
                                                                                                                                                                                                              12-Apr-08
                                                                                                                                                                                                              5-Apr-08




                                                                                  Shipments: N=65
                                                                                                                                                                                                              29-Mar-08
                                                                                                                                                                                                              22-Mar-08
                                                                                                                                                                                                              15-Mar-08
                                                                                                                                                                                                              8-Mar-08




                                                                                                                                                                                                                                                  UNCLASSIFIED
                                                                                                                                                                                                              1-Mar-08
                                                                                                                                                                                                              23-Feb-08
                                                                                                                                                                                                              16-Feb-08
                                                                                                                                                                                                              9-Feb-08
                                                                                                                                                                                                              2-Feb-08




                                                   18


                                                        16


                                                             14


                                                                  12


                                                                        10


                                                                              8


                                                                                                     6


                                                                                                                                 4


                                                                                                                                                                                 2


                                                                                                                                                                                                          0
                                                                  AVERAGE AGE (In Days)
                                                            UNCLASSIFIED

     TRAUMA CENTERS % OF RBC TRANSFUSED (AGE in DAYS)
             NOVEMBER – DECEMBER – JANUARY
                       2007 vs 2008


2007                                 2008
•    n = 2931                        •   n = 823
•    Average Age: 35.3 days          •   Average Age: 33.5 days
•    Lowest Age: 13 days             •   Lowest Age: 9 days
•    Highest Age: 42 days            •   Highest Age: 42 days
•    % of RBCs transfused that       •   % of RBCs transfused that
     were ≤ 14 Days Old: 0.03%           were ≤ 14 Days Old: 11.8%


    February 2009 – 332nd AFTH Balad transfused RBCs that were
    only 7 days old



UNCLASSIFIED
                                                                                                                UNCLASSIFIED

                         TRAUMA CENTERS % OF RBC TRANSFUSED (AGE in DAYS)
                                 NOVEMBER – DECEMBER – JANUARY
                                           2007 vs 2008

                                                                     2008   2009
                      30.0%



                      25.0%
% of RBC Transfused




                      20.0%



                      15.0%



                      10.0%



                       5.0%



                       0.0%
                              9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42
                                                                       RBC Age (in Days)

                      UNCLASSIFIED
                                                UNCLASSIFIED




                  FROZEN BLOOD

•   Located at BSDs Balad/Bagram
•   Equipment Validation: August 2008
•   BSD staff trained in country: August 2008
•   Final Validation: September 2008
•   BSDs stocked with O Positive.
    – O Negative deglyced only upon request




UNCLASSIFIED
                              UNCLASSIFIED




               FROZEN BLOOD




UNCLASSIFIED
                                                         UNCLASSIFIED




                    FROZEN BLOOD

• First Transfusion: 86th CSH Baghdad 07 NOV 2008
    – Burn Victim
       • 3 Units RBCs (1 PRBC, 2 DRBC)
       • H&H ↑ from 7.4/22.0 to 8.3/25.1
       • No adverse effects/complications report

• Second transfusion 332nd AFTH BALAD 08 NOV 2008
    – IED Injury
        • 3 Units RBCs (1 PRBC, 2 DRBC)
        • H&H ↑ from 6.4/19.0 to 9.4/27.5
        • Patient had Febrile reaction to PRBCs, but tolerated
          Deglycerolized Blood with no problems.


UNCLASSIFIED
                                                      UNCLASSIFIED




                   FROZEN BLOOD

• First U.S. transfusions of Deglycerolized Blood
  during hostile conflict since Viet Nam
    – Dutch have been using Frozen Blood in OEF for several
      years.
• All three Level III MTFs have transfused
  Deglycerolized Blood
• As of 17 Feb 2009, 32 units have been transfused by
  U.S. MTFs.




UNCLASSIFIED
                                             UNCLASSIFIED




               CENTCOM THEATER ISSUES

• Donor/Recipent Records
    – More fall-out of British Contractor Whole
      Blood Collection
    – Records Shortfall
• ASBPO Contract
• In-theater Work-around
    – BSDs scan-in Whole Blood ―Lot Release
      Packets‖


UNCLASSIFIED
                                           UNCLASSIFIED


          Implementation of Platelet Golden Hour
                         Boxes




UNCLASSIFIED
                                                        UNCLASSIFIED




                        RESUPPLY

• 440th BSD Bagram has split the personnel in their
  unit between Bagram and Kandahar.
    – Kandahar operates as a BSD in RC South
• Al Udeid BTC supplies Kandahar directly
    – Bagram eliminated as an interim stop
    – Blood arrives to Kandahar faster and fresher
• Restructured BTC shipments
    – Dry Ice sent twice/week ensuring delivery is spaced equally
    – Frozen products sent mid-week
    – RBCs sent twice/week




UNCLASSIFIED
                                 UNCLASSIFIED




                      RESUPPLY

• Future Challenges
    – Temp Tales
    – Second Channel Flight




UNCLASSIFIED
                                                              UNCLASSIFIED




               New Theater Delivery System

• USAMMC-SWA and AFMOA are coordinating efforts
  to procure the newly proposed theater blood delivery
  system.
• Advantages
    – Not subjected to challenges associated with weather
      allowing it to be operated 365 days/year
         • Particularly useful in OEF during winter months.
    – Low maintenance
    – Requires minimal additional training for BSD staff to operate




UNCLASSIFIED
                                             UNCLASSIFIED




               New Theater Delivery System




UNCLASSIFIED
                                  UNCLASSIFIED




               QUESTIONS?




                            SAFMLS
                            February 2009
UNCLASSIFIED

								
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