Prehospital blood transfusion in prolonged evacuation

Background: Prehospital blood transfusion for hemorrhaging trauma patients has been used infrequently and is controversial. Currently, there is no sat isfactory nonsanguineous fluid therapy for use during prolonged transport, such as in military or rural trauma. Methods: We retrospectively reviewed prehospital data and hospital charts o f all trauma patients in Israel who had received prehospital blood transfus ion during a period of 30 months. Results: Forty patients received 60 U of Ph-positive type O packed red bloo d cells. Mean time from injury to hospital admission was 120 minutes. Twent y-one of 31 patients admitted to the hospital alive (68%) received addition al blood transfusions during the initial resuscitation phase, justifying th e prehospital transfusion. Of nine documented admissions with hemoglobin of less than 7 g/dL, one patient died of exsanguination. There was one case o f a minor adverse reaction that could be attributed to prehospital transfus ion. Conclusion: Prehospital blood transfusion is justified in certain trauma pa tients, especially when long prehospital transport is required. Blood may b e safely maintained and used by physicians with little experience in care o f major trauma.