The United States faces a "bloody transfusion problem" that is fueling preventable deaths and putting national security at risk, three military and civilian physicians write in a JAMA opinion essay.
The JAMA op-ed, published Oct. 12, highlights blood transfusions' importance in emergency care. Emergency transfusions can decrease deaths, especially when given early, the physicians write. But not enough health-care facilities and emergency vehicles are equipped for the procedures, they add, and that presents a "substantial risk to our nation's security infrastructure."
One reason is the national blood supply, which the writers call "tenuous" because of its reliance on volunteers, as well as problems with blood storage and the places where blood is collected and processed.
The physicians cite a 2020 Health and Human Services report that characterized the national blood supply system as "struggling." That report said blood availability is hindered by issues with donor recruitment, an aging donor population and problems funding collection centers.
As a result, not enough blood products are available in hospitals, they write. "Of the 2045 hospitals to which the American Red Cross supplied blood components in 2019, 33% did not routinely have platelets ready to transfuse to bleeding patients," they write. Most were in rural settings.
In contrast, transfusions are common on the battlefield and have been part of the Defense Department's "damage control resuscitation" protocol for nearly two decades. That standard of care calls for battlefield physicians to administer plasma, platelets and red blood cells to resuscitate patients in hemorrhagic shock, often before they reach the hospital.
Similar early transfusions have been associated with better survival rates in civilians, too, but the researchers say more is needed to expand such programs and equip ambulances and evacuation services.
Better collaboration between government agencies, academics, the military and civilian trauma centers could produce lasting change, the researchers write, but it will take a lasting, sustained effort to bolster infrastructure and make transfusions available to all.
Meanwhile, a national blood shortage continues. In September, the American Red Cross made a plea for more donors to help boost the nation's blood supply.
"The need for blood is constant," the organization wrote. "Every two seconds, someone in the U.S. needs blood - an often-invisible emergency that the rest of the world doesn't see."