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

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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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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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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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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

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Cambodia Ground Breaking CeremonyUNCLASSIFIED

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National Blood Transfusion CenterUNCLASSIFIED

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Equipment Equipment UNCLASSIFIED

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New EquipmentNew EquipmentUNCLASSIFIED

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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?