The role of freeze-dried plasma in a world of whole blood: a Canadian prehospital and transport perspective.

BACKGROUND: Hemorrhage is the leading preventable cause of trauma death, and timely transfusion remains a major challenge in Canada, particularly in rural and remote regions where long transport times create "blood deserts." Whole blood has re-emerged as the gold standard for resuscitation, but donor limitations, short shelf-life, and cold-chain requirements restrict its universal deployment.

ROLE OF FREEZE-DRIED PLASMA: Freeze-dried plasma (FDP) offers a complementary solution with unique advantages for Canadian prehospital and transport systems. FDP is pathogen-reduced, shelf-stable for up to two years at room temperature, lightweight, and rapidly reconstituted at the point of care. Evidence from military and civilian studies demonstrates its logistical feasibility and safety, particularly in settings with prolonged transport times. FDP has been successfully integrated into NATO and Canadian Armed Forces operations and is increasingly recognized internationally as a practical adjunct to whole blood. In Canada, heterogeneous access to prehospital transfusion, high wastage rates of thawed plasma, and the inequities faced by Indigenous and remote communities highlight the urgent need for alternative strategies.

CONCLUSION: FDP and whole blood are not competing but rather they are complementary therapies in a prehospital transfusion system. FDP represents a scalable, equitable, and operationally feasible option to extend balanced resuscitation to patients in rural and remote Canada. A coordinated national strategy, including regulatory approval, pilot projects, and outcome evaluation through networks such as CAN-PATT, is essential to move FDP from battlefield innovation to civilian standard of care.