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iii
Preface
The Joint military community provides a wide array of medical support services to
its personnel. As in the civilian medical sphere, an essential component of that care is
the provision of blood and blood products to patients, both in the United States and
overseas. Blood is important not only for its use in a variety of medical therapies and
treatments, but also for its utility to surgical patients and trauma victims. Ensuring
that blood and blood products remain safe and available for patients requires sophisti-
cated logistical support, especially for the military community’s provision of blood to
its medical operations around the globe.
However, some operating environments that the U.S. military might face in the
future could lead to challenges in the operation of the blood supply chain, especially in
sourcing, storage, and distribution. For example, peer and near-peer adversaries could
conduct large-scale combat operations with a capability to significantly degrade the
freedom of movement for U.S. forces. In those environments, combat action could
result in significant demand spikes for blood while simultaneously limiting the capacity
to transport products to forward operating locations. The Defense Advanced Research
Project Agency’s (DARPA’s) Defense Sciences Office asked the RAND Corporation to
examine these challenges and to explore mechanisms that might offer greater resiliency
in the military’s management of its blood supply chain operations.
This report is oriented toward a general readership interested in learning about
blood supply chains, the challenges they may face, and mechanisms to strengthen
them. Medical professionals with an interest in blood should also find the analysis of
value, especially in its presentation of frameworks for exploring supply chain resiliency.
Logisticians and supply chain managers for other product lines may find the examina-
tion of the blood supply chain useful as an analogue for exploring resiliency in their
own operations.
This research was sponsored by DARPA and conducted within the Acquisition
and Technology Policy Center of the RAND National Defense Research Institute, a
federally funded research and development center sponsored by the Office of the Sec-
retary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the
Marine Corps, the defense agencies, and the defense Intelligence Community.
ivToward Resiliency in the Joint Blood Supply Chain
For more information on the RAND Acquisition and Technology Policy Center,
see /nsrd/ndri/centers/atp or contact the director (contact information is
provided on the webpage).
v
Contents
Preface .iii
Figures and Tables ...........vii
Summary ..........ix
Acknowledgments ...........xv
Abbreviations ...xvii
CHAPTER ONE
An Introduction to the Joint Blood Supply Chain .........1
Blood and Blood Products ....1
Elements in the Joint Blood Supply Chain .........6
Organization of This Report .9
CHAPTER TWO
Developing a Blood Supply Chain Framework 11
A Qualitative Supply Chain Framework ...........11
Using the Blood Supply Chain Framework to Evaluate System Stressors ..........14
Adding Resiliency to the Blood Supply Chain ....17
Conclusions ........19
CHAPTER THREE
Enhancing Upstream Resiliency of the Blood Supply Chain .......21
Augmenting Blood Delivery by Airdrop or Unmanned Aerial Vehicle 21
Implementing Whole Blood Collection Protocols ...........24
Sourcing Blood from Partner Nations .26
Producing Red Blood Cells in Vitro ...28
Conclusions ........29
CHAPTER FOUR
Enhancing Local and Downstream Resiliency of the Blood Supply Chain ..31
Expediting the Processing of Frozen Red Blood Cells ........31
Extending the Shelf-Life of Blood......32。