Call to enhance civilian and military blood preparedness.

# Call to enhance civilian and military blood preparedness *The Lancet 2026* Correspondence Harvard Medical School, Boston, MA 02115, USA nuclear explosions, natural disasters, practices to estimate realistic surge (JSF); Department of Health Services Policy and and combat injuries. Recent violations requirements. Practice, Brown University School of Public Health, of NATO airspace underscore that Whole blood is not the only Providence, RI, USA (MLB) aggression is no longer a distant threat. option. Pre-hospital transfusion 1 Prada D, Ritz B, Bauer AZ, Baccarelli AA. Evaluation of the evidence on acetaminophen The violation of the airspace of Estonia with thawed plasma reduces 30-day use and neurodevelopmental disorders using by armed Russian military aircraft on mortality by 9·8% in patients who the Navigation Guide methodology. Environ Health 2025; 24: 56. Sept 19, 2025, occurred alongside are haemorrhaging, and is especially 2 Ahlqvist VH, Sjöqvist H, Dalman C, et al. several other documented breaches beneficial when transport times are Acetaminophen use during pregnancy and of NATO airspace, including incidents longer than 20 min.7 Plasma use is children’s risk of autism, ADHD, and intellectual disability. JAMA 2024; 331: 1205–14. in Poland, Finland, Latvia, Lithuania, constrained in environments without 3 Hamilton J. Leucovorin for autism? Many Norway, and Romania.1,2 Casualties freezing and thawing capabilities. scientists—and parents—are skeptical. https:// from potential NATO operations Dried plasma is stable at room www.npr.org/sections/shots-health- news/2025/09/25/nx-s1-5552751/autism- could reach numbers unseen since temperature for at least 2 years and is leucovorin-folinic-acid-folate-vitamin-reality- World War 2. Inadequate national blood rapidly rehydrated, making it a viable check (accessed Dec 25, 2025). 4 Martin JA, Hamilton BE, Osterman MJK. Births logistics will have severe consequences. alternative. Stockpiling dried plasma in the United States, 2024. https://www.cdc. Whole blood is the recommended in remote and austere environments gov/nchs/products/databriefs/db535.htm resuscitation fluid in life-threatening would mitigate sudden spikes in (accessed March 3, 2026). 5 Niburski K, Niburski O. Impact of Trump’s haemorrhage. NATO policy allows demand. However, current global promotion of unproven COVID-19 treatments whole blood to be stored cold dried plasma production is critically and subsequent internet trends: observational for 21–35 days or obtained from insufficient. During World War 2, study. J Med Internet Res 2020; 22: e20044. 6 D’Antonio F, Flacco ME, Valle LD, et al. Prenatal prescreened emergency donors and the Allies produced over 10 million paracetamol exposure and child used within 24 h. Low-titre group O dried plasma units;4 today, economic neurodevelopment: a systematic review and meta-analysis. Lancet Obstet Gynaecol Women’s whole blood can be used for all patients considerations mean NATO nations Health 2026; published Jan 16. https://doi. pre-hospital, whereas type-specific produce barely 100 000 units annually. org/10.1016/S3050-5038(25)00211-0. whole blood could offer advantages Bridging this gap requires coordinated 7 American Society of Health-System Pharmacists. Leucovorin calcium tablets. in hospitals.3 Based on evidence from civil–military–industry action, including https://www.ashp.org/Drug-Shortages/ past conflicts,4 the NATO Blood Panel government incentives to expand dried Current-Shortages/Drug-Shortage-Detail. aspx?id=1189 (accessed Jan 19, 2026). estimates that 20% of casualties who plasma production, establish surge 8 Dreier JW, Andersen AMN, Berg-Beckhoff G. survive to medical care will require capacity, and integrate blood logistics Systematic review and meta-analyses: fever in transfusion, each needing eight units of into national defence planning. pregnancy and health impacts in the offspring. Pediatrics 2014; 133: e674–88. whole blood or equivalent components. Broader investment is also essential. In any mass-casualty event, transfusion Research into universal blood products demand will surge sharply: civilian with extended shelf life, protection of Call to enhance civilian guidelines suggest three units per civilian blood services from physical and military blood admission.5 Blood must also remain and cyber threats, and strengthening available