Prehospital Whole Blood Transfusion During Medically Directed Rescue of an Entrapped Trauma Patient: A Case Report

Prehospital blood programs and Hospital Emergency Response Teams (HERT) have independently emerged to address critical gaps in early trauma care, particularly when rapid transport is not feasible. We describe a case demonstrating coordinated use of these capabilities during a prolonged and complex medically directed rescue. A multi-agency response, involving a fire-based paramedic unit with prehospital blood capability, an Urban Search and Rescue (US&R) team, and a HERT for physician-level on scene care, managed an entrapped patient following a major motor vehicle collision. Prolonged extrication necessitated extended field care, including advanced airway management, finger thoracostomies, and multiple units of O-positive low-titer group O whole blood (O-positive LTOWB) to treat hemorrhagic shock in the prehospital setting . This case demonstrates that coordinated integration of prehospital blood programs can enhance medically directed rescues of patients with prolonged entrapment. Notably, the blood units deployed with the HERT were supplied through the regional prehospital blood transfusion program and redistributed to the trauma center prior to the response, demonstrating bidirectional integration of blood resources across prehospital and hospital systems.