Request for Information: Nationwide Implementation of Prehospital Blood Transfusion

Issuing agencies

Abstract

The National Highway Traffic Safety Administration (NHTSA), on behalf of the Federal Interagency Committee on Emergency Medical Services (FICEMS), is seeking comments from all sources (public, private, governmental, academic, professional, public interest groups, and other interested parties) on the nationwide implementation of prehospital blood transfusion. The purpose of this notice is to solicit comments on strategies, barriers, and solutions to advance prehospital blood transfusion capabilities across State, local, tribal, and territorial emergency medical services (EMS) and 911 systems, and to request responses to specific questions provided below. This notice is an information-gathering inquiry and is neither a request for proposals nor an invitation for bids.

Full Text

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<title>Federal Register, Volume 91 Issue 192 (Tuesday, October 6, 2026)</title>
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[Federal Register Volume 91, Number 192 (Tuesday, October 6, 2026)]
[Notices]
[Pages 63650-63651]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-20426]


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DEPARTMENT OF TRANSPORTATION

National Highway Traffic Safety Administration

[Docket No. NHTSA-2026-2113]


Request for Information: Nationwide Implementation of Prehospital 
Blood Transfusion

AGENCY: National Highway Traffic Safety Administration (NHTSA), 
Department of Transportation (DOT).

ACTION: Notice; Request for Information (RFI).

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SUMMARY: The National Highway Traffic Safety Administration (NHTSA), on 
behalf of the Federal Interagency Committee on Emergency Medical 
Services (FICEMS), is seeking comments from all sources (public, 
private, governmental, academic, professional, public interest groups, 
and other interested parties) on the nationwide implementation of 
prehospital blood transfusion. The purpose of this notice is to solicit 
comments on strategies, barriers, and solutions to advance prehospital 
blood transfusion capabilities across State, local, tribal, and 
territorial emergency medical services (EMS) and 911 systems, and to 
request responses to specific questions provided below. This notice is 
an information-gathering inquiry and is neither a request for proposals 
nor an invitation for bids.

DATES: Comments on this announcement must be submitted on or before 
November 5, 2026.

ADDRESSES: You may submit comments, identified by Docket No. NHTSA-
2026-2113, by any of the following methods:
    <bullet> Federal eRulemaking Portal: Go to <a href="http://www.regulations.gov">http://www.regulations.gov</a>. Follow the online instructions for submitting 
comments.
    <bullet> Mail: Docket Management Facility, M-30, U.S. Department of 
Transportation, West Building, Ground Floor, Room W12-140, 1200 New 
Jersey Avenue SE, Washington, DC 20590.
    <bullet> Hand Delivery or Courier: West Building, Ground Floor, 
Room W12-140, 1200 New Jersey Avenue SE, Washington, DC, between 9 a.m. 
and 5 p.m. Eastern Time, Monday through Friday, except Federal 
holidays.
    Instructions: Regardless of how you submit your comments, you must 
include the docket number identified in the heading of this document. 
Note that all comments received, including any personal information 
provided, will be posted without change to <a href="http://www.regulations.gov">http://www.regulations.gov</a>. 
Please see the Privacy Act heading below.
    Privacy Act: In accordance with 5 U.S.C. 553(c), DOT solicits 
comments from the public to inform its decision-making process. DOT 
posts these comments, without editing, including any personal 
information the commenter provides, to <a href="http://www.regulations.gov">http://www.regulations.gov</a>, as 
described in the system of records notice (DOT/ALL-14 FDMS), which can 
be reviewed at <a href="https://www.transportation.gov/privacy">https://www.transportation.gov/privacy</a>.

[[Page 63651]]

Anyone is able to search the electronic form of all comments received 
into any of our dockets by the name of the individual submitting the 
comment (or signing the comment, if submitted on behalf of an 
association, business, labor union, etc.). You may review DOT's 
complete Privacy Act Statement in the Federal Register published on 
April 11, 2000 (65 FR 19477-78).

FOR FURTHER INFORMATION CONTACT: Office of Emergency Medical Services, 
National Highway Traffic Safety Administration, U.S. Department of 
Transportation, 1200 New Jersey Avenue SE, Washington, DC 20590; email: 
<a href="/cdn-cgi/l/email-protection#195f505a5c544a597d766d377e766f"><span class="__cf_email__" data-cfemail="a2e4ebe1e7eff1e2c6cdd68cc5cdd4">[email&#160;protected]</span></a>.

