BACKGROUND Despite countless advancements in trauma care a survivability gap still exists in the prehospital setting. Military studies clearly identify hemorrhage as the leading cause of potentially survivable prehospital death. Shifting resuscitation from the hospital to the point of injury has shown great promise in decreasing mortality among the severely injured. MATERIALS AND METHODS Our regional trauma network (Southwest Texas Regional Advisory Council) developed and implemented a multiphased approach toward facilitating remote damage control resuscitation. This approach required placing low‐titer O+ whole blood (LTO+ WB) at helicopter emergency medical service bases, transitioning hospital‐based trauma resuscitation from component therapy to the use of whole blood, modifying select ground‐based units to carry and administer whole blood at the scene of an accident, and altering the practices of our blood bank to support our new initiative. In addition, we had to provide information and training to an entire large urban emergency medical system regarding changes in policy. RESULTS Through a thorough, structured program we were able to successfully implement point‐of‐injury resuscitation with LTO+ WB. Preliminary evaluation of our first 25 patients has shown a marked decrease in mortality compared to our historic rate using component therapy or crystalloid solutions. Additionally, we have had zero transfusion reactions or seroconversions. CONCLUSION Transfusion at the scene within minutes of injury has the potential to save lives. As our utilization expands to our outlying network we expect to see a continued decrease in mortality among significantly injured trauma patients.

Introduction The implementation of a low-titer O+ whole blood (LTOWB) resuscitation algorithm, particularly in the prehospital environment, has several inherent challenges, including cost, limited and inconsistent supply, and the logistics of cold-chain management. The Southwest Texas Regional Advisory Council has implemented the nation’s first multidisciplinary, multi-institutional regional LTOWB program. This research effort was to illustrate the successful deployment of LTOWB within a regional trauma system. Materials and Methods A deliberate systems approach to the deployment of LTOWB was used. Tenets of this program included the active management of blood donor sources and blood supply levels to minimize wastage as a result of expiration, maximize product utilization, the use of prehospital transfusion triggers, and efforts to decrease program costs prehospital agencies. A novel LTOWB rotation system was established using the concept of a “rotation site” and “rotation center.” Standardized transfusion criteria, a regional approved equipment list, a regional Prehospital Blood Product Transfusion Record, and a robust multilevel communication plan serves as the framework for the program. The San Antonio Whole Blood Consortium was developed to create a consensus driven forum to manage and guide the program. Results From January 2018 to October 2019, LTOWB has been placed at 18 helicopter emergency medical services (HEMS) bases, 12 ground emergency medical service (EMS) agencies, 1 level I trauma center, and 1 level IV trauma center. A total of 450 patients have received a prehospital LTOWB transfusion. Program wide, the wastage rate of LTOWB due to expiration is between 1% and 2%. No complications related to prehospital LTOWB administration have been identified. Discussion This work demonstrates a novel model for the development of a trauma system LTOWB program. The program’s implementation augments remote damage control resuscitation strategies and requires the integration and collaboration of a multidisciplinary stakeholder team to optimize efficiency, performance, and safety of the program.

Background: Spinal protection during emergency medical service (EMS) transport after trauma has become a focus of debate. Historically, patients at risk for spine injury are transported in a rigid collar, long spineboard and headblocks. The cervical collar (c-collar) is hypothesized to provide stabilization for the cervical spine. However, little is known how the c-collar affects cervical blood flow.Methods: Cerebral blood flow was measured in multiple conditions using a non-invasive cerebral blood flow monitor to establish cerebral blood flow index (CBFI). The CBFI data were collected at: standing, sitting, 45°, 30°, 10° or 15°, and supine, with and without c-collar. Descriptive statistics were used for CBFI in each condition, and parametric statistical methods were utilized to determine the significance of changes in CBFI.Results: Five volunteers were recruited, and each tested in six positions with and without c-collar. Mean age was 49 (standard deviation (SD) 15) years and 60% were male. The CBFI mean of means was 71.0 with and 69.4 without the c-collar. Only one subject demonstrated a statistically significant difference in CBFI with c-collar. The CBFI mean of means for position was 72.6 for head of bed less than 30° and 68.1 for greater than 30°. All subjects demonstrated > 99% confidence for a statistically significant difference in CBFI when dichotomized using head of bed at 30°. Conclusions:Head of the bed position has greater influence on CBFI than the c-collar . Clinical significance in healthy volunteers is unknown but this change in cerebral blood flow may have clinical significance in traumatic brain injury or neurologic conditions that compromise autoregulation.

Background: Recent evidence suggests that long spine board (LSB) may do little to manage spinal motion, and pose increased risk. This project sought to measure cervical and thoracolumbar motion during ambulance transport. The hypothesis was transport on a mattress with the head elevated without the LSB would allow less spinal movement than transport on an LSB. Methods: A randomized healthy volunteer crossover trial measured spinal motion using biometric sensors. Positions analyzed included 0 and 10° on LSB. Stretcher alone with head elevated to 10°, 30°, 45° and 60°, with and without head blocks. Simulated ambulance transport was on city streets at or below posted speed limits. Results: Nine subjects were included, with 66% being male. For cervical movement, there was no difference in axial, flexion/extension, or rotation (0.2 ± 0.1 mm vs. 0.2 ± 0.1 mm, 24 ± 12 mm vs. 22 ± 10 mm, and 5.1 ± 19° vs. 5.8 ± 20°, respectively). There were significant differences in lateral (3.7 ± 7 mm LSB vs. 2.0 ± 5 mm no LSB) movement and volumetric movement of the head (120 ± 172 mm 3 LSB vs. 77 ± 86 mm 3 no LSB). Positions allowing the lowest mean cervical volume of head movement were bed elevated to 30° and 45° with head blocks, (20 ± 22 mm 3 and 12 ± 6 mm 3 , respectively). For thoracolumbar movement, there was no statistical difference in threedimensional volumetric movement of the thoracolumbar spine (2 ± 0.6 mm 3 LSB vs. 4.7 ± 5 mm 3 no LSB). Conclusion: Spinal motion was small in all groups. The stretcher mattress without LSB allowed less cervical motion than the LSB. Subjects secured to a stretcher mattress with head of the bed elevated to 30° had the least spinal movement.