Whole Blood Training Program in the Bundeswehr Medical Service – Concept, Implementation, and Qualification Profile

Martin Teufel^a, Diana Sauer^b, Christoph Jänig^c, Jens Prein^d, Tobias Markmeyer^d, Jan Ammann^e

^a Training and Simulation Center, Medical Regiment 3 Dornstadt

^b Department of Transfusion Medicine, Bundeswehr Central Hospital Koblenz

^c Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Bundeswehr Central Hospital Koblenz

^d Rapid Deployment Medical Command Leer

^e Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy Bundeswehr Hospital Ulm

Summary

Trauma-related hemorrhage remains one of the leading preventable causes of death in both military and civilian settings. Logistical constraints, longer evacuation times, and limited infrastructure can significantly restrict the availability of component-based blood products, especially in deployed military environments. In this context, structured whole blood transfusion strategies are becoming increasingly important. The Bundeswehr Medical Service has developed a standardized, team-based training program for whole blood donation and transfusion. The program trains physicians and selected non-physician medical personnel to collect, process, and administer whole blood in operational conditions, in accordance with transfusion law. The curriculum is simulation-based, competency-oriented, and fully integrated within the regulatory framework. This article describes the legal background, training structure, exam procedures, and qualification requirements, and places the concept within the broader scope of military medicine.

Keywords: whole blood; emergency transfusion; military medicine; hemotherapy; training; transfusion law; simulation-based training

Introduction

Uncontrolled bleeding remains one of the most common preventable causes of death in both military and civilian settings [5][10]. Early hemotherapy is a key part of damage-control resuscitation (DCR) and greatly affects morbidity and mortality [9]. Whole blood includes erythrocytes, plasma, and, depending on the manufacturing process, platelets in a physiological ratio, and it is considered a first-line treatment in tactical medicine according to current guidelines [12]. The organized use of whole blood is therefore becoming increasingly important in both military and civilian environments [3][11], including in Germany [7][8].

Internationally, the adoption of whole blood programs in civilian emergency medicine is being actively encouraged. Notable examples are the Norwegian Blood Preparedness Project [1] and the whole blood program of Royal Caribbean Cruise Lines [6].

Blood donations and transfusions in Germany are governed by the binding requirements of the Transfusion Act and the Hemotherapy Guidelines of the German Medical Association; this is also fully applicable in the military sector.

In response, the Bundeswehr Medical Service has created a standardized, multidisciplinary training program for whole blood donation and transfusion to enable personnel with diverse qualifications to collect, process, indicate, and administer whole blood in compliance with regulations. This article outlines the structure, content, and qualification framework of this training and situates it within the context of military medical and transfusion law.

Legal Framework and Conditions

The conduct of blood donations, transfusions, and the use of blood products are thoroughly regulated by law in Germany. Even in the military context, the collection, production, and use of blood products must comply with civil legal standards. The purpose of these legal norms, guidelines, and regulations is to ensure the highest level of safety for both donors and recipients of blood products.

For the Bundeswehr Medical Service, it means the obligation to follow the core principles of quality, safety, and traceability even during operations. Training for whole blood donation and transfusion is therefore consistently aligned with recognized standards of transfusion medicine and the relevant official requirements.

Training

Overview

The goal of the training is to provide participants with the necessary theoretical knowledge and practical skills to safely perform an emergency transfusion or blood donation, including the production of a transfusion-ready whole blood unit. Participants also gain insights into organizational and structural quality assurance processes and are trained on safety issues related to whole blood products, including relevant infectious factors. A key aspect of the training is its interprofessional approach. The certification for collecting and using whole blood is not limited to medical personnel; it has been extended to qualified non-medical staff under specific legal and professional conditions. This ensures the availability of whole blood even during extreme operational circumstances.

The following groups are generally eligible for the “Whole Blood Donation Practitioner” training.

• Medical personnel,
• specially qualified nurses for anesthesia and intensive care,
• specially qualified emergency medical technicians, and
• specially qualified deployment paramedics (especially Combat First Responder C or similar qualifications).

