Estimated blood storage requirements for a North Korean invasion of South Korea and South Korea's preparedness.

Purpose: Hemorrhage is the leading cause of preventable battlefield deaths, and up to 30% of casualties could survive with timely transfusions. In a potential North Korea-South Korea conflict, ensuring adequate blood supply would be crucial for military medical readiness. This study estimated the 2-week blood demand in such a conflict and evaluated South Korea's preparedness to meet it.

Methods: A multifaceted approach was employed, incorporating historical casualty data, medical literature on battlefield transfusions, South Korean blood supply reports, and military blood logistics models. Projections indicate 80,000 to 150,000 casualties within the first 2 weeks, with 30% of military and 15% of civilian casualties requiring transfusions. The estimated total blood demand ranges from 360,000 to 600,000 L, surpassing current South Korean reserves.

Results: Despite a 100,000-L prewar storage goal, weekly replenishment needs could reach 150,000 to 300,000 L, placing immense strain on collection, storage, and distribution systems. Key shortages include packed red blood cells, fresh frozen plasma, and platelets, with projected deficits of up to 120,000, 70,000, and 30,000 units, respectively. The logistical challenges of storing and transporting platelets, given their 5-day shelf life, make them particularly vulnerable to depletion. To address these shortages, a multipronged strategy is required, including pre-war stockpiling, mobile blood banks, rapid military-civilian coordination, international cooperation with US and other allies, and prioritization of whole blood over component therapy.

Conclusions: South Korea's current blood reserves are insufficient for a large-scale war. A combination of strategic stockpiling, military-civilian coordination, and alternative blood sources (synthetic oxygen carriers, prewar autologous donation programs) is essential to sustaining medical operations and improving survival rates.