Scaling of prehospital blood: A model describing impact on U.S. blood donors, distribution and cost

BACKGROUND: Prehospital transfusion improves survival in traumatic and medical hemorrhage, but the blood supply implications of scaling this capability across U.S. emergency medical services (EMS) systems are unclear. STUDY DESIGN AND METHODS: We developed an analytic model incorporating national estimates of prehospital transfusion demand, EMS station deployment, product shelf life, hospital rotation practices, donor availability, and unit costs. We modeled deployment to 10% (approximately 4200) and 50% (approximately 21,000) of U.S. EMS stations. Low-titer group O whole blood (LTOWB) and liquid plasma (LP) were evaluated separately. Outcomes included units shipped to EMS, units rotated to hospitals, total units collected, discard with and without hospital rotation, LTOWB donor requirements, and annual product costs. RESULTS: Implementation required approximately 148,000-220,000 units annually at 10% deployment and 741,000 to 1.1 million at 50%, representing an 8%-24% increase over current U.S. whole-blood collections. LTOWB was the principal constraint, requiring about 110,000 new donors at 10% deployment and up to 550,000 at 50%. LP demand could be met through redistribution from existing collections without new donor recruitment. Hospital rotation substantially reduced discard. At 50% deployment, annual costs exceeded $540 million for LTOWB versus approximately $47 million for LP. CONCLUSION: National-scale prehospital transfusion will require coordinated EMS-hospital rotation, major donor recruitment for LTOWB, and targeted investment. A hybrid LTOWB-LP strategy may provide the most feasible path to broader implementation.