Case Study: Nakul Raykar, MD, MPH
Some responses have been edited for length and/or clarity.
Q: How many people are affected by traumatic blood loss each year and what are the current practices to address this health crisis?
A: About 6 million people die of trauma every year around the world and 90% of these deaths occur in low- and middle-income countries. To put this in context, we lost between 7 and 8 million people globally due to the COVID-19 pandemic. The leading cause of preventable death after trauma is blood loss. In a highly functional, well-developed trauma system like the United States, we know that if a patient experiencing severe blood loss after trauma makes it to a hospital, less than 2% of these patients will die. We have blood on the shelves and trained providers to administer this blood immediately upon patient arrival. This gives us just enough time to stabilize the patient and get them to an operating room for surgery. If you live in a part of the world that does not have access to blood transfusion, these patients are much more likely to die. Trauma mortality in blood deserts in low- and middle-income countries ranges as high as 60% — when it is even measured.
Q: Tell us about your innovative solution to help trauma patients and how it advances the field of trauma care.
A: We are adapting an established military process — called a walking blood bank — that has been refined over the last two decades of war in Iraq and Afghanistan, to the civilian, low-resource setting which has chronic blood insufficiency.
Q: How has your work progressed to impact the field of trauma?
A: At the end of 2023, we finished our phase one study, supported by the Stepping Strong Innovator Award. This demonstrated a clear need for, and the feasibility and safety of, a walking blood bank in a civilian, low-resource setting in northwestern Kenya.
We were also fortunate enough to win the Stepping Strong Breakthrough Award which will allow us to implement a civilian walking blood bank in one of Kenya’s most remote and socioeconomically challenged contexts.
Q: Following your collaboration with the Stepping Strong Center, what additional opportunities have come from your research?
A: Leveraging the momentum and connections from this work, we convened a multidisciplinary meeting on the Harvard Radcliffe Institute campus in April of 2023, also with the support of the Stepping Strong Center.
In March 2024, The Lancet Global Health released our paper outlining innovative strategies to alleviate the crisis in the world’s blood deserts which includes the concept of civilian walking blood banks. Our group also decided to form what we call the Blood D.E.S.E.R.T. Coalition, whose mission is to advance the research, education, and policy agenda necessary to eliminate the world’s blood deserts.
Q: What is your goal for survivors who have experienced a traumatic injury? What does success in this work mean to you?
A: We think that nobody should die of a treatable condition when treatments exist. Trauma is one of the world’s largest public health challenges. Blood transfusion is one of the medicine world’s most tried and tested treatments. Where there are people, there is blood. It makes no sense, therefore, that people die because there is no blood available for transfusion.