Armed Services Blood Program
Blood Safety Support
CAPT Roland L. Fahie, MSC, US Navy
Director, Armed Services Blood Program
International Blood Safety Forum
Global Healing
March 20, 2015
www.militaryblood.dod.mil
Armed Services Blood Program
 Established by Executive Order in 1952
 DoDD 6000.12 – Health Services and Operational
Readiness
 DoDI 6480.4 – Armed Services Blood Program
(ASBP) Operational Procedures
 Implements policy, assigns responsibilities, and prescribes
procedures to carry on the responsibilities of the ASBP during
peacetime, contingency (includes humanitarian), and wartime
operations
The Armed Services Blood Program (ASBP)
Coordination for Global Engagements
Armed Services Blood Program
Office
Navy Blood Program
Office
Air Force Blood
Program Office
Army Blood Program
Office
COCOM Joint Blood
Program Offices
Blood Program Contacts
 ASBPO – (703) 681-8024
 Combatant Command Joint Blood Program Officers
 USEUCOM– Major Matthew Swingholm, Landstuhl, GE
011-49 6371868176
 USAFRICOM - Major Matthew Swingholm, Landstuhl, GE
011-49 6371868176
 USPACOM – LCDR Frederick Matheu, Camp Smith, HI
(808) 477-7895
 USSOUTHCOM – Mr. Walt Diaz, Miami, FL
(305) 437-4287 / 1330
Provide blood safety support via
 DoD PEPFAR
 Theater Security Cooperation Programs in
COCOMS
Many Partners
Countries Receiving Assistance
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Cambodia
Ethiopia
Indonesia
Laos
Mozambique
Thailand
Ukraine
Vietnam
UNCLASSIFIED
Blood Safety Program
Enduring program of Blood Safety in Lao P.D.R.,
Vietnam, and Cambodia since 2007
Purpose
• Builds host nation for a sustainable blood program in
support of care, treatment and disaster response
 Program progression to include frozen blood products,
administrative, technical, physician, and nursing training,
and linkages to humanitarian assistance construction
projects for Blood Banks
 Brings together civilian and military blood programs
stakeholders in host nations to support the country
UNCLASSIFIED
Goals and Benefits of ASBP Global Engagements
 Promotes and strengthen partnerships with host nations,
partners, and NGOs
 Improves response to disease and natural or manmade
disasters
 Improves general healthcare commodities
 Fosters quality systems improvement
 Assists with developing good governance and democracy
“Global Force for Good”
 Helps nations to strengthen and take ownership of its own
programs and initiatives
 Gives nations more confidence with sustaining programs of
their own
Types of Assistance
UNCLASSIFIED
Blood Safety Assistance
 National Policy for Blood – commitment, responsibility, and
accountability
 Blood Donor Selection
 Blood Collection
 Infectious Disease Screening
 Blood Component Manufacturing
 Compatibility Testing
 National Guidelines for Blood Administration
 Appropriate Use of Blood Products
 Adverse Blood Transfusion Events (identification,
counseling and treatment)
UNCLASSIFIED
Blood Safety Assistance
 Donor and recipient notification of positive
infectious disease test results
 Blood products recall
 Equipment and building construction
 Build capacity in the centers of excellence and
extend the services to the provinces
 Assessments
 Policy and SOP development
 Technical Assistance
UNCLASSIFIED
Blood Safety Assistance
 Designing Quality Assurance Programs focusing
on the goal of accreditation
 Divide the country regions in centers of excellence
using “train the trainer approach”
 Build capacity in the centers of excellence and
extend the services to the provinces
 Training at the hospitals and blood centers
 Regional workshops
UNCLASSIFIED
What do we do?
Blood Center Designing
Five Blood Safety Centers - Vietnam
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Military Hospital 103 – Hanoi
Military Hospital 175 – Ho Chi Minh City
Military Hospital 17 – DaNang
Military Hospital 121 – Cantho
Military Hospital 87 – Nha Trang
Robust blood safety program. Collaborates and lead
country in the Pacific and partners for training.
