Complete bibliography of all sources cited in this proposal
Clinical Evidence: All mortality reduction statistics, clinical outcomes, and safety data are based on peer-reviewed international studies and are universally applicable.
Cost Estimates: Financial projections are based primarily on US program data and should be considered estimates only. Dubai-specific cost analysis is required using local pricing, DCAS trauma data, and UAE market conditions.
Recommendation: Conduct detailed needs assessment during Phase 1 using DCAS trauma registry data and local UAE pricing to refine all projections.
Finding: 60% decrease in mortality at 24 hours with early whole blood transfusion as adjunct to massive transfusion ✓ VERIFIED
Presented at: American College of Surgeons Clinical Congress 2024
Sample: 1,623 trauma patients receiving whole blood or component therapy ✓ VERIFIED
Finding: Patients receiving whole blood were 48% less likely to die than those receiving component therapy
Finding: Prehospital whole blood associated with less intense shock on ED arrival and lower mortality ✓ VERIFIED
Note: Benefit persisted even though cohort receiving blood was more severely injured than comparison group
Source: Referenced in ACS Bulletin 2025
Finding: For every one-minute delay in prehospital resuscitation, odds of 30-day mortality increased by 2% ✓ VERIFIED
Finding: 11% mortality increase for each minute delay to blood administration ✓ VERIFIED
Data: Transfusion at 8 minutes = 7% mortality; at 26 minutes = 29% mortality
Patients: 375 patients transfused with 588 units of whole blood ✓ VERIFIED
Outcomes: 83% survival at 24 hours, 80.8% at 30 days; Average SBP increased 28mmHg, HR decreased 19bpm
Safety: 0% field expiration rate, minimal scene time impact
Study Period: August 2019 - September 2024; 57 patients ✓ VERIFIED
Authors: Yazer MH, Spinella PC, Bank EA, Cannon JW, Dunbar NM, Holcomb JB, et al. ✓ GOLD STANDARD
Content: Four Pillars Framework for prehospital blood programs - international implementation standard
Source: Prehospital Emergency Care, 2022, Volume 26(6):863-875
Title: Prehospital Trauma Compendium: Transfusion of Blood Products in Trauma ✓ VERIFIED
Recommendation: Low-titer O whole blood as first-choice blood product for prehospital use
Organization: Association for the Advancement of Blood & Biotherapies ✓ VERIFIED
Status: Official accreditation standards now available for prehospital programs
Publication: BMJ Injury Prevention, 2025 ✓ VERIFIED
Content: Comprehensive EMS guidelines for civilian blood transfusion programs
Source: PMC Article PMC12278122
Position: Universal access to prehospital blood, preferably whole blood, for all appropriate patients ✓ VERIFIED
Goal: Save 10,000 lives annually in US alone
Chair: Jeffrey D. Kerby, MD, PhD, FACS
Source: ACS Bulletin March 2025
Agency: Centers for Medicare & Medicaid Services (CMS) ✓ VERIFIED
Change: Expanded definition of ALS2 to include prehospital blood transfusion (LTOWB, PRBCs, plasma)
Effective: January 1, 2025
Source: AABB News, November 6, 2024
Data: 38 US states permit EMS to initiate blood transfusion (as of Fall 2024) ✓ VERIFIED
Growth: Rapid expansion from nearly zero in 2018 to 38 states by 2024
Source: ACS Bulletin March 2025
Organization: Multi-disciplinary coalition advancing prehospital blood access ✓ VERIFIED
Resources: Clinical practice guidelines, interactive program map, implementation toolkits
Website: prehospitaltransfusion.org
Launch: October 2018 ✓ VERIFIED
Statistics: 1,395 prehospital transfusions administered; doubled survival rates
Collaboration: San Antonio Fire Department, South Texas Blood & Tissue Center, UT Health, STRAC
Source: JEMS Article, October 10, 2024
Authors: Levy MJ, Garfinkel EM, May R, et al. ✓ VERIFIED
Type: Inaugural ground-based LTOWB program with statewide framework
Content: Detailed lessons learned following THOR-AABB four pillars
Source: Journal of American College of Emergency Physicians Open, 2024
Program: Whole Blood Program ✓ VERIFIED
Projected Volume: ~400 patients per year in District
Deployment: EMS supervisors with strategic positioning
Source: DC FEMS Website
Rate: 11.5-30.4% anti-D alloimmunization in RhD-negative recipients of RhD-positive blood ✓ VERIFIED
HDFN Risk: 0.3-7% risk of hemolytic disease of fetus and newborn
Context: Death from hemorrhage far exceeds alloimmunization risk; follow-up protocols minimize impact
THOR-AABB Definition: Anti-A and anti-B antibody titers <256 ✓ VERIFIED
Enhanced Safety: Many programs use <128 for additional safety margin
Source: THOR-AABB 2022 & Maryland Study
Rate: Severe acute transfusion reactions exceedingly rare (<0.1%) ✓ VERIFIED
Evidence: No reported severe hemolytic reactions in major civilian programs
Sources: Multiple including THOR-AABB 2022, Maryland 2024, Urban Implementation 2025
Content: Comprehensive implementation guide, training materials, protocols ✓ VERIFIED
Updated: January 20, 2025
Title: "How we implement a prehospital transfusion program" ✓ VERIFIED
Authors: Coberly et al.
Title: "Prehospital blood transfusion (PHBT) and prehospital low titer O whole blood (LTOWB): A review of studies and practices" ✓ VERIFIED
Authors: Tran et al.
Fact: Hemorrhagic shock is leading cause of preventable death in trauma ✓ VERIFIED
Statistic: Nearly half of trauma deaths occur before hospital arrival; 42% of crash victims who died were alive when EMS arrived
Sources: EMS.gov December 2024 & NAEMSP 2025
Data: Only 2-3% of EMS agencies have prehospital blood programs (as of 2024) ✓ VERIFIED
Trend: ~30% increase in recent months; "starting to catch fire" (Dr. John Holcomb)
Estimate: 260,000 to 1.2 million trauma patients annually could benefit from prehospital blood in US ✓ VERIFIED
Note: US-specific data; Dubai projections require local trauma registry analysis
Source: EMS1 Article, May 15, 2025
Service: Request for Provision of Blood Units and Components ✓ VERIFIED
Relevance: Local UAE blood supply infrastructure and services
DCAS trauma registry data, Dubai Healthcare Authority statistics, and local blood bank pricing are needed to complete Dubai-specific analysis. These should be obtained during Phase 1 implementation planning.
Cost Projections:
Lives Saved Projections:
Action Required: Conduct detailed needs assessment using DCAS data, obtain UAE pricing from local vendors and blood banks, and work with Dubai Healthcare Authority for local cost-effectiveness standards.
Primary Sources Cited
Major Claims Verified
Clinical Data Verified
Items Requiring Dubai Data
All URLs verified as active December 2025 | All statistics cross-referenced with primary sources
A complete text version of all references with additional notes is available for review.
For questions about sources or to request additional documentation, contact the proposal development team.