POWDERED BLOOD FOR THE BATTLEFIELD
From Historical Blood Substitutes to FSHARP, RAPIID, and the Modern Military Hemorrhagic Resuscitation System
Scientific and Operational Review – Updated 2026
DrRamonReyesMD
EMS Solutions International
INTRODUCTION
Traumatic hemorrhage remains one of the leading preventable causes of death in combat, civilian trauma, mass-casualty incidents, and austere medicine. The problem is not merely the loss of intravascular volume. The real problem is the simultaneous loss of oxygen-carrying erythrocytes, plasma, coagulation factors, fibrinogen, platelets, functional calcium, temperature, physiologic pH, and hemostatic capacity.
During the wars in Iraq and Afghanistan, Western military medicine developed an increasingly aggressive doctrine of early hemorrhage control, early tourniquet (TQ) use, blood-product resuscitation, rapid evacuation, and damage-control surgery. However, the war in Ukraine, high-intensity conflict scenarios, drones, persistent artillery, electronic warfare, anti-access environments, and prolonged operations have brought an old question back to military medicine:
What happens when the casualty needs blood, but blood cannot reach the casualty?
This need has renewed interest in what is popularly called “powdered blood,” although the technically more accurate term would be:
a bio-artificial system designed to reproduce critical functions of whole blood, stable at room temperature, and reconstitutable at the point of care.
THE CURRENT SYSTEM: WHAT IS USED IN COMBAT TODAY
As of 2026, the real and operational reference system is not artificial blood. The current system is based on human blood and blood-derived products.
The current doctrinal priority in advanced military medicine is:
1. Immediate hemorrhage control. Tourniquet (TQ) use for massive extremity hemorrhage, hemostatic wound packing, direct pressure, junctional devices, pelvic control, and damage-control surgery.
2. Hemostatic resuscitation. Avoid large-volume crystalloids. Replace blood or blood products as early as possible.
3. Blood Far Forward. The modern concept of pushing blood as far forward as operationally feasible seeks to bring blood products closer to the point of injury through low-titer group O whole blood, freeze-dried plasma, cold-stored platelets, walking blood banks, and Remote Damage Control Resuscitation capabilities.
4. Low-Titer Group O Whole Blood. The most valued standard in many current military programs is Low-Titer Group O Whole Blood (LTOWB), especially in far-forward environments.
5. Fresh Whole Blood through Walking Blood Banks. When stored blood is not available, previously screened donors within the military unit may be used.
6. Balanced blood components. When whole blood is unavailable, clinicians attempt to approximate its composition through packed red blood cells, plasma, and platelets in ratios close to 1:1:1.
7. Freeze-dried plasma where available. Dried or lyophilized plasma is already used in some military and prehospital environments. It does not replace whole blood, but it provides coagulation factors and facilitates hemostatic resuscitation when fresh frozen plasma is not logistically feasible.
8. Cold-stored platelets. Cold-stored platelets are regaining operational interest because they may offer greater utility in hemorrhagic trauma and better logistical compatibility than conventional room-temperature platelets.
9. Pharmacologic adjuncts. Tranexamic acid, calcium, hypothermia correction, pH control, fibrinogen or cryoprecipitate when available, and clinical or viscoelastic monitoring whenever feasible.
In summary:
Today, human blood remains the gold standard. Artificial blood has not replaced whole blood. FSHARP and RAPIID are attempting to solve the logistical problem that human blood alone cannot solve.
WHY BLOOD IS SO DIFFICULT TO REPLACE
Blood is not simply a red fluid that transports oxygen. It is a liquid organ with multiple simultaneous functions.
It provides oxygen transport through hemoglobin contained within erythrocytes; carbon dioxide transport through bicarbonate, hemoglobin, and plasma; primary hemostasis through platelets; secondary hemostasis through plasma coagulation factors; immunity through leukocytes, complement, immunoglobulins, and cellular mediators; circulating volume through oncotic pressure, perfusion, and venous return; acid-base balance through physiologic buffering; thermoregulation; and endothelial interaction.
That is why many historical substitutes failed: they could transport oxygen but caused vasoconstriction; they expanded volume but diluted coagulation; they improved hemodynamic numbers but worsened mortality; or they were logistically attractive but biologically incomplete.
HISTORY OF BLOOD SUBSTITUTES
The search for a blood substitute is not new. It has been a military-medical, surgical, and transfusion obsession for more than a century.
1. Saline Solutions and Crystalloids
Saline solutions were among the earliest rational attempts to replace lost volume. Their main utility was to temporarily restore blood pressure and intravascular volume.
However, they have a fundamental limitation:
they do not transport oxygen, they do not provide platelets, and they do not provide coagulation factors.
Excessive crystalloid use in hemorrhagic trauma promotes hemodilution, hypothermia, acidosis, tissue edema, coagulopathy, and worsening of the lethal triad.
