Cities Prevent Road Deaths by Adopting a Proven Battlefield Intervention at Home

By:

CitiesSpeak Guest

October 28, 2026 - (7 min read)

Authored by Jonathan Morrison, Administrator of the National Highway Traffic Safety Administration (NHTSA)

No matter the size of a city or where it’s located, traffic fatalities are a tragedy every municipality faces. While new vehicles continue to get safer, and states and cities are working to lower those numbers with traffic safety improvements, identifying more ways to save people who are seriously injured or die in a motor-vehicle crash is something those of us who work at the National Highway Traffic Safety Administration (NHTSA) think about every day. Although traffic deaths fell to the lowest levels in recent history in 2025, every death on U.S. roads is one too many.

It’s estimated that of the more than 35,000 people who die in a traffic crash each year, about 43 percent of the crash fatalities were alive when EMS arrived on the scene. This is a clear opportunity. Scientific research tells us that not only is uncontrolled bleeding caused by trauma the leading cause of preventable death, but increasingly it shows that giving people exactly what they’re losing, whole blood or blood components like red blood cells or plasma, can save lives. Especially if it’s given as quickly as possible following injury.

Such compelling evidence is why more emergency medical services (EMS) agencies are adding prehospital blood transfusion to the care they provide. Once primarily used on military battlefields, these programs allow paramedics to deliver blood products to a trauma victim at the scene of the incident or enroute to a hospital or trauma center.

City Leaders Help Stand Up Blood Transfusion Programs

While the first ambulance-based transfusion programs kicked off in 2017, prehospital blood transfusion is still a brand-new protocol for most EMS agencies. This means that launching a program isn’t simple, inexpensive or fast, but once in place, the benefits are far-reaching, both on our roadways and beyond.

The support of city councils, mayors and other stakeholders in local government has proven invaluable in establishing many of the roughly 430 transfusion programs currently in operation. When Fort Lauderdale, Fla., launched its program in March 2026 as part of a broader goal to reduce traffic deaths in the city, Mayor Dean J. Trantalis was a critical collaborator. (Broward County, where Fort Lauderdale sits, saw 243 traffic fatalities in 2024.) In announcing the program, Mayor Trantalis credited the Fort Lauderdale Fire Rescue Department and healthcare partner Broward Health, calling prehospital transfusion “a major advancement in emergency medical care that allows lifesaving blood transfusions to begin before a patient even reaches the hospital.”

“This program places Fort Lauderdale among a select group of cities nationwide equipped to deliver this level of advanced, evidence-based trauma care in the field. By reducing the time to transfusion, we are giving patients facing severe injuries and blood loss a significantly greater chance of survival.”

– Mayor Dean J. Trantalis

Small Cities Lead and Benefit from Blood Transfusion Programs

Smaller cities and towns are also finding ways to stand up a transfusion program in spite of facing different obstacles than those of urban and suburban centers. Trauma patients in rural areas are more likely to have medically complex injuries, for example, and likelier to experience longer transport times. One study found that EMS response times in rural areas were 92.8 minutes, compared to 74.1 minutes nationally. It’s more common, too, for rural residents to live in an “ambulance desert,” meaning an area where the nearest ambulance station is more than 25 minutes away. Ambulances with ready access to blood products, or who carry blood on board, could deliver lifesaving care significantly sooner.

When Todd D. Barton, Mayor of Crawfordsville, Ind., a town of about 38,000, saw the Crawfordsville Fire Department’s proposal for a blood transfusion program, he recognized it as truly out-of-the-box thinking. “We were able to collectively create a program that has not only impacted lives but has quite literally saved lives,” says Mayor Barton. “Our fire department faces the challenge of a high-run volume for emergency medical situations — many of which are trauma-related — coupled with potentially long transport times to definitive trauma care.”

“The addition of whole blood to the treatment modalities available to our paramedics is a quantum leap forward and has already received praise from trauma physicians for having been the critical difference between life and death for patients who’ve received care under our whole blood program.”

– Todd D. Barton, Mayor of Crawfordsville, Indiana

Since launching their program in 2024, Crawfordsville Fire Department has seen a 83 percent survival rate for transfusion used in trauma cases.

Maximizing the Potential of Early Transfusion

While it’s exciting to see more EMS agencies launching new transfusion programs every week, the potential impact of prehospital blood remains very much underutilized — which is why NHTSA prioritized its expansion as part of the Pathways to Safer Streets (P2SS) initiative announced earlier this year. This national traffic safety action plan defines prehospital transfusion programs as one of eight critical elements that will reduce death and injury from motor-vehicle crashes across the country.

Prehospital blood transfusion was also highlighted as a key protocol for saving lives in the 2026 update of DOT’s National Roadway Safety Strategy (NRSS), released in August. More specifically, the NRSS notes that “prehospital blood transfusion programs coupled with 911 call taking protocols are promising tools that support faster, more informed responses. Investing in these life-saving advancements can help ensure more parents, children and spouses return home to the families who need them.”

Find Out More

If you’re interested in establishing prehospital transfusion in your city, town or village or want to support your local fire and EMS departments’ plans for a program, there are steps you can take to make it easier and faster for the agencies where you live to save more lives:

Reach Out to Local EMS Leadership

Every EMS prehospital blood transfusion program requires oversight by a local medical director. Start by finding out who your State EMS Director is and whether a program(s) is already operating or being planned in your jurisdiction or those of your neighbors (some agencies create mutual-aid arrangements to provide blood products). The National Association of State Emergency Medical Services Officials (NASEMO) maintains contact information for State EMS Offices on its site.

Offer Your Support

The first step in planning a prehospital blood transfusion program is establishing a stakeholder committee. If there isn’t a program already underway in your community, seek out your local EMS leaders, EMS medical director and/or highway safety leaders to start or join conversations about local regulations (not every state allows paramedics to deliver blood, for example), governance requirements and budget. Many agencies build the cost of their program into their operating budget, often planning a year or more in advance, and require approval by their city council or another entity.

As a member of a stakeholder committee you’ll likely work with EMS leaders; a medical director; local 911 leaders; a community, regional or hospital blood bank; hospital administrators; trauma/ER personnel; a hospital trauma program manager or medical director; and/or traffic or highway safety partners. Offering to make introductions to these and any other connections you have could help smooth the path for an EMS agency.

Learn More About Prehospital Blood Transfusion

Making a program operational means EMS and fire-rescue agencies must meet a number of requirements:

finding funding for equipment, training and blood products
preparing paramedics to administer blood in the field
establishing relationships and working closely with local healthcare providers, blood suppliers and highway safety partners
creating policies and adopting clinical protocols
tracking metrics for every blood administration to ensure safety, appropriate use and improvement

To learn more about prehospital blood transfusion, including the benefits of this protocol and how EMS agencies can build their own program, visit NHTSA’s Office of EMS, or visit the Prehospital Blood Transfusion Coalition, which tracks research and the expansion of EMS transfusion programs across the country.