With the revision of the procedural instruction for collecting and using whole blood in Bundeswehr military operations in 2026, emergency nursing staff will also be included.

The qualification’s validity is limited to 36 months for medical personnel and 24 months for all other participants.

In 2022, initial pilot trainings for practitioner development took place, initially for special and specialized forces of the Bundeswehr. Building on these experiences, the Expert Working Group on Whole Blood at the Training and Simulation Center of Medical Regiment 3 developed the curriculum “Whole Blood Donation Practitioner” in 2023, which was then tested in a pilot phase. Since 2024, the training has been part of the official Bundeswehr training catalog.

In 2025, a compressed two-day training variant for anesthesiology specialists with continuing education as transfusion officers was established. The performance evaluations are identical in content and form to those of the regular practitioner training. Additionally, a curriculum-embedded e-learning format is used.

So far, approximately 260 individuals have completed the regular practitioner training, from sergeant to senior medical officer. Of these, 27% were medical personnel and 73% were non-medical personnel. The average pass rate was nearly 87% (n=226). Twelve specialists completed the shorter training version with a 100% pass rate.

Practitioner Training

The training is based on the theory of experiential learning according to Kolb [2] and is consistently simulation-based. The goal is to develop operational security under realistic conditions. Additionally, an e-learning module built on Moodle was implemented via the Bundeswehr “link&learn” platform. Providing teaching materials, supplementary literature, and instructional videos significantly enhanced the theoretical foundational understanding of non-medical participants. The preparatory learning phase ends with a mandatory online pre-test. Although the result is not a formal requirement for participation, it enables differentiated learning-group analysis and targeted adjustments to classroom instruction.

The week-long classroom phase includes 16 theoretical units and 15 practical training units in small groups. The training ends with an individual exam before a panel, comprising written, practical, and oral components. The total time commitment is approximately 2 to 2.5 hours per participant.

Theoretical Training Content

Theoretical instruction covers, among other aspects:

• Physiology of hemorrhage and shock, including basics of hemostasis and coagulation diagnostics.
• Blood products and coagulation-modulating drugs, as well as concepts of massive transfusion.
• Immunohematology, including blood group characteristics (ABO, Rhesus, Kell), blood typing, and clinical-chemical diagnostic procedures, including sample shipping and transport.
• Transfusion-relevant infectious diseases, including diagnostic procedures, risk assessment, transfusion reactions, and management of adverse events.
• Algorithm-based indications for (massive) transfusions.
• Donor selection and guideline-compliant blood donation, including performance capacity post-donation.
• Documentation on both donor and recipient sides.
• Legal foundations, including relevant guidelines, recommendations, and documentation requirements.
• Logistics and proper handling of blood products (component-based products and whole blood).

The theoretical training starts with the e-learning phase, then moves to classroom instruction in a closed seminar room. The practical training is closely connected to the theoretical modules and gradually increases throughout the course. Starting on the third day, the focus shifts to scenario-based execution of the entire process – from indication to transfusion. Practical training takes place in small groups of three to four soldiers, each with an instructor. The instructor ratio is one medical and one non-medical instructor for every six participants (Figure 1).

Fig. 1: German soldier performing a whole blood donation during training, shown at the start of leukocyte depletion after blood collection (Source: Bundeswehr Media Database)

Practical Training Content

Practical training includes the following steps:

• indication based on the existing algorithm,
• determination of ABO, Rhesus, and Kell blood groups on the recipient’s side, including the use of commercially available bedside tests,
• subsequent donor selection, donor history, counseling, and assessment or determination of suitability for blood donation, including prioritization of donors in mass casualty incidents,
• performing whole blood donation, including collection of reserve samples,
• diagnostics for HIV, hepatitis B and C, and syphilis, including rapid test-based infection serology as point-of-care diagnostics,
• determination of ABO, Rhesus, and Kell blood groups on the donor’s side, including the use of commercially available bedside tests, and
• leukocyte depletion and the production/labeling of the final transfusion product, including documentation on both donor and recipient sides, as well as
• transfusion of the finished whole blood product after blood group confirmation.

