LAUSR

Hemorrhage is still the leading cause of preventable deaths in the battlefield and transfusion of blood products has a pivotal role in the management of these patients. Of note, time to transfusion has a major impact on patient's outcome and transfusion should be performed within the first 30 min. In order to provide the most suitable standard of care to soldiers, the French Armed Forces Health Service (FAFHS) has implemented a dedicated blood field transfusion policy since several decades. This policy is regularly updated, based on the most recent evidences from the literature and on the availability of improved logistic equipment. Up to now, four principles rule this policy of trauma-related massive hemorrhage management: transfuse as early as possible, transfuse plasma rather than crystalloids, provide platelets during massive transfusion protocol and reach a 1:1:1 ratio between red cells concentrates, plasma and platelets units at the end of the protocol.3–6 Additionally, recent advances now allows for safe packaging and transport of several blood products: French Lyophilized Plasma (FLyP), red blood cells units (RBC), and coldstored low-titer (<1/64) group O whole blood (LTOWB). In the field, this transfusion support is adapted from role 1 to role 3, with each role providing a higher level of care. Since 2009, each role 1 medical team deployed on an operational mission carries FLyP when the situation requires it. Prepared by the French Military Blood Institute (FMBI), FLyP is particularly suitable for remote and austere settings, as it can be stored at temperatures from 4 to 25°C, for 2 years (even in hot environments), then reconstituted in less than 6 min, while being compatible for all blood types. RBCs are available in medical treatment facilities (role 2), in rotary and fixed wings MEDEVACs, as well as on the ground in the prehospital setting for some special operations. The large use of Golden hour boxes (GHB) enables RBCs and LTOWB deployment on the field. Indeed, current GHB may contain three RBCs or two LTOWB units, under safe conditions, regardless of external temperatures, up to 48 h. Moreover, FAFHS prehospital medical teams deployed in the field are trained to perform warm fresh whole blood (wFWB) collection and transfusion, even in austere setting by using a