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Current transfusion practices vary, and there is uncertainty about the optimal strategy. Whole blood (WB) transfusion, which contains all components in one bag, is considered potentially advantageous, particularly for resuscitating patients with major bleeding in the prehospital setting. It could potentially improve survival, reduce donor risk and simplify the processes of delivering blood transfusions outside hospitals. However, the evidence supporting the effectiveness and safety of WB compared with the standard separate blood component therapy is limited. A multicentre randomised controlled trial will be conducted, alongside an implementation study, to assess the efficacy, cost-effectiveness and implementation of prehospital WB transfusion in the prehospital environment. The implementation study will focus on evaluating the acceptability and integration of the intervention into clinical settings and on addressing broader contextual factors that may influence its success or failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A type 1 effectiveness\u2013implementation hybrid design will be employed. The implementation study will use qualitative methods, encompassing comprehensive interviews and focus groups with operational staff, patients and blood donor representatives. Staff will be purposefully selected to ensure a wide range of perspectives based on their professional background and involvement in the WB pathway. The study design includes: (1) initial assessment of current practice and processes in the WB pathway; (2) qualitative interviews with up to 40 operational staff and (3) five focus groups with staff and donor representatives. Data analysis will be guided by the theoretical lenses of the Normalisation Process Theory and the Theoretical Framework of Acceptability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study was prospectively registered and approved by the South Central\u2014Oxford C Research Ethics Committee and the Health Research Authority and Health and Care Research Wales. The results will be published in peer-reviewed journals and provided to all relevant stakeholders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN23657907\">ISRCTN23657907<\/jats:ext-link>\n                      ; EudraCT: 2021-006876-18; IRAS Number: 300414; REC: 22\/SC\/0072.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-078953","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T22:31:34Z","timestamp":1707172294000},"page":"e078953","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Study of Whole blood in Frontline Trauma (SWiFT): implementation study protocol"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"isrctn23657907","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn23657907","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7742-8003","authenticated-orcid":false,"given":"Grazia","family":"Antonacci","sequence":"first","affiliation":[{"name":"Department of Primary Care and Public Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6143-0421","authenticated-orcid":false,"given":"Jason","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Emergency, University Hospitals Plymouth NHS Trust, Plymouth, UK"},{"name":"Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Green","sequence":"additional","affiliation":[{"name":"NHS Blood & Transplant and Barts Health NHS Trust, London, UK"},{"name":"Queen Mary University of London Blizard Institute, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,5]]},"reference":[{"key":"2025121602285524000_14.2.e078953.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61728-0"},{"key":"2025121602285524000_14.2.e078953.2","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1001\/jama.2017.15097","article-title":"Association of Prehospital Blood Product Transfusion During Medical Evacuation of Combat Casualties in Afghanistan With Acute and 30-Day Survival","volume":"318","author":"Shackelford","year":"2017","journal-title":"JAMA"},{"key":"2025121602285524000_14.2.e078953.3","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1097\/SHK.0000000000001166","article-title":"Effect of Prehospital Red Blood Cell Transfusion on Mortality and Time of Death in Civilian Trauma Patients","volume":"51","author":"Rehn","year":"2019","journal-title":"Shock"},{"key":"2025121602285524000_14.2.e078953.4","doi-asserted-by":"crossref","unstructured":"Tucker H , Brohi K , Tan J , et al . 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