Hemorrhage is the leading cause of preventable death in combat, although early recognition of hemorrhage is still challenging on the battlefield.

The objective of this study was to describe the shock index (SI) in a healthy military population, and to measure its variation during a controlled blood loss, simulated by blood donation.

A prospective observational study that enrolled military subjects, volunteers for blood donation, was conducted. Demographic and clinical information, concerning both the patient and the blood collection, were recorded. Baseline vital signs were measured, before and after donation, in a 45° supine position. Statistical analysis was performed after calculation of SI.

A total of 483 participants were included in the study. The mean blood donation volume was 473mL (SD = 44mL). The median pre- and post-blood donation SI were significantly different: 0.54 (IQR = 0.48-0.63) and 0.57 (IQR = 0.49-0.66), respectively (P = .002). Changes in pre-/post-donation blood pressure (BP) and heart rate (HR) also reached statistical difference but represented a clinically poor relevance. The multivariate analysis showed no significant associations between SI variations and age, sex, body mass index (BMI), sport activities, blood donation volume, and enteral volume replacement (EVR).

In this model of mild hemorrhage, SI exhibited significant variations but failed to reach clinical relevance. Further studies are needed to prove the benefit of SI calculation as a possible parameter for early recognition of hemorrhage in combat casualties at the point of injury.

Pasquier P, Duron S, Pouget T, Carbonnel AC, Boutonnet M, Malgras B, Barbier O, de Saint Maurice G, Sailliol A, Ausset S, Martinaud C. Use of shock index to identify mild hemorrhage: an observational study in military blood donors. Prehosp Disaster Med. 2019;34(3):303–307.

Crises require a timely and well-prepared response by health services, especially those that are directly engaged with the lives of the patients such as blood services. The Iranian Blood Transfusion Organization as a single national authority of blood transfusion has left many crises behind. In this study, we examined the main international crises that the blood transfusion organization has faced during its 44-year history and objectively evaluated the methods for crisis risk reduction, both administrative and operational, all of which have led to fundamental advances in the organization. By proper planning and effective strategy setting, the Iranian Blood Transfusion Organization has managed to cope with international threats and in some cases has turned threats into opportunities to implement new, permanent administrative and operational strategies. It is not prudent for blood transfusion centers to develop their disaster risk reduction strategies on an individual-country basis in a world where global risk and crisis factors are rapidly increasing. Reduction of risk for blood transfusion centers must become a strategic priority nationally and globally. (Disaster Med Public Health Preparedness. 2019;13:410-413)