The mortality from hemorrhage in trauma patients remains high. Early balanced resuscitation improves survival. These truths, balanced with the availability of local resources and our goals for positive regional impact, were the foundation for the development of our pre-hospital whole blood initiative-using low titer cold stored O RhD positive whole blood (LTOWB). The main concern with use of RhD positive blood is the potential development of isoimmunization in RhD negative patients. We used our retrospective massive transfusion protocol (MTP) data to analyze the anticipated risk of this change in practice. In 30 months, out of 124 total MTP patients, only one female of childbearing age that received an MTP was RhD negative. With the risk of isoimmunization very low and the benefit of increased resources for the early administration of balanced resuscitation high, we determined that utilization of LTOWB would be safe and best serve our community.

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