SUPPLEMENTARY INFORMATION: 

I. Background and Statutory Authority

    FICEMS was created (42 U.S.C. 300d-4) by the Secretaries of 
Transportation, Health and Human Services and Homeland Security to, in 
part, ensure coordination among the Federal agencies involved with 
State, local, tribal or regional emergency medical services and 9-1-1 
systems. FICEMS has statutory authority to identify State and local 
Emergency Medical Services (EMS) and 9-1-1 needs, to recommend new or 
expanded programs and to identify the ways in which Federal agencies 
can streamline their processes for support of EMS. FICEMS includes 
representatives from the Department of Defense (DoD) Office of the 
Assistant Secretary of Defense for Health Affairs, the Department of 
Health and Human Services (HHS) Office of the Administration for 
Strategic Preparedness and Response (ASPR), HHS Indian Health Service 
(IHS), HHS Centers for Disease Control and Prevention (CDC), HHS Health 
Resources and Services Administration (HRSA), HHS Centers for Medicare 
and Medicaid Services (CMS), the Department of Homeland Security (DHS) 
Office of Health Security (OHS), DHS U.S. Fire Administration (USFA), 
NHTSA, the Federal Communications Commission (FCC) and a State EMS 
Director appointed by the Secretary of Transportation.
    Severe hemorrhage remains a leading cause of preventable death 
following traumatic injury. To address systemic challenges and improve 
clinical outcomes nationwide, FICEMS is prioritizing the implementation 
of prehospital blood transfusion in its strategic planning process. By 
focusing national efforts on this critical clinical intervention, 
FICEMS aims to support EMS systems in preventing up to 10,000 deaths 
annually and achieving a 5% reduction in overall mortality from severe 
bleeding by 2028.
    On June 11, 2025, FICEMS convened a national Prehospital Blood 
Transfusion Summit in Washington, DC, bringing together nearly 900 in-
person and virtual stakeholders across EMS, 911 dispatch, trauma 
surgery, blood banking, public health, and regulatory entities.

II. Questions Regarding Nationwide Implementation of Prehospital Blood 
Transfusion

    Responses to the following questions are requested. Please provide 
references as appropriate.
    1. What are the current impediments to possible solutions for 
achieving the following national goals by the end of calendar year 
2028?
    a. Increasing the number of EMS agencies nationwide with active 
prehospital blood transfusion programs to 2,028;
    b. Providing 911 pre-arrival instructions to 25% of pediatric 
patients with life-threatening bleeding;
    c. Providing 911 pre-arrival instructions to 25% of all patients 
with life-threatening bleeding;
    d. Administering a prehospital blood transfusion to 28% of 
pediatric patients with life-threatening bleeding;
    e. Administering a prehospital blood transfusion to 16% of all 
patients with life-threatening bleeding;
    f. Capturing outcomes data in the National EMS Information System 
(NEMSIS) for 10% of all children transfused prehospitally;
    g. Capturing outcomes data in NEMSIS for 10% of all patients 
transfused prehospitally;
    h. Participation from at least 51 states and territories in the 
National EMS Licensure Compact; and
    i. Establishing 10,000 prehospital pediatric emergency care 
coordinators (PECCs) across the nation.
    2. What role can technology such as Advanced Automatic Crash 
Notification (AACN) play in improving timely delivery of prehospital 
blood transfusion to patients injured in crashes?
    3. What is the potential role of structured 911 call-taking 
protocols, including Emergency Medical Dispatch (EMD), in optimizing 
call processing, dispatch accuracy, and early bystander intervention 
for patients with life-threatening bleeding?
    3. What mechanisms, technical standards, or policy enhancements are 
needed to advance data integration and linkage across local, State, and 
national data systems (e.g., NEMSIS, trauma registries) in support of 
prehospital blood transfusion surveillance and quality measurement?
    4. How might improve military and civilian EMS integration advance 
prehospital blood transfusion practices, logistics, cold-chain 
management, and clinical training?
    5. What improvements and curriculum enhancements are needed within 
the EMS education and training system to support transfusion medicine, 
clinical competency, and other innovative prehospital practices?
    6. Do you have any additional comments regarding the nationwide 
implementation of prehospital blood transfusion programs?
    Authority: 42 U.S.C. 300d-4; 44 U.S.C. 3506(c)(2)(A); 23 U.S.C. 
403(b)(1)(A)(iv); 49 CFR 1.95; 501.8.

    Issued in Washington, DC.
Angie Wang,
Acting Associate Administrator, Research and Program Development.
[FR Doc. 2026-20426 Filed 10-5-26; 8:45 am]
BILLING CODE 4910-59-P


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