In March 1999, Slobodan Milosevic and the Yugoslavian government refused to accept and comply with the terms of the United Nations Security Resolution (UNSR) 1199. The primary goals of UNSR 1199 were the immediate and unconditional withdrawal of Serbian military forces from the Kosovo province and an end to "ethnic cleansing" activities against Kosovar Albanians. As a result, the North Atlantic Treaty Organization (NATO) commenced Operation Allied Force, a phased air bombing campaign on 20 March. The United States (U.S.) identified their portion of this operation as Operation Noble Anvil. There was also a concurrent NATO humanitarian operation called Allied Harbour. The U.S. called their piece of the operation Joint Task Force (JTF) Shining Hope. JTF Shining Hope was an operation to support the Albanian refugees fleeing Kosovo.
As Operation Noble Anvil proceeded, the United States European Command (USEUCOM) established operating bases throughout the European continent. The USEUCOM Office of the Command Surgeon, along with JTF and component medical planners, developed plans to provide medical support to the deployed forces scattered throughout Europe. Medical planners established various Level II and Level II(+) medical treatment facilities (MTFs) throughout the region. The USEUCOM Command Surgeon designated Landstuhl Regional Medical Center (LRMC), Landstuhl, Germany, as the central receiving Level III MTF. The USEUCOM Joint Blood Program Office (JBPO) developed a blood distribution plan to support the deployed MTFs. Early in the operation, there were only two primary deployed MTFs, the 67th Forward Surgical Team (FST) out of Wuerzburg, Germany, and the 212th Mobile Army Surgical Hospital (MASH) out of Wiesbaden, Germany. Along with these two MTFs, the Air Force deployed an Expeditionary Medical System (EMEDS) to support JTF Shining Hope. The EMEDS had limited surgical capability and was located adjacent to the 212th MASH. Since their primary mission was refugee support and support to troops building and protecting the refugee tent city, the EMEDS Surgeon and the JBPO decided that the EMEDS could utilize the blood inventory at the 212th MASH, if required. With just these two primary MTFs to support, the five USEUCOM blood donor centers (BDC) were able to provide all of the blood products to meet existing requirements.
The JBPO considered two main issues as the blood support plan developed. The first issue was the location of the MTFs. The 67th FST and the 212th MASH were located too far apart to consider deploying a Blood Supply Unit (BSU) to the region. Deployment of a BSU would not be practical, considering a BSU generally works in conjunction with the established Class VIII medical supply lines. USEUCOM was shipping all of the medical supplies from the central European region to airheads located near each of the MTFs and the blood program was able to utilize the same supply lines. The US Army Europe (USAREUR) BDC, located at LRMC, functioned as a BSU and provided blood shipments downrange via Ramstein AFB.
The second issue was the laboratory and blood bank staffing at each of the MTFs and how they could respond to a mass casualty situation. The 212th MASH had two lab/blood bank technicians and the 67th FST had one technician. This meant that they did not have enough staff to conduct basic clinical lab tests in addition to the blood bank work. The JBPO felt that even though a MASH is considered a Level III facility, their lab staffing was essentially at Level II. So, it would be safer to keep both MTF's inventory strictly Type O packed red blood cells (85% Rh positive and 15% Rh negative). With this in mind, the JBPO tasked the five BDCs to send Type O packed red blood cell (PRBC) units to the USAREUR BDC specifically for Kosovo operations. This requirement was in addition to their support to operations in Bosnia. The BDCs at Navy Hospital Rota, Navy Hospital Sigonella, and Navy Hospital Naples provided two (2) Type O positive and one (1) Type O negative PRBC every four (4) weeks. The BDC at Lakenheath, UK, provided two (2) Type O positive and one (1) Type O negative PRBC every two (2) weeks. The USAREUR BDC, being the largest BDC in USEUCOM, provided seven (7) Type O positive and three (3) Type O negative PRBC every two (2) weeks. At this point in the operation, the USEUCOM BDCs were able to meet the blood requirements without CONUS support.