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
Blood Safety Support
Armed Services Blood ProgramArmed 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
Armed Services Blood Program Office
Navy Blood Program Office
Air Force Blood Program Office
Army Blood Program Office
COCOM Joint Blood Program Offices
The Armed Services Blood Program (ASBP)Coordination for Global Engagements
Blood Program ContactsBlood 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 viaProvide blood safety support via
DoD PEPFAR Theater Security Cooperation Programs in
COCOMS
Many Partners
Countries Receiving AssistanceCountries Receiving Assistance
Cambodia Ethiopia Indonesia Laos Mozambique Thailand Ukraine Vietnam
Blood Safety ProgramBlood 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
UNCLASSIFIED
Goals and Benefits of ASBP Global EngagementsGoals 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
Blood Safety AssistanceBlood 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)
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Blood Safety AssistanceBlood 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
Blood Safety AssistanceBlood 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
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UNCLASSIFIED
Blood Center Designing
What do we do?
Five Blood Safety Centers - VietnamFive Blood Safety Centers - Vietnam
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 TrainingHospital Ship – Blood Bank Training
US PACOM Blood Safety ProgramUS 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
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UNCLASSIFIED
US PACOM Blood Safety ProgramUS PACOM Blood Safety Program
2012: Equipment needs identified, equipment purchased and turnover to Lao P.D.R
2009: Initial Planning PhaseMeetings with Ministry of Health and National Blood Transfusion Center
2010 – 2011: Blood Safety Workshops in Lao P.D.R and Cambodia
2013: Center of Excellence identified in Luang Prabang, Lao P.D.R., building finalized and turned over to Ministry of Health.
Training performed at new Donor Center to integrate Ministry of Health and Ministry of Defense personnel in Northern provinces
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UNCLASSIFIED
US PACOM Blood Safety ProgramUS 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
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.
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Cambodia Ground Breaking CeremonyUNCLASSIFIED
UNCLASSIFIED
Cambodia Ground Breaking CeremonyUNCLASSIFIED
UNCLASSIFIED
National Blood Transfusion CenterUNCLASSIFIED
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Equipment Equipment UNCLASSIFIED
UNCLASSIFIED
New EquipmentNew EquipmentUNCLASSIFIED
UNCLASSIFIED
Training in the CentersTraining in the CentersUNCLASSIFIED
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Blood Program AssessmentBlood Program Assessment
Capability None End StateMinimal SignificantModerate
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0 1 2 3 4
Doctrine No legislation and/or regulatory frameworkNo national standards for manufacturing/adminNo quality assurance plan
Little specific legislative and/or regulatory frameworkDeveloping standards for manufacturing, QA, & admin
Partially specific legislative & regulatory frameworkDeveloping standards for manufacturing/admin/QA planLocal HV System
Specific legislation & regulationsNatl blood policy & strategic planNatl manufacturing/admin standardEstablished QA planRegional HV System
Compliance with international standardsNational surveillance & HV System100% TTI testing
Organization No BTC Hospital/Clinic collectionNo NBTC/ Transfusion CommitteeNo comp/standardized screening or lookback
Developing NBTC, Transfusion CommitteeDelegation to NGODeveloping comp/standardized screening and lookback
Have NBTC & Developing RBTCHave Transfusion CommitteeHave comp/standardized screeningLookback 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 progNo trainers
Developing trng programDeveloping trainers
Have a standardized trng programHave trainers
Regional training provider
Material No functional refrigeratorsNo functional centrifuges No testingNo PPE
<50% functional refrigerators<50% functional centrifugesNo plasma expresserNo collection beds<50% sterile connectorsAll rapid testingLab coats only
>50% functional refrigerators>50% functional centrifuges2 expressers per Regl center1 bed per phlebotomist>50% sterile connectorsCombination of ELISA & rapid testing with confirmatory testLab coats & gloves only
100% functional refrigerators100% functional centrifuges5 expressers per Regl center2 beds per phlebotomist 100% sterile connectorsElisa testing per Regl center with confirmatory testingLab coats, gloves, eye protection
HIV, HCV, HBV, Malaria, Syphilis testing
Leadership & Education
None trained in blood safetyNot aligned w/technical schoolsNot aligned w/medical & nursing schools
25% trained blood safety25% of Regl ctrs aligned w/technical schools25% of Regl ctrs aligned w/medical & nursing schools
50% trained blood safety50% of Regl ctrs aligned w/technical schools50% of Regl ctrs aligned w/medical & nursing schools
80% trained blood safety75% of Regl ctrs aligned w/technical schools75% of Regl ctrs aligned w/medical & nursing schools
100% trained in WHO guidelines, blood admin, donor/recipient counselingAll Regl ctrs aligned w/schools
Personnel Staff works 100 hours/wkNo qualified personnel0% Hep B vaccinated100% paid donors
Staff works 75 hours/week25% qualified personnel25% Hep B vaccinated≥75% remunerated donors
Staff works 60 hours/week50% qualified personnel50% Hep B vaccinated≤50% remunerated donors
Staff works 50 hours/week75% qualified personnel75% Hep B vaccinated≤25% remunerated donors
Staff works 40 hours/week100% graduated from course100% Hep B vaccinated100% voluntary unpaid donors
Facilities ≤25% WHO design<25% aligned by region<25% floor centrifuge<25% cold chain mgmt<25% emerg generator
≥25% WHO design25% aligned by region25% floor centrifuge25% cold chain mgmt25% emerg generator
≥50% WHO design50% aligned by region50% floor centrifuge50% cold chain mgmt50% emerg generator
≥75% WHO approved design75% aligned by region75% floor centrifuge75% cold chain mgmt75% emerg generator
100% WHO approved designAll regions hub & spoke alignedFloor centrifuge (s) availableAll Regl ctrs cold chain mgmtAll Regl ctrs have emerg power
EthiopiaEthiopia
Facility Scope of Service
Armed Forces General Hospital (Addis Ababa)
Transfusion Service
Bahrdar (northwest Ethiopia) Transfusion Service
Bella Blood Bank (Addis Ababa) Blood Donor Collections Donor Testing Laboratory Blood Distribution Center
Harar Transfusion Service (eastern Ethiopia)
Transfusion Service
Mekelle Blood Bank (northern Ethiopia) Blood Donor Collections Blood Distribution Center
Mekelle Transfusion Service (northern Ethiopia)
Transfusion Service
Shire Transfusion Service (northern Ethiopia)
Transfusion Service
New Bella FacilityNew Bella Facility
Addis AbabaBella Defense Blood Bank Center
Blood Safety Challenges in CountriesBlood 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 ChallengesBlood 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 ChallengesBlood Safety Challenges
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 FoodChallenge Food
Courtesy of the USAFCourtesy of the USAF
In ConclusionIn Conclusion
QUESTIONS?
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