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340 Prehospital administration of whole blood for civilian traumatic resuscitation
  1. BY Yang1,
  2. CR Counts1,
  3. S Stewart1,
  4. M Dang1,
  5. P Ubaldi2,
  6. EE Tuott3,
  7. JR Hess3,
  8. MR Sayre1
  1. 1Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
  2. 2Seattle Fire Department, Seattle, Washington, USA
  3. 3Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA


Background Hemorrhagic shock is the leading cause of survivable death in trauma patients. Recent guidelines recommend initiation of whole blood transfusion within 30 minutes of injury.1 Little is known about this emerging practice in the civilian prehospital environment.

Aim To describe the process of care for patients who received prehospital low-titer O-positive whole blood (LTOWB).

Method This cohort study evaluated injured patients who received prehospital LTOWB in a US city of over 750,000 persons. Criteria for transfusion were systolic blood pressure (SBP)≤70, SBP<90 and heart rate >110, or witnessed traumatic arrest.2

Results Over 22-months, 57 patients received 74 units of LTOWB. 83% were male, and median age was 34 [IQR 26–46]. The mechanism of injury was 42% from guns, 23% from stabbings, and 35% blunt trauma. Median injury severity score was 26 [IQR 17–41]. Transfusion criteria were SBP≤70 in 35%, SBP<90 and heart rate>110 in 37%, witnessed traumatic arrest in 9%, and none in 19%. Time to blood initiation from the 911 call was 24 minutes [IQR 21–31]. 42% received at least 6 units of additional blood products in the first 4 hours after hospital arrival. Of those not meeting criteria, 73% received additional blood products in the first 4 hours. 98% received surgical intervention in the first 24 hours. Survival to discharge was 65%. Limitations include lack of a comparison group.

Conclusion Patients receiving LTOWB were severely injured. The prehospital system succeeded in starting LTOWB within 30 minutes.


  1. Shackelford SA, Gurney JM, Taylor AL, Keenan S, Corley JB, Cunningham CW, Drew BG, Jensen SD, Kotwal RS, Montgomery HR, Nance ET, Remley MA, Cap AP; Joint Trauma System Defense Committee on Trauma; Armed Services Blood Program. Joint Trauma System, Defense Committee on Trauma, and Armed Services Blood Program consensus statement on whole blood. Transfusion 2021 Jul;61(Suppl 1):S333-S335. doi: 10.1111/trf.16454. PMID: 34269445.

  2. Sperry JL, Guyette FX, Brown JB, Yazer MH, Triulzi DJ, Early-Young BJ, Adams PW, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Witham WR, Putnam AT, Duane TM, Alarcon LH, Callaway CW, Zuckerbraun BS, Neal MD, Rosengart MR, Forsythe RM, Billiar TR, Yealy DM, Peitzman AB, Zenati MS; PAMPer Study Group. Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. N Engl J Med 2018 Jul 26;379(4):315–326. doi: 10.1056/NEJMoa1802345. PMID: 30044935.

Conflict of interest None.

Funding None.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: .

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