{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T01:01:10Z","timestamp":1793494870923,"version":"4.5.0"},"reference-count":15,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004102","name":"Laerdal Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004102","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Stepping Strong Center for Trauma Innovation","award":["GR0126650"],"award-info":[{"award-number":["GR0126650"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,12]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Trauma, obstetric haemorrhage and severe anaemia lead to millions of deaths every year. Many of these deaths occur in regions known as \u2018blood deserts\u2019 where there is virtually no access to blood transfusions. A community or civilian walking blood bank (CWBB) is a low-resource strategy that can provide just-in-time, point-of-care tested blood transfusions in blood deserts when banked blood is not readily available and the alternative is almost-certain death. This protocol is designed to evaluate the effectiveness and implementation of a CWBB at Lodwar County Referral Hospital located in a blood desert in rural north-west Kenya.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will use a mixed-methods approach relying on an implementation science design to evaluate effectiveness, acceptability, applicability and impact of a CWBB. The study will be conducted over 1 year in two parts: pre-emergency and post-emergency transfusion protocol (ETP) implementation. First, a previously developed ETP will be validated and finalised by key hospital stakeholders. Effectiveness will be assessed quantitatively and qualitatively. Prospective laboratory-based data collection will measure changes in blood ordering practices. We expect a sample size of approximately 140 (20\/month) unmet blood transfusion requests, with 40 (5\/month) of those being emergent (requiring blood in less than 2\u2009hours). These cohorts will be compared pre-implementation and post implementation. Qualitatively, key informant interviews of hospital staff and the community will explore clinical blood demand and general understanding and perceptions about blood donation and transfusion. Lastly, we will determine the adaptability and scalability of a CWBB to other low-resource settings with in-depth interviews and a modified Delphi approach to achieve consensus regarding key components of a CWBB and its transferability to other settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval was granted by the Strathmore University Institutional Scientific and Ethics Review Committee (SU-ISERC2234\/24) and the Mass General Brigham (MGB) Hospital\u2019s Institutional Review Board (#2024P001878; #2024P001879; #2024P001885; #2024P001887). The study team also secured a research licence from the National Commission for Science, Technology and Innovation (#168094) before initiating the study. Interviews will be voluntary and consent will be obtained prior to participation. Blood transfusion consent will be collected as per standard hospital process. The findings will be disseminated through academic publications, conference presentations and workshops, contributing valuable insights into emergency blood transfusion protocols. These findings will also be conveyed to Lodwar County Referral Hospital in order to facilitate quality improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113702","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:40:29Z","timestamp":1783942829000},"page":"e113702","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Implementation and evaluation of a community walking blood bank for haemorrhagic shock when banked blood is unavailable: protocol for a mixed-methods, effectiveness-implementation study \u2013 phase 2 of the Local Initiative for emergency blood (LIFE-Blood) study"],"prefix":"10.1136","volume":"16","author":[{"given":"Nikathan","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School Program in Global Surgery and Social Change, Boston, Massachusetts, USA"},{"name":"University of California San Francisco East Bay Department of Surgery, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fleming","family":"Mathew","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0812-4791","authenticated-orcid":false,"given":"Riya","family":"Sawhney","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School Program in Global Surgery and Social Change, Boston, Massachusetts, USA"},{"name":"Blood DESERT Coalition, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery A","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard 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