Participation in puncture is voluntary only. The maximum donation limit is 150 ml per person. Autologous retransfusion is not performed. The training uses the current blood donation systems (Figure 2).

Fig. 2: Material overview of whole blood donation showing the donor, recipient, test components, and the prepared system, including a puncture simulator and artificial skin (Source: Bundeswehr, A. Schmidt)

Simulation and Scenario Training

The training is conducted using prepared blood donation systems. The fill weight is continuously monitored with a spring scale (target value: 475 g ± 10%) to ensure realistic product quality.

In simulation-based training and assessments, it is important not only to provide a realistic puncture experience but also to realistically vary or control both the blood flow rate and the duration of filtration (leukocyte depletion). Accurately representing the puncture site on living humans is important but challenging. The use of large-bore donation needles significantly limits the usability of IV skill trainers, as they cannot be sealed after puncture and can only be used once. To address this, a cost-effective, safe puncture simulator was developed using standard cross-sectional items and leftover materials, combined with homemade artificial skin, offering an inexpensive and realistic simulation option. By utilizing polyethylenglycol (PEG) bags as artificial blood supplies, any donation volume and duration can be realistically simulated using commercially available products. Developing artificial blood recipes based on commercially available components allows for the realistic mimicking of blood behavior during leukocyte depletion, including temperature- or environment-dependent changes, enabling filtration intervals of 12 to 25 minutes to be reliably simulated.

Therefore, on the third day of training, participants focus almost entirely on practically implementing the entire process, from indication to donor selection and examination, counseling, whole blood donation, and the initiation of transfusion. After practicing individual steps or working in a controlled classroom environment during the previous two days, the third training day takes place under realistic conditions. The training is conducted in full combat gear, typically outdoors. The goal is to prepare participants to be ready for transfusion within 45 minutes of initial contact with the donor. During this session, 12 participants are trained and evaluated by 4 instructors.

Examination Procedures

The assessment of the training is conducted similarly to the practical exam, using a standardized test form that covers all individual activities of the entire process in 30 steps. Errors are categorized into three groups:

• red: immediately life-threatening (e.g., major incompatible transfusion),
• yellow: indirectly threatening but not immediately life-threatening,
• green: minor errors.

Four errors within one category equate to one error in the next higher category.

On the following training day, participants undergo individual assessments. This exam is a vital part of the training to ensure and showcase the high quality of future practitioners’ skills. Examinations are performed in written, oral, and practical formats before an examination board composed of two equal examiners, one medical and one non-medical instructor. If the examiners cannot agree on the evaluation, the practical exam must be repeated before three examiners. This situation has not yet happened.

The written exam lasts 60 minutes and includes 40 multiple-choice questions, with a passing threshold of 75%. The practical exam follows, with the same time limit of 45 minutes, from donor contact to transfusion readiness. The exam is considered failed if there is one red error. The oral exam takes place shortly after the practical exam. Participants answer 25 questions covering various course topics, and the exam lasts approximately 30 minutes. The same evaluation standards apply as in the written exam. Grading is on a scale of 1 to 6, with a minimum average grade of 4.49 needed to pass. The written and oral grades can compensate for each other. The practical exam is a barrier subject, meaning a result of at least 4 is required to pass. With excellent scores, an Instructor Potential (IP) is awarded, qualifying participants for further instructor training or required for it. To earn the IP, none of the three partial grades can be worse than 2, and the overall score must be 90% or higher. The IP must be confirmed by both examiners and emphasizes solid answers or a deep understanding of the topics (Figure 3).