for routine surgery, obstetric supply chains for consumables Published Online preparedness haemorrhage, haemoglobinopathies, and storage infrastructure are all March 6, 2026 https://doi.org/10.1016/ and malignancies. crucial. Governments must invest S0140-6736(26)00322-3 In February, 2026, the North Atlantic Global demand already exceeds in scalable dried plasma production, Treaty Organization (NATO) Blood supply: in 2017, 304·7 million units were prioritise donor pool expansion, and Panel convened in Brussels, Belgium, needed annually, yet only 272·3 million accelerate authorisation of emerging to update policies for adequate blood were available.6 Donor numbers are blood products. International supply for future conflicts and health unlikely to limit blood supply during interoperability between military crises. Although our focus was military a crisis; rather, inadequate personnel, and civilian blood systems requires support, we recommend civilian equipment, and consumables for standardised nomenclature, screening blood services assess their ability to collection, processing, and storage practices, and secure data exchange to deliver timely, life‑saving transfusions will constrain production. Because enable real-time insight into supply during major surges in demand. In most services permit whole blood and demand. Establishing a clear this Correspondence, we present the donation only every 2–3 months, preparedness timeline is vital, as delays rationale for this recommendation and preparedness plans should avoid will lead to preventable deaths. the actions we believe are required. exhausting donor capacity early. We call NF reports employment with the French Ministry Blood supply is a strategic capability for urgent modelling that incorporates for Armed Forces and serves as Co-Chair of the that affects the resilience of health regional disease burden, health- COMEDS NATO Blood Panel. AB serves as Chair of the COMEDS NATO Blood Panel. MCR reports systems after radiological incidents, care infrastructure, and transfusion employment with the Australian Defence Force; Correspondence serves as the national representative for Australia can reasonably be expected at this qualified doctors wishing to broaden on the COMEDS NATO Blood Panel; is a member of career stage. In round 1 of 2026 IMT their training before specialisation. the Australian Resuscitation Council; and recruitment, 8251 applications were Furthermore, since portfolio domains participates on a data safety and monitoring board for Bloodworks Northwest. considered for shortlisting in England, overlap (for example, independently Northern Ireland, and Wales.2 The organised teaching vs paid teaching *Nadira Frescaline, Andrew Beckett, median score of these applications qualifications), the system acquires a Michael C Reade was 21 (maximum 35), an increase pay-to-win bias, amplifying advantage nadira.frescaline@intradef.gouv.fr from 15 points in 2025.2 Scores are for those with time, money, or Centre de Transfusion Sanguine des Armées, self-assessed across portfolio domains supportive institutions that encourage Clamart, France (NF); French Armed Forces Health Services, Paris 75509, France (NF); St. Michael’s and, for 2026, include an additional presentations and publications by Hospital, University of Toronto, Toronto, ON, five points for applicants who apply design, with little palpable scientific or Canada (AB); Royal Canadian Medical Services, only to the internal medicine vacancy. public health benefit. Ottawa, ON, Canada (AB); Medical School, University of Queensland, Brisbane, QLD, Australia An appointable applicant must now Shortlisting should be anchored to (MCR); Joint Health Command, Australian Defence be able to demonstrate academic the outcomes IMT is meant to deliver. Force, Canberra, Australia (MCR) output and credential accumulation: We propose recalibration: reduce 1 North Atlantic Treaty Organization. Statement higher level of qualifications, national double-counting across domains; by the North Atlantic Council on recent airspace violations by Russia. 