Implementing a whole blood pilot program in a rural trauma system: A feasibility, utilization, and cost analysis

Fouad Saeg; Christopher L Berry; Barbara Tubby; Lisa LaRock; Steven R Casos; Robert Behm; Sayre, Pennsylvania

doi:10.1097/TA.0000000000005019

Implementing a whole blood pilot program in a rural trauma system: A feasibility, utilization, and cost analysis

J Trauma Acute Care Surg. 2026 Apr 27. doi: 10.1097/TA.0000000000005019. Online ahead of print.

Authors

Fouad Saeg¹, Christopher L Berry, Barbara Tubby, Lisa LaRock, Steven R Casos, Robert Behm; Sayre, Pennsylvania

Affiliation

¹ Division of Trauma and Acute Care Surgery, Robert Packer Hospital (F.S., L.L., S.R.C., R.B.); Division of Emergency Medicine, Robert Packer Hospital (C.L.B.); Department of General Surgery, Blood Bank, Guthrie Medical Group Laboratories (B.T.), Sayre, PA.

PMID: 42425697
DOI: 10.1097/TA.0000000000005019

Abstract

Background: Hemorrhage is a leading cause of preventable trauma death, particularly in rural settings where prolonged transport times delay resuscitation. Low-titer O+ whole blood (LTOWB) is increasingly favored for prehospital resuscitation due to its combined oxygen-carrying and hemostatic properties. However, logistical challenges and concerns regarding waste and cost have limited its implementation in rural trauma systems. This study evaluates the feasibility and clinical utility of a prehospital LTOWB pilot program at a rural Level I trauma center.

Methods: We conducted a prospective, single-center pilot study from April 2023 to March 2024, comparing LTOWB data to historical component therapy from the prior year. One unit of LTOWB was deployed weekly to the Helicopter Emergency Medical Services. To mitigate waste, unutilized LTOWB was converted to packed red blood cells on Day 14 post collection. Data on utilization, waste, cost, and availability were collected and analyzed.

Results: During the 55-week period, 55 units of LTOWB were deployed, of which 45.5% were used as LTOWB (27.3% prehospital, 18.2% in-hospital) and 47.3% as processed packed red blood cells. Only four units (7.2%) were lost to waste or expiration. The average monthly waste cost was $1,576.79 during the study versus $1,493.89 historically (p = 0.692). Despite supply limitations, prehospital LTOWB availability was maintained for 84.2% of the study days.

Conclusions: Implementing a prehospital LTOWB pilot program in a rural trauma system is feasible and cost-neutral. A structured processing protocol achieves high utilization while minimizing waste. These findings support the expansion of whole blood programs to enhance early resuscitation and potentially improve patient outcomes in resource-limited environments. (J Trauma Acute Care Surg. 2026;00: 00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).

Level of evidence: Economic/Value-based Evaluations, Level III.

Keywords: Whole blood; prehospital; rural; transfusion; trauma.