Fig. 3: New algorithm for whole blood donation presented as a pocket card (Source: Bundeswehr, procedural instruction whole blood)

Participants’ learning progress can be objectively measured based on the results of the pre-test and final exam (n = 266). The performance development aligns with the subjective satisfaction of the participants. Since 2025, a shortened training format with a total duration of two days has been offered for specialists in anesthesiology with completed further training as transfusion officers (specialist knowledge in transfusion medicine). This allows key personnel with high routine and expertise to be less burdened by absences. Participants have access to the same self-paced e-learning; along with the high level of training, the theoretical training is reduced to the necessary minimum of two teaching units in favor of practical training. To maximize practical training time, the exam is conducted by three examination boards with six participants each. This arrangement, along with the parallelization of the written and practical-oral components in two exam groups, limits the total exam time to three hours. The modalities of the final exam are identical to those used in regular practitioner training.

Instructor Training

Despite the challenges brought by the SARS-CoV-2 pandemic, a one-week instructor training by the Expert Working Group on Whole Blood at the Bundeswehr Central Hospital in Berlin started after a pilot phase in 2021. During practitioner training and the new training priorities, the previous instructor training was assigned to the Training and Simulation Center of Medical Regiment 3 in 2023, where it was adapted both structurally and content-wise, and continued.

The instructor training follows, similar to internationally validated training formats, two modules: Module 1 “Preparation Course” and Module 2 “Mentoring.”

Module 1, the “Preparation Course,” involves a training week covering the planning, organization, and execution of practitioner training, as well as training content, teaching methods, and guidelines for consistent, standardized training. It requires teaching samples and intensive practical training focusing on teaching, assessment, didactic skills, team leadership, and evaluation and improvement. The module ends with a comprehensive assessment; a formal exam is not included.

Module 2, “Mentoring,” takes place within six months of Module 1 at the latest and lasts one week. Under the supervision of experienced instructors at the Training and Simulation Center of Medical Regiment 3, candidates independently conduct at least one “Whole Blood Donation Practitioner” course. Similar to Module 1, there is no final exam, but a comprehensive evaluation.

To qualify as an instructor for whole blood donation, one must complete both modules. This qualification is valid for 24 months and is available to both medical and non-medical personnel. The teaching qualification is maintained through active instructor involvement; within 24 months, at least two regular practitioner courses must be conducted. The qualification is renewed by extending the practitioner certification.

Conclusion

The implementation of a structured whole blood program addresses the urgent treatment of life-threatening bleeding in logistically constrained situations. The interprofessional approach greatly expands operational capabilities without compromising regulatory safety standards. The presented concept combines operational flexibility with transfusion law compliance and offers a structured, quality-assured model for military deployment. The Bundeswehr Medical Service is the only national institution [4] that provides and promotes this capability. This opens opportunities for further international and civil-military cooperation in military and disaster medicine.

Key Statements

• Traumatic hemorrhage is one of the leading preventable causes of death in military operations.
• Whole blood allows for logistically practical emergency transfusions, even in resource-­limited settings.
• The training is interprofessional, simulation-­based, and consistently aligned with transfusion law requirements.
• Medical and non-medical personnel are trained and qualified for application.
• The concept combines regulatory safety with operational effectiveness.

