Young PP, Wood D, Holcomb JB, Jenkins DH, Levy MJ.

Transfusion. 2026 Jul 18. doi: 10.1111/trf.70325. Online ahead of print.

PMID: 42470163

This Red Cross led study evaluated via modeling the impact of scaling prehospital transfusion nationally would require significant new blood collection, up to 1.1 million additional units annually at 50% deployment, an 8%–24% increase over current U.S. collections. Low-titer O whole blood (LTOWB) is the key constraint, potentially requiring 550,000 new donors, while liquid plasma (LP) demand could be met through redistribution alone. Hospital rotation of unused units is critical to reduce waste, and costs diverge sharply: $540 million for LTOWB versus $47 million for LP at scale. The authors conclude a hybrid LTOWB–LP strategy offers the most practical path forward, requiring coordinated EMS-hospital systems and targeted donor recruitment investment.

Why this matters: As more EMS agencies and trauma systems across the U.S. move to add prehospital blood transfusion capability, this paper offers one of the first data-driven assessments of whether the blood supply can actually support that expansion at scale. It shifts the conversation from "should we do this" to "can the system sustain it", flagging donor recruitment and cost as the real bottlenecks, not just clinical protocols or EMS readiness. That makes it directly relevant to blood bank planning, EMS policy, and funding decisions as programs scale beyond pilot sites.