Implementing frozen blood technology.
Hospital Ship – Blood Bank Training
UNCLASSIFIED
US PACOM Blood Safety Program
Coordinate with US Army Corps of Engineers and country
team to design and build Regional Blood Donor Centers in
Laos and Cambodia using World Health Organization
Guidelines
UNCLASSIFIED
UNCLASSIFIED
US PACOM Blood Safety Program
2009: Initial Planning Phase
Meetings with Ministry of Health and National
Blood Transfusion Center
2013: Center of Excellence identified in
Luang Prabang, Lao P.D.R., building
finalized and turned over to Ministry of
Health.
2010 – 2011: Blood Safety Workshops in Lao P.D.R
and Cambodia
2012: Equipment needs identified,
equipment purchased and turnover to
Lao P.D.R
UNCLASSIFIED
Training performed at new Donor Center to integrate Ministry of
Health and Ministry of Defense personnel in Northern provinces
UNCLASSIFIED
US PACOM Blood Safety Program
2014: Blood safety
Workshop in Pakse, Lao
P.D.R. to integrate Ministry of
Health and Ministry of
Defense personnel in
Southern provinces
UNCLASSIFIED
2014: Meeting in Vientiane, Laos
P.D.R. with Nurses and Doctors to
discuss development of National
Blood Administration Guidelines.
Vientiane will be used as pilot
program.
UNCLASSIFIED
Cambodia Ground Breaking Ceremony
UNCLASSIFIED
UNCLASSIFIED
Cambodia Ground Breaking Ceremony
UNCLASSIFIED
UNCLASSIFIED
National Blood Transfusion Center
UNCLASSIFIED
UNCLASSIFIED
Equipment
UNCLASSIFIED
UNCLASSIFIED
New Equipment
UNCLASSIFIED
UNCLASSIFIED
Training in the Centers
UNCLASSIFIED
UNCLASSIFIED
Blood Program Assessment
None
Capability
Minimal
Moderate
2
Significant
3
End State
0
1
4
Doctrine
No legislation and/or
regulatory framework
No national standards for
manufacturing/admin
No quality assurance plan
Little specific legislative
and/or regulatory framework
Developing standards for
manufacturing, QA, & admin
Partially specific legislative &
regulatory framework
Developing standards for
manufacturing/admin/QA plan
Local HV System
Specific legislation & regulations
Natl blood policy & strategic plan
Natl manufacturing/admin standard
Established QA plan
Regional HV System
Compliance with international
standards
National surveillance & HV
System
100% TTI testing
Organization
No BTC
Hospital/Clinic collection
No NBTC/ Transfusion
Committee
No comp/standardized
screening or lookback
Developing NBTC, Transfusion
Committee
Delegation to NGO
Developing comp/standardized
screening and lookback
Have NBTC & Developing RBTC
Have Transfusion Committee
Have comp/standardized screening
Lookback program
NBTC tasked with overseeing
blood safety, managed by
competent clinical authority
trained in blood bank with
adequate funding
Training
No training program
No standardized trng prog
No trainers
Developing trng program
Developing trainers
Have a standardized trng program
Have trainers
Regional training provider
Material
No functional refrigerators
No functional centrifuges
No testing
No PPE
<50% functional refrigerators
<50% functional centrifuges
No plasma expresser
No collection beds
<50% sterile connectors
All rapid testing
Lab coats only
>50% functional refrigerators
>50% functional centrifuges
2 expressers per Regl center
1 bed per phlebotomist
>50% sterile connectors
Combination of ELISA & rapid
testing with confirmatory test
Lab coats & gloves only
100% functional refrigerators
100% functional centrifuges
5 expressers per Regl center
2 beds per phlebotomist
100% sterile connectors
Elisa testing per Regl center with
confirmatory testing
Lab coats, gloves, eye protection
HIV, HCV, HBV, Malaria,
Syphilis testing
Leadership
& Education
None trained in blood
safety
Not aligned w/technical
schools
