Establishing a regional prehospital whole blood program in a border community: the Trauma Regional Advisory Council-V initiative in the Rio Grande Valley of Texas

Hemorrhagic shock is a leading cause of preventable death after traumatic injury, and the prehospital interval is the most critical, underused window for hemostatic intervention. Low Titer O-Positive Whole Blood (WB) improves survival in military and civilian settings, yet its implementation in rural, border-region communities with limited healthcare infrastructure remains largely undescribed. The Rio Grande Valley (RGV) of Texas-a predominantly Hispanic, medically underserved region along the USA-Mexico border-presents logistical, demographic, and infrastructural challenges that make prehospital hemorrhage control both harder and more consequential. We describe how the Trauma Regional Advisory Council-V (TRAC-V, Cameron, Hidalgo, Starr, and Willacy counties, South Texas) conceptualized, operationalized, and expanded a regional prehospital WB program across four RGV counties, encompassing emergency medical service (EMS) agencies and trauma-receiving hospitals. The region is defined by extended transport intervals, a predominantly rural, medically underserved population, limited trauma infrastructure relative to population burden, and high injury rates. A phased, stakeholder-driven implementation methodology spanned eight domains: (1) stakeholder engagement and governance development; (2) memorandum of understanding between TRAC-V, the South Texas Blood and Tissue Center, EMS agencies, and hospitals; (3) evidence-based clinical protocols and transfusion criteria; (4) a structured blood product rotation system to minimize waste; (5) standardized provider training and credentialing; (6) regional data collection and quality improvement; (7) grant funding and equitable equipment distribution to rural EMS agencies; and (8) community blood drive engagement. The TRAC-V regional WB program demonstrates that a structured, collaboration-driven methodology can establish prehospital whole-blood capability in resource-limited, geographically challenging environments. This stepwise model offers a replicable framework for regional advisory councils and EMS systems in underserved communities. Prospective outcome data will inform programmatic refinements and contribute to the national evidence base for prehospital WB programs.