Getting blood products for transfusions to a battlefield in Canada's High Arctic is feasible but complex, according to newly published research in the journal Transfusion.
The Canadian military recruited Dr. Jason Acker, professor in the Departments of Laboratory Medicine and Pathology and Biomedical Engineering, senior research scientist with Canadian Blood Services and associate vice-president of research integrity support for the University of Alberta, to help lead its northernmost deployment of blood products to date.
"What we've learned through conflict is that a fighting force that has access to blood will have a higher survival rate than a fighting force that doesn't," Acker says. "So blood becomes really as essential as bullets when it comes to deploying them to the front line."
"In remote settings like the High Arctic, medical evacuation to a hospital can take several hours, if not days, yet access to blood products is extremely limited or non-existent, leaving both military and northern communities vulnerable if trauma or hemorrhage occurs," says first author Major Philippe Simon. "When it comes to bleeding, time is everything, and blood is the currency that buys us time until we can get the patient in surgery."
Acker has been part of previous military studies moving blood products in the extreme heat of the Middle East, as well as domestically, but this is the first time anyone has looked at the impact of northern conditions such as extreme cold, long flights, and even movement by snowmobile over Arctic terrain.
"We need to ensure life-saving blood is available wherever our forces operate and Canadians reside," says co-principal investigator Kanwal Singh of Defence Research and Development Canada. "This research demonstrates that we can transport blood thousands of kilometres through some of the harshest environments on earth."
The NATO standard for treatment of trauma victims aims to provide life-saving interventions within 10 minutes, blood-based resuscitation within an hour and surgery within two hours, but this standard has not been feasible in the High Arctic given the vast distances and extreme conditions.
The key to successful transportation of blood products is to maintain a relatively constant temperature. Whole blood and red cells need to be kept between 1-6 C, much like a refrigerator temperature. Plasma is stored frozen at -18 C, and dried plasma and platelets are stored at room temperature. The need to maintain all three temperature ranges makes the logistics even more complex, Acker says.
During the study, the blood products were deployed from Ottawa to the CAF Arctic Training Centre in Resolute and to Fort Eureka in Nunavut, which temporarily served as one of the most advanced medical facilities and largest blood bank in the Arctic. The blood was exposed to temperatures ranging from 30 C in overheated plane cabins to -40 C outdoors.
After the trip, the products were sent to Acker's Edmonton laboratory for quality testing. He found they maintained their transfusion suitability and functional integrity throughout the three-week operation, up to their expected expiry date.
Acker will continue to support the Canadian Armed Forces with further testing this coming winter. The team will focus on operational validation of both emergency and contingency blood collection, which means collecting and storing blood in anticipation of increased transfusion demand such as a high-risk mission. Blood collected during the operation will be shipped back to the Acker lab, which has testing equipment unique to Canada.
"This will give us the assurance and the evidence that should those products need to be used, they would be safe for soldiers and Northern residents to receive," he notes.
Acker is also working with Alberta Precision Laboratories, Canadian Blood Services and the Canadian military on drone delivery of blood products - a technology that could have both civilian and defence applications.