References

1. Apelseth TO, Arsenovic M, Strandenes G. The Norwegian blood preparedness project: a whole blood program including civilian walking blood banks for early treatment of patients with life-threatening bleeding in municipial health care services, ambulance services, and rural hospitals. Transfusion. 2022;62 Suppl 1:S22-S29 mehr lesen
2. Bergsteiner H, Avery GC, Neumann R. Kolb's experiential learning model: critique from a modelling perspective. Stud Contin Educ. 2010;32(1):29–46. mehr lesen
3. Cap AP, Beckett A, Benov A, et al. Whole blood transfusion. Mil Med. 2018;183:44-51 mehr lesen
4. Cole R, Shen C, Shumaker Jet al. The impact of simulation-based training on medical students´ whole blood transfusion abilities. Transfusion. 2024; 64:1533-1542 mehr lesen
5. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73:S431-S437 mehr lesen
6. Jenkins D, Stubbs J, Williams S, et al. Implementation and execution of civilian remote damage control resuscitation programs. Schock. 2014;41(Suppl 1):84-89. mehr lesen
7. Meizoso J, Cotton B, Lawless R, et. al. Whole blood resuscitation for injured patients requiring transfusion: A systematic review, meta-analysis, an practice management guideline from the Eastern Asociation for the Surgery of Trauma. J Trauma Acute Care Surg. 2024; Sep 1;97(3):460-470. mehr lesen
8. Robert Koch Institut. Einsatz von Vollblut im Kontext militärischer Einsätze. 2025. Votum 50 der 98. Sitzung [Internet].RHKI 2025.[last access March 16, 2026]; available from: https://www.rki.de/DE/Themen/Infektionskrankheiten/Blut-und-Transfusionsmedizin/Arbeitskreis-Blut/Voten/Downloads/V50.pdf?__blob=publicationFile&v=2 mehr lesen
9. Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA. 2017;328(16):1581-91 mehr lesen
10. Spinella PC. Zero preventable deaths after traumatic injury: an achievable goal. J Trauma Acute Care Surg. 2017;82:S2-S8 mehr lesen
11. Taylor aL, Corley JB, Swingholm MT, et al. Lifeline for the front line: blood products to support warfighter. Transfusion. 2019;59:1453-1458 mehr lesen
12. Tactical Combat Casualty Care (TCCC) Guidelines. [Internet] 2025. [last access March 16, 2026]; available from: https://deploydmedicine.com/ mehr lesen

Conflict of Interest Statement:

The authors declare no conflict of interest in accordance with the guidelines of the International Committee of Medical Journal Editors.

Manuscript Data

Citation

Teufel M, Sauer D, Jänig C, Prein C, Markmeyer T, Ammann J. Whole Blood Training Program in the Bundeswehr Medical Service – Concept, Implementation, and Qualification Profile. WMM 2026;70(5E):6.

DOI: https://doi.org/10.48701/opus4-882

For the Authors

Lieutenant Colonel (MC) Martin TEUFEL

Training and Simulation Center Sanitätsregiment 3

Auf dem Lerchenfeld 1, D-89160 Dornstadt

E-Mail: martinteufel@bundeswehr.org

Massive Transfusion in a Military Setting

Sascha Hashemian^a, Jan Ammann^a

^a Department AINS, Bundeswehrkrankenhaus Ulm

Summary

Massive transfusion is a crucial stabilizing measure for severely bleeding trauma patients, characterized by rapid and high blood product use. To manage this effectively, so-called massive transfusion protocols are widely adopted. These hospital-specific standard operating procedures (SOPs) enhance medical care and logistics while reducing the workload on treatment teams. The benefits also offer opportunities in military settings. This article discusses the unique aspects and challenges of massive transfusion in a military context, as well as the advantages of implementing massive transfusion protocols.

Keywords: massive transfusion; massive transfusion protocol (MTP); transfusion in a military context; blood product logistics

Introduction

Hemorrhage is the leading potentially survivable cause of death on the battlefield. Therefore, military medical training has traditionally emphasized hemostasis. When a wounded person with hemorrhage reaches a treatment facility of various levels, one of the main goals is damage control resuscitation (see the article “Damage Control Resuscitation” in this issue). It is now understood that aggressive fluid therapy with crystalloids should be avoided due to its dilution effect on coagulation factors, the risk of developing acidosis, lowering core body temperature, and possibly worsening active bleeding by increasing arterial and venous pressure [4]. Instead, blood products should be administered promptly to bleeding, hemodynamically unstable patients, and in cases of severe bleeding, a massive transfusion protocol (MTP) should be employed. This article aims to describe the specific features of massive transfusion and the options for implementing an MTP in a military setting.

Fig. 1: Illustration of a possible indication algorithm for a massive transfusion protocol

Massive Transfusion Protocol

A massive transfusion is defined as the transfusion of 10 or more units of red blood cell concentrates (RBCs) within 24 hours or 4 or more units within 6 hours. A massive transfusion protocol (MTP) is a standardized, hospital-specific process that coordinates the rapid delivery of various blood products. MTPs are common in civilian trauma care, considered standard practice, and recommended in various guidelines [2]. The purpose of an MTP is to replace blood loss with blood components that match the physiological composition of blood, as well as to provide coagulation therapy.

