Emergency Department Initiated Versus Trauma Team Initiated Massive Transfusion Protocols After Injury: A Review of Activation, Time to Transfusion, and Clinical Outcomes

Authors

  • Abdullah Abdulaziz F. Alhowidi Emergency Medicine Consultant, Emergency Department, Riyadh First Health Cluster, Riyadh, Saudi Arabia Author
  • Mohammed Ibrahim Alshaban Medical Student, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia. Author
  • Modhi Ghunaim Alharbi Medical Student, College of Medicine, Qassim University, Buraidah, Saudi Arabia. Author
  • Raghad Fahad Aloufi Author
  • Yousef K. Alenizi Medical Intern, College of Medicine, Al-Jouf University, Al-Jouf, Saudi Arabia. Author
  • Hooriah Mohammed Alasmari Medical Intern, College of Medicine, Tabuk University, Tabuk, Saudi Arabia. Author
  • Hala S. Hajjaj Medical Student, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia Author
  • Nasaym A. Alaraj Medical Intern, College of Medicine, Qassim University, Buraidah, Saudi Arabia. Author
  • Faisal A. Alsaleem Medical Intern, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Author

DOI:

https://doi.org/10.65759/641hzr37

Keywords:

Massive transfusion protocol, emergency department, trauma team, traumatic hemorrhage, time to transfusion

Abstract

Background: Massive transfusion protocols coordinate urgent blood delivery after injury. Activation authority varies in trauma systems and frequently overlaps between emergency physicians and trauma teams. This review examined activation practices, transfusion timing, and clinical outcomes. Methods: Ten original studies published before June 2026 were examined through structured narrative synthesis. Evidence addressed clinician decisions, prehospital activation, automatic activation, blood delivery, and protocol implementation. Direct specialty comparisons were distinguished from indirect workflow data. Results: One prospective cohort reported transfusion initiation by trauma surgeons in 35% and emergency clinicians in 19%, without comparative specialty outcomes. A multicenter analysis associated each additional minute to initial cooler delivery with increased adjusted mortality odds. Simulation informed improvement reduced activation to blood administration from 11.6 to 9.1 minutes. Implementation cohorts reported faster blood availability, with inconsistent mortality findings. A contemporary cohort documented protocol reactivation in 7.5% of patients, illustrating the importance of reassessment after initial activation. Conclusion: Data supports rapid recognition, coordinated activation, and efficient transfusion delivery after injury in routine clinical practice. Comparative research requires clinician attribution, standardized timing intervals, and adjustment for injury severity, shock, blood availability, and resuscitation changes in participating trauma systems and different treatment environments.

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Published

2026-11-09

Issue

Vol. 3 No. 04 (2026): Journal of Tazeez for Public Health

Section

Articles