The Israel Defense Forces has become the first army in the world to use powdered blood products in field operations.
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Western hospitals have been using powdered blood products to treat hemorrhaging patients for years. A military committee, convened last year by the IDF Medical Corps, studied the treatment and recommended adopting the concept.
“Once the bleeding is stopped, the wounded troops are given fluids to restore blood volume," said Dr. Sammy Gendler of the Air Force’s operational medicine department. Also, he pointed out, the dried plasma contains coagulants, which help halt internal bleeding. "Another advantage is that it can be stored for 15 months at room temperature," he said.
The product in question is freeze-dried plasma, which in its normal form comprises about 55 percent of blood volume. The plasma comes from healthy donors with AB-negative type blood, making it suitable for any patient without need to check blood type.
The Israeli army used dried plasma for the first time last month: it was given to a Palestinian man injured in an auto accident. The man was found with an abdominal injury and massive blood loss and was given a transfusion of the dried plasma immediately. He was then evacuated by helicopter to Hadassah Hospital.
“The wounded man, who was in his 30s, was semi-conscious, and no tourniquet could be applied his bleeding was abdomenal," explained army paramedic Staff Sergeant Alona Bublil. "He was given dried plasma intravenously.” He was then sedated until his evacuation: by the time the helicopter arrived, the patient had been stabilized. He was recently discharged.
“I didn’t know I was the first to administer plasma in the field, but I found out pretty quickly,” said Bublil. “When he received the medication, his blood pressure went up a bit."."
Dried plasma was issued to medical teams in the field in February this year, along with the protocol for administering it.
The protocol states that the plasma is to be used for trauma patients suffering from serious hemorrhaging with a systolic blood pressure of less than 80 in two blood-pressure checks, or without a pulse in both arms after two checks. No more than three doses should be given, according to need, and while monitoring side effects.
The qualified parties for administering the treatment include physicians, paramedics who have undergone 14 months of training and those with medical authority to administer in emergency conditions.
Several dried plasma products are available, including ones from Germany, France and the United States. The product used by the Israel Defense Forces, LyoPlas N-w, is made by the German Red Cross. It has been marketed to medical institutions for about a decade, and hundreds of thousands of patients have been treated with it. Stored in powder form, orange in color, the treatment is administered intravenously after being dissolved in distilled water.
According to Medical Corps estimates, it takes about five minutes to prepare in the field.
Research has shown that the dried plasma has roughly 25 percent less coagulant compared to fluid plasma, but according to a study published in 2012 in the journal Anesthesiology, there were no significant differences in the risk of blood clots between dried and fresh plasma.
The use of dried plasma began in 1945 at the end of World War II. At that time, each unit was made of blood from several donors, like blood transfusions given in hospitals, but because of product safety problems and the fear of passing on infections, the idea was abandoned. Later it was rediscovered and retooled. The product the IDF uses contains plasma from a single donor.
“Hemorrhaging is the world’s most preventable cause of death, and most of our resources are directed toward treating it,” said Gendler. For years, he said, the IDF has sought to improve the treatment of bleeding in the field. Fresh plasma cannot be used because it needs to be refrigerated or frozen (at -25 degrees Celsius or below, it can last up to a year). Some IDF units, like the Air Force’s Combat Search and Rescue Unit 669, have mobile freezer units for storing whole blood in the field as well.
In September 2011, the Medical Corps began equipping teams with another medication for hemorrhaging patients, called tranexamic acid, which aids in coagulation. Now, according to the protocol, the medication and the plasma will be given simultaneously, one in each arm, during treatment.
The Medical Corps has been working for years to develop ways to stop bleeding, all of which are still in the experimental stage. They include an automatic tourniquet that will stop bleeding in the extremities and a coagulant powder that induces clotting to stop bleeding from smaller bullet wounds. In December 2010, Haaretz reported about another treatment was being tested on animals to stop massive bleeding using brief electric currents that caused blood vessels to contract.