THOR-AABB Working Party Recommendations for a Prehospital Blood Product Transfusion Program

Prehosp Emerg Care. 2022 Nov-Dec;26(6):863-875. doi: 10.1080/10903127.2021.1995089. Epub 2021 Nov 19.


The evidence for the lifesaving benefits of prehospital transfusions is increasing. As such, emergency medical services (EMS) might increasingly become interested in providing this important intervention. While a few EMS and air medical agencies have been providing exclusively red blood cell (RBC) transfusions to their patients for many years, transfusing plasma in addition to the RBCs, or simply using low titer group O whole blood (LTOWB) in place of two separate components, will be a novel experience for many services. The recommendations presented in this document were created by the Trauma, Hemostasis and Oxygenation Research (THOR)-AABB (formerly known as the American Association of Blood Banks) Working Party, and they are intended to provide a framework for implementing prehospital blood transfusion programs in line with the best available evidence. These recommendations cover all aspects of such a program including storing, transporting, and transfusing blood products in the prehospital phase of hemorrhagic resuscitation.

Keywords: emergency; plasma; prehospital transfusion; recommendations; red blood cells; whole blood.

MeSH terms

  • Blood Transfusion
  • Emergency Medical Services*
  • Hemorrhage / therapy
  • Hemostasis
  • Humans
  • Resuscitation
  • Wounds and Injuries*