Suitable criteria for initiating an MTP include injuries with expected significant blood loss (half of the circulating blood volume or ongoing bleeding), lactate levels ≥ 5 mmol/L, systolic blood pressure ≤ 90 mmHg, heart rate ≥ 105/min, and organ dysfunction. Figure 1 schematically illustrates a possible indication algorithm. An MTP initially sets the basic conditions necessary for hemostasis: normothermia, pH > 7.2, and ionized Ca²⁺ > 0.9 mmol/L. These are derived from the “lethal triad” of trauma – hypothermia, acidosis, and coagulopathy – recently supplemented by hypocalcemia as the “lethal diamond” [6].

The MTP process is usually divided into phases. The initial treatment phase typically includes transfusing 4 units of red blood cells (RBCs), 4 units of fresh frozen plasma (FFP), and 1 unit of platelet concentrate (PC), along with providing additional coagulation products such as fibrinogen, tranexamic acid, and calcium. Early steps like cross-matching extra RBCs, conducting a standard trauma lab, and performing point-of-care (POC) diagnostics should be completed. POC diagnostics encompass venous or arterial blood gas analysis and viscoelastic testing methods like thromboelastography.

In subsequent MTP blocks, additional blood products are transfused in the same ratio (4:4:1), with standardized administration of calcium and fibrinogen based on POC diagnostics. During an MTP, prothrombin complex concentrate (PCC), Factor XIII, Factor VII, and desmopressin may also be given. In patients on anticoagulation, these can be countered with appropriate antidotes or coagulation preparations. Hospital-specific differences often lead to deviations from the standard protocol due to logistical challenges in providing PCs, which can delay the initial administration of a PC until the second or third block, ensuring the 4:4:1 ratio is restored.

Fig. 2: Schematic representation of two MTPs for packaged blood products (left) and whole blood (right) * Adjustment according to clinic and laboratory chemistry necessary

MTPs enable faster, more organized delivery of blood products through logistical planning and enhanced interdisciplinary communication [7]. This also shortens the delay before the first transfusion, directly improving trauma patient care. A meta-analysis showed that implementing an MTP results in a statistically and clinically meaningful reduction in overall mortality among trauma patients [3]. Contrary to some beliefs, MTPs do not increase blood product use; instead, they decrease it [8].

MTP in the Military Context

The benefits demonstrate that MTPs are essential in civilian trauma treatment and can also help injured personnel in military settings. Specifically, structured transfusion protocols and early stabilization of the wounded can reduce treatment times, allowing for quicker surgical interventions.

Due to tactical medical principles and logistical challenges, an MTP is only appropriate for treatment levels of Role 2 and above. In the military setting, a limitation is the reduced availability of blood products. During mass casualty situations, a massive transfusion for a single wounded person may consume so many resources that it significantly affects the care of other injured individuals. In such events, the use of blood products and an MTP must be carefully evaluated to prevent prioritizing one patient at the expense of others. Additionally, storing and transporting RBCs, FFP, and PCs pose challenges because of their different temperature requirements, making whole blood a more suitable option.

Massive Transfusion of Whole Blood

The transfusion of whole blood is an essential aspect of military transfusion medicine. In addition to its well-known benefits, its use becomes particularly important in the context of massive transfusions and MTPs. Physiologically, transfusing whole blood more accurately reflects the blood components that need to be replaced due to blood loss. Whole blood is superior to various concentrates regarding coagulation and coagulation factor activity [9].

The additive solution in whole blood varies in type and amount from those in RBCs, FFP, and PCs. Whole blood contains about 70 ml of a citrate-containing additive solution. RBCs have 100–120 ml of citrate, PCs 100–150 ml, and FFP no volume but also citrate [1][5]. A whole blood equivalent of various concentrates in a 1:1:0.25 ratio contains twice the amount of additive solution with a higher citrate level. This leads to more dilution and increased calcium chelation because of the higher citrate concentration during massive transfusion with concentrates [9].

