Bleeding Out: The Trauma We Can Actually Fix

Jul 15, 2025

In this enlightening discussion, Dr. Mark Piehl, a pediatric ICU physician and trauma resuscitation expert, dives deep into the critical realm of trauma care. He shares compelling insights on early blood product administration, asserting that it significantly boosts survival rates in trauma cases. Mark emphasizes the effectiveness of both whole blood and component therapy, explaining that transport times are crucial, even in urban settings. With real-world examples and bold recommendations, he challenges conventional practices and advocates for innovative approaches to prehospital blood management.

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INSIGHT

Early Field Blood Saves Lives

Early pre-hospital blood administration markedly improves survival, especially in penetrating trauma.
Multiple civilian programs reported ~90% survival after implementing field blood resuscitation.

ADVICE

Don’t Wait For Whole Blood

If whole blood is unavailable, implement component therapy (PRBCs + plasma) rather than waiting.
Use balanced ratios to approximate whole blood and start now while pursuing whole blood access.

INSIGHT

Every Pre-Hospital Minute Changes Outcome

Minutes matter for all transports, urban or rural; pre-hospital minutes change physiology before hospital care.
Even very short on-scene interventions can transform the patient's trajectory into the ED.

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In this powerful and unfiltered episode, Eric Bauer sits down with Dr. Mark Piehl—pediatric ICU physician, trauma resuscitation expert, and inventor of the LifeFlow device—for a deep conversation that will reshape how you think about blood product administration in trauma care. From pediatric hemorrhagic shock to adult penetrating trauma, from urban EMS to rural ground teams, they unpack the most critical emerging concepts in early resuscitation.

You’ll hear eye-opening real-world cases, challenges in implementation, and candid debates about whole blood, plasma vs. PRBCs, and whether saline still has a place. If you’ve ever questioned how fast, how early, or even if we should be administering blood products in the field—this episode is essential listening.

Whether you're just getting into critical care or you're a seasoned physician or flight clinician, there’s something here that will challenge you, inspire you, and push your practice forward.

🎧 Available anywhere you get your podcasts—or right now at flightbridgeed.com. While you're there, explore our award-winning critical care and certification prep courses trusted by over 30,000 providers worldwide.

Contact Mark Piehl at mpiehl@410medical.com

Key Takeaways:

Early blood product administration in the field dramatically increases survival—especially in penetrating trauma.
Whole blood may be ideal, but component therapy (plasma + PRBCs) is a powerful and proven alternative—even in urban EMS with short transport times.
Traumatic arrest is not always the end. With witnessed arrest and early transfusion, survival is possible—even likely in the right cases.
Shock index is an underused but powerful indicator for when to trigger blood administration, and its value applies to both adults and pediatrics.
Volume matters, but so does composition: PRBCs deliver oxygen, plasma helps heal vessels—both are needed, and timing is everything.
Saline isn’t dead—there are valid, lifesaving uses for crystalloids in certain TBI and pediatric cases when blood isn’t available.
Implementing a blood program builds better clinical teams. It’s not just about saving lives—it sharpens every aspect of your trauma care.