CHICAGO — Using data from hospitals and emergency medical service providers to map out areas with the greatest need for trauma care and prehospital whole blood transfusions can enable hospital systems to deploy scarce blood resources quickly and minimize waste, according to a study published in the Journal of the American College of Surgeons (JACS).
Quick access to blood before a patient arrives at a hospital can be the difference between life and death. However, the vast majority of ambulances in the United States still do not carry blood, but that is changing. Experts estimate up to 10,000 lives could be saved every year with more access to prehospital blood.
This study retrospectively analyzed trauma registry data from 427 patients who, between June 2019 and March 2025, received massive transfusion protocol (which includes multiple units of blood) at five trauma centers in Omaha and Lincoln, Nebraska. The researchers used geo-mapping, which includes plotting data points on a map to visualize geospatially where events occur to identify high-need areas for prehospital whole blood transfusion, according to lead study author Nicolle K. Barmettler, MD, a general surgery resident at the University of Nebraska Medical Center (UNMC) division of trauma in Omaha.
These two cities, the largest in Nebraska, have a combined population of about 800,000, and about 1.35 million in their metropolitan areas. They are about 60 miles apart in the eastern part of the state.
“We also took the maps of the massive transfusion trauma patients and layered them with a map of household income in those zip codes, and we found that the lowest income areas were significantly more likely to experience a trauma,” said Dr. Barmettler. “That shows that allocating blood products to those areas where they’re most needed could really benefit those underserved communities and could help improve equity in trauma care.”
Study Findings
The analysis included transfusion data from the five trauma centers, along with assault and motor vehicle crash data from the Nebraska Department of Transportation and local police databases. The goal was to identify patterns of where trauma incidents occur and whether they correlate with where patients who received massive transfusions are coming from.
“We found out they do,” Dr. Barmettler said. Statistical analysis demonstrated strong correlations between activation for massive trauma protocol and distributions for blunt and penetrating trauma, both of which were concentrated in the downtown areas of the respective cities. “This shows that we can use in-hospital massive transfusion as an indicator of patients who would have benefited from prehospital blood transfusion.”
Layered mapping of fire stations with transfusion data identified potential prehospital whole blood locations, which were used to plan the placement of whole blood resources on ambulances in high-need areas.
The study authors note that evidence supports the early administration of blood products to improve patient outcomes, but that several barriers exist to establishing a prehospital blood program, including the high cost of blood and equipment, limited supply, and supply chain issues.
“Preserving blood products is important because they’re a very scarce and costly resource, and whole blood especially is in low supply,” Dr. Barmettler said. “But they also save lives.”
Storage of whole blood products is another challenge because they have a shelf life of about three weeks before they must be returned to the blood bank for separation into its components, she added.
“It’s important to send whole blood products to the highest-need areas in order to avoid waste and reduce cost,” Dr. Barmettler said. “It’s important to have this kind of data-driven approach to determine where those high-need areas are again to avoid waste.”
A Scalable Model for Any City
This study provides a model for geo-mapping that could be used anywhere, she said. “Any hospital has access to their own blood transfusion data and has the ability to map that.”
“This is a scalable tool,” she said. “The hope is that we could expand the use of it to other areas of Nebraska, even rural areas, other surrounding states, and eventually nationally.”
The city of Omaha, in collaboration with UNMC and the Omaha Fire Department, has already used this study as a foundation for its own prehospital blood program. Four ground transportation units in the highest-need areas of Omaha each have one unit of low-titer group O whole blood on board. Future research includes conducting a prospective study to analyze outcomes of that initiative and perform a cost analysis of patients who receive whole blood before arriving at the hospital, Dr. Barmettler added.
“This will hopefully give us an idea of whether or not using geo-mapping for positioning of the blood is actually benefiting patient outcomes and if we are over- or underestimating the need for blood in certain areas,” she said.
Study co-authors are Coulter Knapp; Ashley A. Raposo-Hadley, MPH; Kevin Kemp, MD, FACS; Christopher Barrett, MD, FACS; Eric J. Kuncir, MD, FACS; Elizabeth R. Maginot, MD; Justus Boever, MD; Charit H. Evans, MD, FACS; and Reynold Henry, MD, MPH, FACS.
This work was a winning presentation of the resident research competition at the American College of Surgeons Committee on Trauma Region 7 annual meeting, December 4-6, 2024, in Kansas City, Missouri. It was also presented at the 76th annual meeting of the Southwest Surgical Congress, April 6-9, 2025, in Sonoma, California.
The study is published as an article in press on the JACS website.
Citation: Barmettler NK, Knapp C, Raposo-Hadley AA, et al. Geo-Mapping Using In-Hospital Massive Transfusion Data as a Method for Prehospital Blood Management for Trauma Patients. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001896
