Editorial
Dear Reader,
„Blood is a very special juice“
(Goethe, Faust I, Line 1740).
To take military medicine seriously, one must understand blood supply for what it truly is: not an interchangeable consumable, but a biological medicinal product with limited shelf life, high-quality requirements, and logistics that are challenging in peacetime and potentially fragile during deployment. Simultaneously, the availability of blood and blood products in cases of severe injuries and hemorrhages often determines life or death within minutes. In a military context, transfusion medicine is therefore an indispensable factor for operational readiness.
This special issue analyzes military blood supply along the entire chain: from planning and provision to clinical application, training, and development. The focus is on an area that is often taken for granted in everyday life but must have its robustness actively ensured with clear concepts, standardized processes, interdisciplinarity, and regular training, both in domestic hospitals and in operations.
Military blood supply is always a combination of medicine, organization, and logistics, making it a leadership and interface task. Its success depends on the ability to plan processes so that they function reliably under stress conditions – despite distances, transport routes, cold chain requirements, storage, and limited resources.
Central to this is transfusion medicine expertise. The Department for Transfusion Medicine at the Bundeswehr Central Hospital in Koblenz demonstrates the necessary services: immunohematological diagnostics, quality assurance, clinical team consultation, and reliable product provision. Transfusion medicine is not merely a „supplier“ but also an active partner in indication setting, risk minimization, and therapy optimization. The historical context further illustrates why standardization, training, and adaptability remain crucial today.
The issue addresses key topics: whole blood as the „state of the art,“ including its indications and limitations. It is crucial not to treat whole blood as a mere buzzword but as an important component of the hemotherapeutic „toolbox.“ This essential blood product is subject to structured procedures with responsibilities, quality assurance, and documented processes.
Also covered are massive transfusion protocols and damage-control resuscitation, including the consistent treatment of hypothermia, acidosis, and coagulopathy. The preclinical administration of blood, such as in air rescue, is presented, although it is only sensible with robustly regulated indications, proper storage, documentation, and handover. Patient Blood Management complements this as a patient-centered concept to conserve scarce resources through rational indication setting, minimization of iatrogenic blood loss, and therapy optimization. Finally, training remains central. Concepts like whole blood programs in the field only work with extensive, recurring, and realistically designed courses and training.
The message of this special issue is clear: Blood supply in operations does not arise „spontaneously.“ It must be built, practiced, and further developed in peacetime to function reliably under strain. In this sense, blood is indeed a very special juice – medically, organizationally, and strategically.
Colonel (MC) Dr. Diana Sauer
Commander (Navy MC) Dr. Jan Ammann
Colonel (MC) Prof. Dr. Martin Kulla