Geo-Mapping Using In-Hospital Massive Transfusion Data as a Method for Prehospital Blood Management for Trauma Patients

BACKGROUND: Prehospital whole blood (PHWB) transfusion improves outcomes in trauma patients, but blood products are a scarce and costly resource. We hypothesized that massive transfusion protocol (MTP) activation could be an indicator for trauma patients who might benefit from PHWB, and we used geo-mapping to identify high need zones. STUDY DESIGN: We retrospectively analyzed trauma registry data from five trauma centers in Omaha and Lincoln, Nebraska, including all patients who had MTP activated in the trauma bay from 6/1/2019-3/31/2025. Assault and motor vehicle crash (MVC) data was collected from the Nebraska Department of Transportation and local police databases. Incidence of MTP, assaults, and MVCs was mapped to identify the highest need zones. Chi-square tests of independence and Pearson and Spearman correlations compared MTP incidence by ZIP Code Tabulated Areas (ZCTA's) with known trauma events. RESULTS: A total of 338 MTP patients from Omaha and 89 from Lincoln were included. Geo-mapping revealed a greater need for PHWB in the downtown centers of both cities. Tests of independence showed significant associations between MTP incidence (Omaha: χ² = 741.22, df = 28, p < 0.001; Lincoln: χ² = 43.75, df = 13, p < 0.001). Spearman and Pearson correlations showed a positive linear correlation between MTP incidence and trauma incidence. CONCLUSION: Geo-mapping MTP data strongly correlated with known traumas, supporting MTP activation as a surrogate marker for PHWB need. This offers a novel method for cities to plan PHWB programs by determining high need zones and ensuring equitable and cost-effective distribution of scarce resources.