1. 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

2. Armed Services Blood Program
Established by Executive Order in 1952
DoDD – Health Services and Operational Readiness
DoDI – 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

3. 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

4. Blood Program Contacts
ASBPO – (703)
Combatant Command Joint Blood Program Officers
USEUCOM– Major Matthew Swingholm, Landstuhl, GE
USAFRICOM - Major Matthew Swingholm, Landstuhl, GE
USPACOM – LCDR Frederick Matheu, Camp Smith, HI
(808)
USSOUTHCOM – Mr. Walt Diaz, Miami, FL
(305) / 1330

5. Provide blood safety support via
DoD PEPFAR
Theater Security Cooperation Programs in COCOMS
Many Partners

6. Countries Receiving Assistance
Cambodia
Ethiopia
Indonesia
Laos
Mozambique
Thailand
Ukraine
Vietnam

7. 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
Partners: DoS, US CDC, USAID, National Blood Transfusion Center, Ministry of Health, US PEPFAR, Australian Red Cross, Laos Red Cross, World Health Organization, US Army Corps of Engineers and Armed Services Blood Program
UNCLASSIFIED

8. 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

9. Types of Assistance

10. Blood Safety 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

11. 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

12. Blood Safety 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

13. Blood Center Designing
What do we do?
Blood Center Designing

14. Five 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.

15. Hospital Ship – Blood Bank Training

16. US PACOM Blood Safety Program
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

17. US PACOM Blood Safety Program
UNCLASSIFIED
US PACOM Blood Safety Program
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
2009: Initial Planning Phase
Meetings with Ministry of Health and National Blood Transfusion Center
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

18. US PACOM Blood Safety Program
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
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

19. Cambodia Ground Breaking Ceremony
UNCLASSIFIED
Cambodia Ground Breaking Ceremony
UNCLASSIFIED

20. Cambodia Ground Breaking Ceremony
UNCLASSIFIED
Cambodia Ground Breaking Ceremony
UNCLASSIFIED

21. National Blood Transfusion Center
UNCLASSIFIED
National Blood Transfusion Center
UNCLASSIFIED

22. UNCLASSIFIED
Equipment
UNCLASSIFIED

23. UNCLASSIFIED
New Equipment
UNCLASSIFIED

24. Training in the Centers
UNCLASSIFIED
Training in the Centers
UNCLASSIFIED

25. Blood Program Assessment
UNCLASSIFIED
Blood Program Assessment
Capability
None
End State
Minimal
Significant
Moderate 1 2 3 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% 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
BTC = Blood Transfusion Center
CME = Continuing Medical Education
ELISA = Antibody-capture Enzyme-linked Imunosorbent Assay
HBV = Hepatitis B Virus
HCV = Hepatitis C Virus
HIV = Human Immunodeficiency Virus
HV = Haemovigilance
NBTC = National Blood Transfusion Center
NBTS = National Blood Transfusion Service
NGO = Non-Governmental Organization
PBTC = Province Blood Transfusion Center
PPE = Personal Protective Equipment
QA = Quality Assurance
RBTC = Regional Blood Transfusion Center
TTI = Transfusion-Transmissible Infections
WHO = World Health Organization
UNCLASSIFIED

27. Ethiopia Facility Scope of Service
Armed Forces General Hospital (Addis Ababa)
Transfusion Service
Bahrdar (northwest Ethiopia)
Bella Blood Bank (Addis Ababa)
Blood Donor Collections
Donor Testing Laboratory
Blood Distribution Center
Harar Transfusion Service (eastern Ethiopia)
Mekelle Blood Bank (northern Ethiopia)
Mekelle Transfusion Service (northern Ethiopia)
Shire Transfusion Service (northern Ethiopia)

28. New Bella Facility Addis Ababa Bella Defense Blood Bank Center
THE RESULTS – THE BELLA DEFENSE BLOOD BANK CENTER

29. 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

30. 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)

31. Blood 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)

32. Challenge Food

33. Courtesy of the USAF

34. In Conclusion

35. QUESTIONS?