Not aligned w/medical &
nursing schools
25% trained blood safety
25% of Regl ctrs aligned
w/technical schools
25% of Regl ctrs aligned
w/medical & nursing schools
50% trained blood safety
50% of Regl ctrs aligned
w/technical schools
50% of Regl ctrs aligned
w/medical & nursing schools
80% trained blood safety
75% of Regl ctrs aligned w/technical
schools
75% of Regl ctrs aligned w/medical
& nursing schools
100% trained in WHO
guidelines, blood admin,
donor/recipient counseling
All Regl ctrs aligned w/schools
Personnel
Staff works 100 hours/wk
No qualified personnel
0% Hep B vaccinated
100% paid donors
Staff works 75 hours/week
25% qualified personnel
25% Hep B vaccinated
≥75% remunerated donors
Staff works 60 hours/week
50% qualified personnel
50% Hep B vaccinated
≤50% remunerated donors
Staff works 50 hours/week
75% qualified personnel
75% Hep B vaccinated
≤25% remunerated donors
Staff works 40 hours/week
100% graduated from course
100% Hep B vaccinated
100% voluntary unpaid donors
Facilities
≤25% WHO design
<25% aligned by region
<25% floor centrifuge
<25% cold chain mgmt
<25% emerg generator
≥25% WHO design
25% aligned by region
25% floor centrifuge
25% cold chain mgmt
25% emerg generator
≥50% WHO design
50% aligned by region
50% floor centrifuge
50% cold chain mgmt
50%UNCLASSIFIED
emerg generator
≥75% WHO approved design
75% aligned by region
75% floor centrifuge
75% cold chain mgmt
75% emerg generator
100% WHO approved design
All regions hub & spoke aligned
Floor centrifuge (s) available
All Regl ctrs cold chain mgmt
All Regl ctrs have emerg power
Ethiopia
Facility
Scope of Service
Armed Forces General Hospital (Addis
Ababa)

Transfusion Service
Bahrdar (northwest Ethiopia)

Transfusion Service
Bella Blood Bank (Addis Ababa)
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Blood Donor Collections
Donor Testing Laboratory
Blood Distribution Center
Harar Transfusion Service (eastern
Ethiopia)
Mekelle Blood Bank (northern Ethiopia)
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Transfusion Service
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Blood Donor Collections
Blood Distribution Center
Mekelle Transfusion Service (northern
Ethiopia)
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Transfusion Service
Shire Transfusion Service (northern
Ethiopia)
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Transfusion Service
Addis Ababa
Bella Defense Blood Bank Center
New Bella Facility
Blood Safety Challenges in Countries
 Donor population – Who are your donors? Paid vs
Volunteer
 Education level of the staff and equivalency
 Staff turnover due to military training or just not
retaining qualified staff
 Lack of knowledge of donor and patient age (older
donors) etc.. Unique identifiers
 No such thing as a medical record number
 Managing funds in the country
 Dependency – Mutual agreed exit strategy and
sustainment plan
Blood Safety Challenges
 Uneducated Beliefs such as catching HIV from
donating blood
 How does the government (MOD) and civilian
(MOH) work? Are they working together?
 Religion and Culture
 Holidays
 Internet connection weak or regulated
 Language barrier (having someone on your team)
 Technology (bringing technology that cannot be
sustained)
Blood Safety Challenges
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Time zone (years)
Logistics and Terrain
Communication – translators
Country Power and Equipment Requirements
(220v vs 110v)
Consistent training and application
Honest Technical Assistance
Retaining key personnel after investing in training
Training together (MDs with Nurses with Admin
with Techs)
Challenge Food
Courtesy of the USAF
In Conclusion
QUESTIONS?