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Nationwide pediatric prehospital blood product use after motor vehicle crashes 2020-2023

Chandler A Annesi1,2, Christine Carico1,3, Daniel T Lammers4

  • 1Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Transfusion
|February 13, 2026
PubMed

Insights

Prehospital blood transfusions are underutilized in pediatric trauma patients after motor vehicle crashes (MVCs). Only 2% of eligible children received this life-saving intervention, highlighting a critical gap in care.

Area of Science:

  • Pediatric Trauma Care
  • Emergency Medicine
  • Transfusion Medicine

Background:

  • Prehospital blood transfusion in pediatric hemorrhagic shock improves survival.
  • Understanding current demand is crucial for optimizing prehospital blood use in children.
  • This study examines prehospital blood resuscitation for pediatric motor vehicle crash (MVC) trauma.

Purpose of the Study:

  • To quantify and understand the demand for prehospital blood transfusion in pediatric MVC patients.
  • To assess the current utilization rates of prehospital blood resuscitation.
  • To identify potential areas for improving blood availability for pediatric trauma.

Main Methods:

  • Identified hypotensive pediatric patients (≤14 years) from the National Emergency Medical Services Information System (NEMSIS) database (2020-2023).
  • Defined hemodynamic instability using age-specific systolic blood pressure and heart rate criteria.
  • Calculated the number and percentage of children receiving prehospital blood products.

Main Results:

  • 391,764 children were involved in MVCs; 1913 (0.5%) were eligible for prehospital blood transfusion.
  • Only 39 (2%) of eligible pediatric patients received prehospital blood.
  • Eligible patients were typically older children (>10 years) and involved in urban MVCs.

Conclusions:

  • Prehospital blood resuscitation is significantly underutilized in hemodynamically unstable pediatric MVC patients.
  • There is an urgent need to evaluate and address barriers to increased prehospital blood utilization.
  • Improving access to prehospital blood can enhance survival rates for critically injured children.
Abstract

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