Prehospital blood for the injured in conflict zones: what about civilians? - a scoping review.

Background: Hemorrhage is the leading cause of preventable death in trauma patients. Prehospital transfusion (PHT) has been proposed to reduce mortality; however, its effectiveness for civilians in a military conflict zone remains uncertain due to logistical and resource constraints. While PHT is endorsed in military contexts, its routine implementation for civilian trauma care during conflicts is still debated. This study aims to explore the challenges, benefits, and limitations of PHT in civilian conflict settings based on available literature.

Methods: A scoping review was conducted using PubMed, Web of Science, and Google Scholar. Peer-reviewed searches were conducted from January to February 2023, with an update in May 2024. Gray literature was reviewed in June, September, and October 2023. Studies published in English with full-text access that addressed the research question were included. Data on study design, interventions, comparisons, and outcomes were narratively synthesized.

Results: Six relevant studies were identified and analyzed. Findings revealed variability in PHT practices, shaped by injury severity, transfusion protocols, and evacuation logistics. While PHT may offer benefits in settings with prolonged evacuation times, current evidence is inconsistent, limiting its routine recommendation for civilian conflict settings. Key barriers include limited resources, deviations from clinical guidelines, and challenges in blood product access and storage.

Conclusion: Optimizing trauma care in civilian conflict zones requires strengthening hemorrhage control, rapid evacuation, and adaptable, context-appropriate guidelines. PHT may offer benefits in select situations, current evidence does not support its routine use. Future research should identify feasible, scalable strategies tailored to the unique logistical, ethical, and resource challenges in these settings.