Trauma Resuscitation with Low-Titer Group O Whole Blood or Products

Inclusion Criteria:

1. Adult trauma patient (estimated age > 15 or weight > 50 kg, if age unknown)

2. Patient taken to trauma center directly from scene

3. Commencement of blood transfusion (PRBC, plasma or LTOWB), in pre-hospital orin-hospital setting

4. Activation of site-specific Massive Hemorrhage Protocol or Massive TransfusionProtocol

5. Traumatic injury with at least one of the following:

6. Confirmed or suspected acute major bleeding

7. Assessment of Blood Consumption (ABC) Score ≥2

Exclusion Criteria:

1. Patients who have received, prehospital or in-hospital more than two units of LTOWB;the equivalent in components (two units of packed red blood cells and two units ofplasma); or a combination of the two (more than one unit of LTOWB, one unit ofpacked cells, and one unit of plasma). Most trauma centers hold two units of eitherpacked red blood cells (with two units of plasma) or two units of LTOWB in theemergency department. This stock is used to initiate transfusion, while the massivehemorrhage protocol is activated from the blood bank.

2. Patients transferred from another hospital

3. Children <15 years (in most communities, patients aged 15-18 years are treated atadult trauma centers, and patients in this age group frequently sufferlife-threatening injuries, and will therefore be included)

4. Known prisoners, defined as individuals involuntarily confined or detained in apenal institution (including juvenile detention, involuntary psychiatric commitment,or court-ordered residential substance abuse treatment)

5. Moribund patients expected to die within 1 hour

6. Patients who required an ED thoracotomy or received more than 5 consecutive minutesof cardiopulmonary resuscitation (prior to receiving randomized blood products)

7. Patients with known "do not resuscitate" orders prior to randomization

8. Patients who refuse the administration of blood products

9. Individuals with a research "opt out" bracelet.

10. Greater than 20% total body surface area (TBSA) burns

11. Suspected inhalation injury victims

12. Patients who are obviously pregnant on clinical examination or known to be pregnantas provided by the subject or legally authorized representative