Another advantage is simpler storage requirements. While RBCs must be refrigerated, FFP frozen, and PCs stored at room temperature with constant agitation, whole blood only needs refrigeration. This lessens the technical and logistical demands on a treatment facility and its supplies. Limitations of using whole blood include its relatively short shelf life compared to plasma products, such as FFP or lyophilized plasma [10].

In practice, the medical treatment team benefits from the reduced number of transfusion bags needed when using whole blood. Using whole blood improves compliance and speeds up the MTP process. Figure 2 illustrates the schematic sequence of an MTP with packaged blood products versus whole blood.

Conclusion

A massive transfusion in a military setting, under conditions of limited personnel and resources and in highly dynamic, hard-to-coordinate situations, presents a significant challenge. Massive transfusion protocols have proved effective in civilian trauma care and could enhance medical treatment and support military medical personnel, especially by using whole blood.

Key Points

• Massive transfusions pose a particular challenge in the military context.
• MTPs are a proven standard in civilian emergency and acute medicine.
• MTPs provide security in massive transfusions and thus relieve medical personnel.
• The military context can benefit from establishing an MTP.
• The use of whole blood simplifies the implementation of massive transfusions and MTPs.

References

1. Beeck H, Becker T, Kiessig ST, et al. The influence of citrate concentration on the quality of plasma obtained by automated plasmapheresis: a prospective study. Transfusion. 1999;39(11-12):1266-1270. mehr lesen
2. Bieler D, Düsing H, Flohé S, et al. Polytrauma/Schwerverletzten-Behandlung S3-Leitlinie (Langfassung) [Internet]. AWMF 2022 [last access March 15, 2026];available from: https://register.awmf.org/assets/guidelines/187-023l_S3_Polytrauma-Schwerverletzten-Behandlung_2023-06.pdf mehr lesen
3. Consunji R, Elseed A, El-Menyar A, et al. The effect of massive transfusion protocol implementation on the survival of trauma patients: a systematic review and meta-analysis. Blood Transfus. 2020;18(6):434-445. mehr lesen
4. Dhillon NK, Kwon J, Coimbra R. Fluid resuscitation in trauma: What you need to know. J Trauma Acute Care Surg. 2025;98(1):20-29. mehr lesen
5. Gulliksson H. Platelet storage media. Vox Sang. 2014;107(3):205-212. mehr lesen
6. Lier H, Hossfeld B. Massive transfusion in trauma. Curr Opin Anaesthesiol. 2024;37(2):117-124. mehr lesen
7. Lim G, Harper-Kirksey K, Parekh R, Manini AF. Efficacy of a massive transfusion protocol for hemorrhagic trauma resuscitation. Am J Emerg Med. 2018;36(7):1178-1181. mehr lesen
8. O'Keeffe T, Refaai M, Tchorz K, Forestner JE, Sarode R. A massive transfusion protocol to decrease blood component use and costs. Arch Surg. 2008;143(7):686-690; discussion 90-1. mehr lesen
9. Ponschab M, Schöchl H, Gabriel C, et al. Haemostatic profile of reconstituted blood in a proposed 1:1:1 ratio of packed red blood cells, platelet concentrate and four different plasma preparations. Anaesthesia. 2015;70(5):528-536. mehr lesen
10. Sauer D, Meyer J. Versorgung mit Blut und Blutprodukten in militärischen Einsatzgebieten. Transfusionsmedizin. 2025;15(01):16-27. mehr lesen

Manuscript Data

Citation

Hashemian S, Ammann A. Massive transfusion in a military setting. WMM 2026;70(5E):7.

DOI: https://doi.org/10.48701/opus4-870

For the Authors

Captain (MC) Dr. Sascha Hashemian

Department of Anesthesiology, Intensive Care, Emergency Medicine, and Pain Therapy (AINS)

Bundeswehr Hospital Ulm

Oberer Eselsberg 40, D-89081 Ulm

E-Mail: saschahashemian@bundeswehr.org