This study investigates how Canadian civilian critical care transport organizations (CCTOs) implement out-of-hospital transfusion (OHT) protocols, comparing current practices to expert guidance, and explores the potential value of standardizing these protocols nationwide. A nationwide cross-sectional survey included all seven Canadian CCTOs providing OHT. Protocols were evaluated for adherence to expert recommendations, focusing on key elements such as transfusion triggers and termination criteria. Analysis revealed that Canadian CCTOs followed expert guidance in 89% of assessed practices. While most protocols were closely aligned with recommendations—likely supported by networks such as CAN-PATT—variability persisted in certain areas, particularly regarding when transfusions should start and stop. Standardizing practices could offer significant advantages, including clearer policy development, better integration of emerging evidence, and more robust evaluation of transfusion outcomes. Canadian CCTOs demonstrate strong adherence to expert OHT recommendations, yet differences in protocol details highlight opportunities for harmonization. Establishing more uniform guidelines could strengthen prehospital trauma care, enhance consistency across transport teams, and support continuous improvements in patient management. Sustained efforts to refine and update OHT protocols are essential to optimize trauma outcomes nationwide.
