LAUSR

During the last decade, the role of blood transfusion in the early resuscitation of haemorrhagic shock has rapidly developed. Transfusion support has transformed from provider to partner, delivering new products and processes. Long-held haematological tenets have been challenged, and an industry of publication has ensued. Recent combat operations have been one of the biggest stimulants to rapid innovation in trauma care. Military practice has delivered unexpected survival, and transfusion support is credited as a key contributor. Developments include pre-hospital transfusion, massive haemorrhage protocols and transfusion triage. However, survival is the product of the entire healthcare system. In the context of trauma, this includes early external haemorrhage control, pre-hospital emergency medicine (PHEM), damage control resuscitation (DCR) including surgery, expert critical care and evacuation. Lessons identified from military medical care have been increasingly adopted into civilian practice and planning. However, pre-hospital transfusion is resource intensive and has implications for blood providers. Evaluation is essential. In this edition, we present two papers that explore the pre-hospital use of red blood cells. They confirm feasibility and safe practice but do not confirm the survival benefit suggested by military practice.