ADF, US CJTMC ‘Blood Cell’: The lifeblood of medical logistics

BRISBANE, Australia – According to the American Society for Hematology, blood is a specialized body fluid with four main components: plasma, red blood cells, white blood cells, and platelets.

Its many functions include transporting oxygen and nutrients to the lungs and tissues, forming blood clots to prevent excess blood loss, carrying cells and antibodies that fight infection, bringing waste products to the kidneys and liver, which filter and clean the blood and regulating body temperature.

A significant disruption to the flow of the circulatory system due to losing blood requires a blood transfusion to replace it.

“The typical adult has about 6,000 milliliters (of blood),” U.S. Army Maj. Julian Stewart, a blood officer and subject matter expert with 18th Medical Command said. “We can safely lose about 800 or so mL of blood before we are thinking about needing a transfusion.”

In combat situations, casualties can be expected. Depending on its severity, having blood readily available can be a matter of death or life.

“If you have a womb that’s gaping and you’re bleeding blood really fast,” she said, “we need to replenish that blood as soon as possible.”

Critical to any military operation is its logisticians’ ability to move personnel and equipment from a point of origin to different locations across the theater of war.

Within that vein, it is equally important to be able to collect, properly store, and transport units of blood to treatment facilities in both the field (Role I, II, III) and hardened traditional-long-term care facilities and hospitals (Role IV).

According to Stewart, blood is considered a medicine, therefore it goes through rigorous testing before it is released.

She added its special storage and shipping requirements are to refrigerate it between 1-6 degrees or freeze it at -30 degrees. Those temperatures must be maintained during the shipping process.

Medical logistics and blood experts from the Australian Defence Force and U.S. Department of Defense, clotted together as part of the lifeblood of the ADF and U.S. Combined Joint Theater Medical Center supporting military activities across the Australian continent during Exercise Talisman Sabre 2023.

Affectionately known as the “Blood Cell”, the mix of ADF – Army, U.S. Army and U.S. Navy logisticians hit the “Land Down Under ” running in a race against time to deliver blood and plasma units to blood support detachments and onward to treatment facilities spanning thousands of miles across Australia’s densely populated areas and its inhospitable Outback.

Our objective when we come out here is to make sure we are strategically placed within this area of operation to be able to sustain the warfighters at any given time,” U.S. Army Maj. Gabriel Pope, a team leader with 6th Medical Logistics Management Center said.

“Class VIII and blood … (are) extremely important to be able to get that combatant commander the confidence to send their Soldiers out to war,” he continued.”

Troops take an oath to serve and defend knowing the risk or injury or worse associated with being the first line of defense for their country. Inherit in the will to take such risk is the confidence a Service Member takes while relying on their training and their resources.

The same may be said for combatant commanders who order their Troops into battle – especially from a medical perspective.

Pope said the CJTMC serves as an enabler to combatant commanders to know their Service Member “are taken care of medically.”

Unlike video games, resupplying items across the battlefield isn’t as quick as the push of a button and a roughly 10-second airdrop.

“The need for medical logistics begins with the customer submitting a requisition, usually done through electronic means,” Rusty Cain, the Defence Logistics Agency’s medical logistics planner for the U.S. Indo-Pacific command said.

“What DLA does is push those supplies to a medical materiel operation known as the Theater Lead Agent for Medical Materiel,” Kings said. “That organization will distribute it to units, or units themselves will use their own organic assets to move it that last tactical mile to the customer on the ground.”

Upon the arrival of blood and plasma units to Australia, the medical logisticians were faced with challenges requiring them to work hand-and-hand with their Australian Army counterparts over several days to overcome regulatory differences and achieve success.

“For the U.S. Forces, medical logistics is an entire entity that’s managed by medical logistics specialists and logisticians,” Australian Army Maj. Mel Soth, a senior pharmacist with 2nd Health Brigade who also serves the CJTMC as a medical logistics coordinator.

“In the Australian Defence Force,” she said, “medical logistics isn’t a separate entity, but (it’s) very much integrated with our wider logistics network.

“Probably, the main difference is any Class VIII materiel is usually managed by pharmacist like myself, but we’re both supported by other general logisticians,” Soth said.

A critical issue the Blood Cell faced was a delay in shipping the blood and plasma due to Australian regulations requiring the units to be repackaged into boxes with fewer units per box.

“As a logistics organization, we’re no good without transportation,”U.S. Army Chief Warrant Officer 2 Juan Herrera, a medical logistician responsible for the distribution and acquisition of medical equipment with 6th MLMC said. “That’s one thing we depend on highly from the logistician standpoint.”

The Troops maintained a never quit mindset and worked through difficulties.

Herrera said although the shipment was delayed due to challenges, it “offered an opportunity for us to learn” about the logistical gap and challenge between how the two nations approach medical logistics in a way that helps them “be more productive and efficient in the future.”

The “Blood Cell” recently achieved its first major victory when blood that traveled from Japan to Australia was received by U.S. Marine Rotational Force – Darwin in Royal Australian Air Force – Darwin, Australia.

“To be frank, I felt relieved,” said U.S. Navy Lt. Cmdr. Rannie Gibson, blood officer with U.S. Marine Corps Pacific who serves the CJTMC as a liaison officer to 18th MEDCOM.

“We have been working (on) it for maybe over three days – trying to move this blood,” Gibson said. “The fact that the Marine Rotational Force – Darwin was able to get involved and assist … it was a huge win for us.”

The U.S. Indo-Pacific Command’s area of operations consists mostly of water. Moving supplies throughout the command’s 4,000-mile area of operation across maritime, air and land domains requires a harmonious joint-logistical effort.

“With Indo-Pacom, with the majority of it being water, it is posing some challenges that we have to work through,” said U.S. Army Master Sgt. Kandi Cox, a senior medical logistics noncommissioned officer with 6th MLMC said.

“It’s been proven, with the one movement of blood or Class VIII that we have delivered in Townsville, that we are dependent on those movers,” Cox said, “not just within the Army, but of course with our Navy, Marines, and Air Force partners.”

The “Blood Cell” hopes to resolve as many challenges and logistical gaps as possible while learning valuable bilateral medical logistics lessons.

“There’s so many different types of experts that we have here,” Pope said. “I think a lesson learned that we see here is understanding how the ADF runs their supply chain, and then understanding how the U.S. runs their supply chain, and making that efficient for this (area or responsibility).”