The bleeding starts before the hospital. The key physiological problem is inadequate oxygen delivery. Can we restore it in time?
Within minutes, severe hemorrhage can reduce perfusion and tissue oxygen delivery - long before definitive hospital care is reached.
From prehospital blood transfusion to prehospital Precision Oxygen Therapeutics: support a sustainable oxygen-delivery response while hemorrhage control and donor blood remain central standards of care.
Blood Collection Capacity Does Not Equal Available Blood
NHSBT increased available whole-blood collection capacity by 7.6% from 2022/23 to 2025/26, while successful donations decreased by 3.4%. The analysis shows a measurable gap between nominal collection capacity and blood that successfully enters the supply pathway.
Read the full evidence analysis →From prehospital blood transfusion to a sustainable oxygen-delivery response.
More than 400 US ground EMS programs now carry blood, yet fewer than 3% of eligible agencies do. The gap is both operational and physiological: blood may be unavailable or delayed, and restoring hemoglobin alone does not always guarantee adequate microvascular and tissue oxygenation.
Nearly half may die before reaching the hospital.
PHBTC reports more than 10,000 US deaths from severe blood loss each year, with nearly half occurring before hospital arrival - roughly 14 prehospital deaths per day. This describes the size of the mortality window, not a guaranteed preventable fraction.
Blood loss is visible. Tissue oxygen debt is the downstream problem.
Hemorrhage control and transfusion remain primary. But the functional endpoint is not the hemoglobin number alone - it is effective oxygen delivery to tissue. Microvascular flow, oxygen unloading and perfusion can remain limiting even after blood is given.
A temporary crisis in wealthy systems. A persistent access crisis elsewhere.
The American Red Cross declared national blood crises in 2022 and 2026. Globally, WHO documents much deeper access gaps: many low- and middle-income systems struggle to maintain reliable blood supplies.
National blood crises declared in the US since 2022
January 2022 and July 2026. This is a US example, not a claim that every country experiences the same pattern. The underlying supply-and-access problem is global and often more persistent in low- and middle-income settings.
Read full analysis: Blood Collection Capacity Does Not Equal Available Blood →
Prehospital Blood Transfusion is now a dedicated EMS.gov topic.
EMS.gov now highlights Prehospital Blood Transfusion as a dedicated EMS issue and features a special implementation series focused on building and operating prehospital blood programs.
Prehospital Blood Transfusion in Practice: Building Your Own Program
The series covers blood-supplier partnerships, program development, financing, clinical protocols, training and performance monitoring.
Additional program & system sources
Related sources on prehospital blood-program growth, blood availability and implementation.
Reuse the evidence library.
Prehospital Precision Oxygen Therapeutics.
Donor blood remains central. The research question is whether a validated complementary oxygen-delivery therapeutic could bridge periods when blood is unavailable or delayed - or when transfusion alone does not adequately restore tissue oxygenation.
Educational evidence page. Daily mortality figures are simple conversions of PHBTC annual estimates and are not projected treatment benefits. BHOC relevance is presented as a research question; no efficacy claim is made.