Fresh whole blood transfusion for a combat casualty in austere combat environment

There are many challenges to treating life-threatening injuries for a healthcare provider deployed to a remote location in a combat setting. Once conventional treatment protocols for exsanguinating hemorrhage have been exhausted and no medical evacuation platform is available, a nonconventional method of treatment to consider is a fresh whole blood (FWB) transfusion. A FWB transfusion can be a life-saving or life-prolonging intervention in the appropriate setting. The authors present the case of a combat casualty in hypovolemic shock and coagulopathy with delayed medical evacuation to a surgical team. While the ultimate outcome was death in this case report, the patient arrived to a surgical team 15 hours after his injury, alert and oriented. In this scenario, FWB transfusion gave this patient the best chance of survival.