2025. https:// or international presentations, recognise sustained National Health www.nato.int/en/about-us/official-texts-and- indexed publications, and formal Service (NHS) clinical service and resources/official-texts/2025/09/23/ teaching qualifications. As consultants workplace teaching; and credit statement-by-the-north-atlantic-council-on- recent-airspace-violations-by-russia (accessed and registrars who contribute to objective indicators of readiness Feb 22, 2026). IMT selection, and as IMT applicants, and commitment, such as achieving 2 Security Council Report. Briefing on incursion of Russian aircraft into Estonian airspace. we are concerned that the system membership of the Royal Colleges of 2025. https://www.securitycouncilreport.org/ rewards portfolio optimisation Physicians UK, part 1. Such changes whatsinblue/2025/09/briefing-on-incursion- rather than clinical apprenticeship, would align incentives with patient- of-russian-aircraft-into-estonian-airspace.php (accessed Feb 22, 2026). with continuity on the wards and centred training and with the 3 Milford EM, Gurney JM, Beckett A, Strandenes G, progressive responsibility for acutely Medical Training Prioritisation Bill, Reade MC. Type-specific whole blood still has a role in the era of low-titer O universal donor unwell patients going unrecognised. which prioritises UK graduates while transfusion for severe trauma hemorrhage. J Most doctors applying to IMT will recognising international medical Trauma Acute Care Surg 2024; 97: e23–27. have only worked for 1 year following graduates with substantial NHS 4 Gurney JM, Cap AP, Holcomb JB, et al. The thin red line: blood planning factors and the graduation from medical school. For experience.4 Internal medicine needs enduring need for a robust military blood many doctors, access to higher levels empathetic doctors who are actively system to support combat operations. J Trauma Acute Care Surg 2024; of qualifications, publications, and working on wards and looking after 97 (2S Suppl 1): S31-S6. conference opportunities is shaped by their patients to a high standard. 5 Ramsey G. Blood transfusions in mass casualty factors beyond their control, including The current recruitment system risks events: recent trends. Vox Sang 2020; 115: 358–66. institutional support, protected time, exclusion of suitable doctors before 6 Roberts N, James S, Delaney M, Fitzmaurice C. and responsible mentorship. Many they can even progress to interview. The global need and availability of blood practising acute medicine consultants products: a modelling study. Lancet Haematol DP reports institutional grant support for a 2019; 6: e606–15. would not meet today’s interview fellowship from the National Institute for Health 7 Pusateri AE, Moore EE, Moore HB, et al. threshold for IMT at the time of and Care Research. All other authors declare no Association of prehospital plasma transfusion competing interests. with survival in trauma patients with applying for their substantive posts See Online for appendix hemorrhagic shock when transport times are (appendix). Nicholas Wong, David Barnes, longer than 20 minutes: a post hoc analysis of The five-point sole application bonus James Hartley, Patricia Yunger, the PAMPer and COMBAT clinical trials. JAMA Surg 2020; 155: e195085. is intended to recognise commitment Chian Chyn Khoo, Neil Bailey, Neil Kelly, Farah Bachar, *Daniel Pan and manage demand within limited interview capacity and funded dp440@leicester.ac.uk Time to change internal posts—applications increased from NHS University Hospitals of Liverpool Group, Liverpool, UK (NW, JH, PY, CCK, NB, NK); medicine training for UK 6273 in 2024 to 8841 in 2025, but Development Centre for Population Health, Published Online decreased to 8251 in 2026.2,3 However, University of Leicester, Leicester, UK (DB, DP); resident doctors March 6, 2026 in a labour market where rejection Leicester NIHR Biomedical Research Centre, https://doi.org/10.1016/ can mean gaps in employment, the Leicester LE3 9QP, UK (DB, DP); Department of S0140-6736(26)00290-4 Infectious Diseases and HIV Medicine, University Internal medicine training (IMT) is five-point bonus incentive might Hospitals of Leicester NHS Trust, Leicester, UK the principal entry route to physician reward risk-avoidant, single-track (DB, DP); Department of Microbiology, University specialities in the UK.1 Yet, shortlisting applications over genuine vocation. Hospitals of Leicester NHS Trust, Leicester, UK (FB) metrics are drifting beyond what The system discourages newly 1054 --- [PDF原文](https://sci-net.xyz/storage/7932541/846eb783e86ea9bd8ade80ee4fd7fd32c927539c207d7c575b3f7273d571de9d/Call-to-enhance-civilian-and-military-blood-preparedness.pdf) DOI: 10.1016/S0140-6736(26)00322-3