Prehospital blood administration in trauma care has gained attention as a critical intervention aimed at improving outcomes for severely injured patients. A variety of studies have explored the efficacy and implications of early blood product transfusion in the prehospital setting, particularly in trauma cases characterized by hemorrhagic shock.
Research has consistently demonstrated that delays in initiating transfusion in trauma patients are associated with higher mortality rates. Broome et al. reported that each minute of delay in prehospital administration of blood products or tranexamic acid (TXA) correlated with a 2% increase in the 30-day mortality rate among trauma patients (Broome et al., 2024). Their findings indicate that rapid infusion during transport could significantly affect survival outcomes, an assertion further supported by studies indicating early transfusion leads to better hemodynamic stability and reduced blood requirements within the first 24 hours post-injury (Brown et al., 2015; Sperry et al., 2023).
The implementation of prehospital blood transfusion programs remains limited in many regions primarily due to logistical challenges and varying guidelines. For instance, while some European countries have established robust prehospital blood product administration protocols often involving specialized medical personnel, others lag in adopting similar practices (Rosenbaum et al., 2025; Bjerkvig et al., 2021). In the U.S., despite the potential for up to 900,000 trauma patients to benefit annually from prehospital transfusions, fewer than 1% receive blood products (Duchesne et al., 2024). This gap highlights the need for improved training and resources in emergency medical services (EMS) to facilitate such life-saving interventions (Rangrass, 2022).
Consistent observational data support the viability of prehospital transfusion. Studies have demonstrated that patients receiving prehospital blood products experience substantial reductions in both shock severity upon arrival at trauma centers and overall in-hospital mortality (Naumann et al., 2018; Braverman et al., 2021). A landmark analysis by Levy et al. emphasized that plasma and whole blood administered prehospital had profound effects on mortality in patients suffering from hemorrhagic shock, particularly when transport times exceeded 20 minutes (Levy et al., 2025). Similarly, Shackelford et al. found that early prehospital blood product transfusions, particularly in military settings, resulted in improved survival outcomes (Shackelford et al., 2017).
A notable component of these studies is the exploration of whole blood's role in resuscitation strategies. Research by Braverman et al. highlights the increasing adoption of whole blood transfusions due to its potential advantages over component therapy, including streamlined administration and more effective management of coagulopathy (Braverman et al., 2023). The tangible benefits of whole blood in trauma care align with findings that earlier administration is crucial for optimizing patient outcomes (Pusateri et al., 2020; Napolitano, 2017).
Furthermore, protocols surrounding prehospital blood and plasma transfusion are evolving. The increasing body of evidence necessitates that trauma systems integrate these practices effectively, considering aspects such as shelf-life, storage capability, and the involvement of qualified medical personnel on EMS teams (Hashmi et al., 2022). Successful implementation of these strategies could lead to transformative changes in trauma care delivery, particularly for severe hemorrhagic injuries.
In conclusion, while evidence increasingly supports the benefits of prehospital blood product transfusion for trauma victims, significant barriers to implementation remain. Future research should focus on overcoming logistical constraints, standardizing protocols, and enhancing training for EMS personnel to maximize the potential lifesaving impact of early blood administration in prehospital trauma care.
References:
- Bjerkvig, C., Strandenes, G., Hervig, T., Sunde, G., & Apelseth, T. (2021). Prehospital whole blood transfusion programs in norway. Transfusion Medicine and Hemotherapy, 48(6), 324-331.
https://doi.org/10.1159/000519676
- Braverman, M., Schauer, S., Ciaraglia, A., Brigmon, E., Smith, A., Barry, L., … & Jenkins, D. (2023). The impact of prehospital whole blood on hemorrhaging trauma patients: a multi-center retrospective study. Journal of Trauma and Acute Care Surgery, 95(2), 191-196.
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- Braverman, M., Smith, A., Pokorny, D., Axtman, B., Shahan, C., Barry, L., … & Jenkins, D. (2021). Prehospital whole blood reduces early mortality in patients with hemorrhagic shock. Transfusion, 61(S1).
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- Broome, J., Nordham, K., Piehl, M., Tatum, D., Caputo, S., Belding, C., … & Duchesne, J. (2024). Faster refill in an urban emergency medical services system saves lives: a prospective preliminary evaluation of a prehospital advanced resuscitative care bundle. Journal of Trauma and Acute Care Surgery, 96(5), 702-707.
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- Duchesne, J., McLafferty, B., Broome, J., Caputo, S., Ritondale, J., Tatum, D., … & Piehl, M. (2024). Every minute matters: improving outcomes for penetrating trauma through prehospital advanced resuscitative care. Journal of Trauma and Acute Care Surgery, 97(5), 710-715.
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- Hashmi, Z., Jansen, J., Kerby, J., & Holcomb, J. (2022). Nationwide estimates of the need for prehospital blood products after injury. Transfusion, 62(S1).
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Levy, M., Jenkins, D., Guyette, F., & Holcomb, J. (2025). Bridging the gap: whole blood and plasma in prehospital hemorrhagic shock resuscitation. Trauma Surgery & Acute Care Open, 10(2), e001828.
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- Pusateri, A., Moore, E., Moore, H., Le, T., Guyette, F., Chapman, M., … & Sperry, J. (2020). Association of prehospital plasma transfusion with survival in trauma patients with hemorrhagic shock when transport times are longer than 20 minutes. Jama Surgery, 155(2), e195085.
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- Rangrass, G. (2022). Whole blood use in trauma resuscitation: targeting prehospital transfusion. Current Opinion in Anaesthesiology, 35(2), 146-149.
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- Rosenbaum, R., Dworkin, M., Eisenman, J., Cowan, P., Burch, K., Dattoli, J., … & Frederick, K. (2025). How do we implement a prehospital whole blood administration program for shock trauma patients on a statewide basis?. Transfusion, 65(4), 654-663.
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- Shackelford, S., Junco, D., Powell-Dunford, N., Mazuchowski, E., Howard, J., Kotwal, R., … & Stockinger, Z. (2017). Association of prehospital blood product transfusion during medical evacuation of combat casualties in afghanistan with acute and 30-day survival. Jama, 318(16), 1581.
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- Sperry, J., Cotton, B., Luther, J., Cannon, J., Schreiber, M., Moore, E., … & Guyette, F. (2023). Whole blood resuscitation and association with survival in injured patients with an elevated probability of mortality. Journal of the American College of Surgeons, 237(2), 206-219.
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