11/18/2025
Is FDP the New Powder on the Streets? 💉🚑
Is It as Addicting as Blood Products?
Freeze dried plasma is getting attention in prehospital care. You want to know if it works. You want to know if it is safe. You want to know where it fits next to whole blood. Here is what the strongest research shows.
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What FDP Really Is 🧪➡️🩸
• Plasma dried into a powder and mixed in the field.
• Room temperature storage, long shelf life, fast mixing.
• Carries clotting factors and proteins.
• Does not carry oxygen.
Why crews like it:
• Mix time is usually 2 to 5 minutes.
• Shelf life is often 2 years or more.
• No freezers or thawing cabinets.
• Small and lightweight for air and rural units.
Stability tests show factor activity remains usable even in hot field conditions. Israeli programs stored FDP for more than a year without major loss in potency. That matters if your cooler becomes a sauna in July.
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What the Trials Show 📊📚
Prehospital plasma as a whole
A 2024 meta analysis of three large RCTs found:
• No clear difference in 24 hour or 30 day mortality.
• Lower PRBC use by about 0.8 units in the first day.
• Better INR on arrival.
• No safety concerns.
Freeze dried plasma specifically
A 2021 systematic review showed:
• Coagulation support similar to standard plasma.
• Survival signals in some cohorts but not consistent.
• Very low reaction rates.
The French PREHO PLYO RCT
• FDP vs saline in severe trauma.
• Similar INR and similar mortality.
• Proven safe and feasible.
The Australian HEMS pilot RCT
• FDP plus RBCs vs RBCs alone.
• Feasible to hang in flight.
• Lower mortality in the plasma group, but sample size was small.
• No major reactions.
Israeli battlefield and civilian programs
• Fast administration at point of injury.
• Lower coagulopathy and mortality in some cohorts.
• Observational data, so bias is possible.
Civilian programs using FDP plus RBCs
• More balanced resuscitation early in transport.
• Lower crystalloid use.
• Strong feasibility in air and ground systems.
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What FDP Can Do 💡
• Replace clotting factors.
• Support thrombin formation.
• Support endothelial stability.
• Improve early coagulation profiles.
• Reduce crystalloid use.
• Bridge long transports until blood is available.
What FDP Cannot Do ❌
• Carry oxygen.
• Replace red cell mass.
• Take the place of whole blood in shock.
• Fix the full pathophysiology of hemorrhage alone.
You still need RBCs or whole blood for oxygen delivery.
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When FDP Makes Sense 🚁🌄
Strong cases
• Long rural transports.
• Air medical missions.
• Tactical or austere environments.
• Programs without refrigerated storage.
• Units that want early balanced resuscitation.
Weak cases
• Urban ground EMS with 10 minute transports.
• Approaches that already have easy access to thawed plasma and whole blood.
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Practical Advice for Your Team 🧰
• Train mixing until you can do it in under 3 minutes.
• Build simple activation triggers.
• Pair FDP with RBCs when possible.
• Give TXA when indicated.
• Give calcium during blood programs.
• Document every unit for traceability.
• Teach your crews that FDP is not blood.
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A Straight Take 🧓⚕️
FDP is not magic. It is a solid tool with real value in systems that face long times, big distances, and broken logistics. It is safe, portable, and reliable. It fixes coagulopathy early. It does not replace whole blood. Use it where it fits. Your patients will benefit when you choose it for the right call.
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📚References
1. Abuelazm M, Rezq H, Mahmoud A, et al. The efficacy and safety of pre hospital plasma in patients at risk for hemorrhagic shock. Eur J Trauma Emerg Surg. 2024;50(6):2697-2707. https://doi.org/10.1007/s00068-024-02461-7 
2. Ateek J, MacDonald S, Goldstein J, et al. State of the Evidence for Prehospital Plasma Infusion for Patients With Suspected Traumatic Hemorrhage. Air Med J. 2025;44(4):242-255. Correct DOI: https://doi.org/10.1016/j.amj.2025.02.006 
3. Jost D, Lemoine S, Lemoine F, et al. Prehospital lyophilized plasma transfusion for trauma induced coagulopathy in patients at risk for hemorrhagic shock. JAMA Netw Open. 2022;5(7):e2223619. https://doi.org/10.1001/jamanetworkopen.2022.23619 
4. Mitra B, Meadley B, Bernard S, et al. Pre hospital freeze dried plasma for critical bleeding after trauma. Acad Emerg Med. 2023;30(10):1013-1019. https://doi.org/10.1111/acem.14745 
5. Mok G, Hoang R, Khan MW, et al. Freeze dried plasma for major trauma, systematic review and meta analysis. J Trauma Acute Care Surg. 2021;90(3):589-602. https://doi.org/10.1097/TA.0000000000003012 
6. Peng HT, Singh K, Rhind SG, da Luz L, Beckett A. Dried plasma for major trauma, past, present, and future. Life. 2024;14(5):619. https://doi.org/10.3390/life14050619 
7. Sheffield WP, Singh K, Beckett A, Devine DV. Prehospital freeze dried plasma in trauma, a critical review. Transfus Med Rev. 2024;38(1):150807. https://doi.org/10.1016/j.tmrv.2023.150807 
8. Mould Millman NK, Wogu AF, Fosdick BK, et al. Association of freeze dried plasma with 24 h mortality among trauma patients at risk for hemorrhage. Transfusion. 2024;64(Suppl 2):S155-S166. https://doi.org/10.1111/trf.17792 
9. Shlaifer A, Siman Tov M, Radomislensky I, et al. Prehospital administration of freeze dried plasma, is it the solution for trauma casualties. J Trauma Acute Care Surg. 2017;83(4):675-682. https://doi.org/10.1097/TA.0000000000001569 
10. Shlaifer A, Siman Tov M, Radomislensky I, et al. The impact of pre hospital administration of freeze dried plasma on casualty outcome. J Trauma Acute Care Surg. 2018;86(1):108-115. https://doi.org/10.1097/TA.0000000000002094 
11. Sunde GA, Vikenes BH, Strandenes G, et al. Freeze dried plasma and fresh red blood cells for civilian prehospital hemorrhagic shock resuscitation. J Trauma Acute Care Surg. 2015;78(6 Suppl 1):S26-S30. https://doi.org/10.1097/TA.0000000000000633 
12. Oakeshott JE, Griggs JE, Wareham GM, Lyon RM. Feasibility of prehospital freeze dried plasma administration in a UK Helicopter Emergency Medical Service. Eur J Emerg Med. 2019;26(5):373-378. https://doi.org/10.1097/MEJ.0000000000000585 
13. Zur M, Glassberg E, Gorenbein P, et al. Freeze dried plasma stability under prehospital field conditions. Transfusion. 2019;59(11):3485-3490. https://doi.org/10.1111/trf.15533 
14. Zur M, Gorenbein P, Nachshon A, et al. Post expiry stability of freeze dried plasma under field conditions, can shelf life be extended. Transfusion. 2021;61(5):1570-1577. https://doi.org/10.1111/trf.16319 
15. Pusateri AE, Malloy WW, Sauer D, et al. Use of dried plasma in prehospital and austere environments. Anesthesiology. 2022;136(2):327-335. https://doi.org/10.1097/ALN.0000000000004089 
