STARS participates in a critical study that could transform care for trauma patients

STARS is always exploring ways to improve patient outcomes, and as leaders in air ambulance transport, STARS’ duty is to deliver the highest standard of care.

Now, groundbreaking research has the STARS team reconsidering a 100-year old method of blood transfusion. STARS is participating in a study led by the University of Pittsburgh. This TOWAR (Type O Whole blood and assessment of AGE during prehospital Resuscitation) study could redefine prehospital care by offering whole-blood transfusions for severely injured patients early in their treatment.

Donated blood is typically separated into red blood cells, plasma, and platelets for storage and individual use. However, when someone bleeds out, they lose all these parts.

Dr. Doug Martin, STARS medical director, explained that the implication of the TOWAR study may be “game changing.”

“It’s a kind of change that comes along once every couple of decades that has the potential to absolutely shift the playing field on how you care for trauma patients,” he said.

During the Battle of Somme in 1916, the story of whole-blood transfusion for injured patients began. Canadian surgeon Dr. Bruce Robertson was among those who pioneered the use of whole-blood transfusions on wounded soldiers during the First World War. He authored an article about his findings and the benefits of whole-blood transfusion that was
published in the British Medical Journal.

“Assigned to a British base hospital, Dr. Robertson was exposed to the practice of using saline for the resuscitation of bleeding patients, and its results were uniformly dismal,” said Dr. Martin. “This article began the process of convincing British army surgeons of the value of whole blood over saline as a resuscitation fluid.”

Over the years, the practice was gradually replaced by the transfusion of blood components in an effort to increase safety and give patients only the parts they absolutely needed. However, in recent years, a renewed interest in whole-blood transfusion has emerged, fueled by its effectiveness in treating trauma patients.

TOWAR study whole-blood transfusions involve the use of low-titer blood with low levels of antibodies and can be transfused to people of various blood types. This practice of giving trauma patients who are losing a lot of blood whole-blood transfusions when they reach the hospital has been associated with a greater chance of these patients surviving their injuries. The TOWAR study is designed to examine whether providing these transfusions earlier, before arrival at hospital, improves outcomes even more.

“We are all expecting that there’s going to be an outcome benefit in terms of lives saved,” said Dr. Martin. “And if the study turns out as expected, then I think the practice of transfusion for trauma is going to look entirely different in two to three years.”

As of February 2025, the STARS Winnipeg base began carrying two units of whole blood on board the aircraft as part of STARS’ participation in the TOWAR study. This was made possible with the help of Canadian Blood Services. Through the study, STARS is one of the first civilian agencies to administer whole blood in Canada.

“It should be seen both as a great privilege and a sign of the growing maturity of our organization that we can be part of the scientific leadership of this important change,” said Dr. Martin.

As STARS continues its work in critical care, the TOWAR study serves as a reminder of the impact that scientific research can have on saving lives. Together, with a commitment to
innovation, STARS can continue to redefine what is possible for patients.