2. Colloids: Gelatins, Dextrans, and Hydroxyethyl Starches
Colloids attempted to improve plasma expansion by maintaining intravascular oncotic pressure.
They included dextrans, gelatins, albumin, and hydroxyethyl starches.
The problem is that they also do not transport oxygen or correct trauma-induced coagulopathy. Some were associated with coagulation abnormalities, renal injury, anaphylaxis, and worse outcomes in critically ill patients.
In modern trauma, colloids do not represent a solution for massive hemorrhagic shock.
3. Perfluorocarbons
Perfluorocarbons are compounds capable of dissolving large amounts of oxygen and carbon dioxide. They became one of the most important research lines in “artificial blood.”
The classic example was Fluosol-DA, approved by the FDA in 1989 as an artificial oxygen carrier. Its use was complex, required special preparation, required high oxygen concentrations, and had significant clinical limitations. It was later withdrawn from the market.
Other related projects included Perftoran, developed in Russia, and Oxycyte, a perfluorocarbon emulsion investigated for traumatic brain injury and tissue oxygenation.
The central problem with perfluorocarbons is that they are not blood. They can transport gases, but they do not provide physiologic hemoglobin, platelets, or coagulation factors.
4. Hemoglobin-Based Oxygen Carriers — HBOCs
Hemoglobin-based oxygen carriers were another major hope. The logic seemed impeccable: if hemoglobin transports oxygen, perhaps free or modified hemoglobin could be administered without red blood cells.
But free hemoglobin outside the erythrocyte is biologically problematic. It may cause nitric oxide scavenging, vasoconstriction, hypertension, oxidative stress, renal injury, endothelial dysfunction, inflammation, and cardiovascular events.
Among the most important historical projects were:
HemAssist. A modified human hemoglobin product developed by Baxter. It reached advanced clinical trials but was associated with increased mortality and vasoconstrictive complications. It was abandoned.
PolyHeme. A polymerized human hemoglobin product developed by Northfield Laboratories. It generated strong military and prehospital trauma interest. Its goal was to provide oxygen transport before hospital arrival. The program ended without approval and with clinical, regulatory, and ethical controversy.
Hemopure. Purified polymerized bovine hemoglobin. It has been one of the most persistent HBOCs. It has had limited approval in some countries, including South Africa and Russia, and use under special circumstances, but it did not become a universal substitute for human blood.
Oxyglobin. A veterinary version related to Hemopure, approved for use in dogs.
The historical message is clear:
oxygen transport is not enough.
A product can carry oxygen and still fail if it disrupts microcirculation, endothelium, coagulation, or cardiovascular safety.
5. Cultured Blood and Ex Vivo-Produced Erythrocytes
Another modern pathway attempts to produce red blood cells from hematopoietic stem cells or progenitor cells.
This approach is scientifically elegant, but still limited by cost, industrial scale, cellular maturation, lifespan, compatibility, regulation, and mass production.
Its most likely initial application will not be replacing all trauma blood, but producing special units for patients with rare blood groups or complex transfusion requirements.
6. Dried Plasma, Freeze-Dried Plasma, and Spray-Dried Plasma
Freeze-dried plasma is one of the most realistic existing solutions for military and prehospital medicine.
It allows coagulation factors to be transported without conventional frozen storage. It can be reconstituted with sterile fluid and administered before hospital arrival.
Historical and current examples include French Freeze-Dried Plasma, German LyoPlas, military lyophilized plasma, and dried plasma for prehospital use.
Its limitation is obvious:
it does not transport oxygen and does not provide platelets.
But within hemostatic resuscitation, it is highly valuable.
7. Cold-Stored Platelets, Lyophilized Platelets, and Platelet Substitutes
Platelets are a major logistical problem. They have a short shelf life, require strict storage conditions, and are difficult to bring to the front line.
For that reason, researchers are investigating cold-stored platelets, cryopreserved platelets, lyophilized platelets, platelet-like synthetic particles, and hemostatic nanoparticles.
Modern concepts include platelet-like particles, hemostatic particles targeted to vascular injury sites, and platforms developed by companies such as Haima Therapeutics.
This field is crucial because artificial blood without platelet function would be incomplete for hemorrhagic trauma.
FSHARP: DARPA’S CURRENT PROGRAM
FSHARP stands for:
Fieldable Solutions for Hemorrhage with bio-Artificial Resuscitation Products.
It is a DARPA program intended to develop a deployable bio-artificial resuscitation system that is stable at room temperature and usable in austere prehospital environments.
The difference between FSHARP and many older programs is that it is not attempting to create only an oxygen carrier. It is attempting to create a broader functional system capable of reproducing several critical functions of whole blood.
Its objectives include oxygen transport, hemorrhage control, volume restoration, coagulation support, and logistical stability.
Official DARPA FSHARP URL:
https://www.darpa.mil/research/programs/fieldable-solutions-for-hemorrhage-with-bio-artificial-resuscitation-products
THE CORE BIOLOGICAL COMPONENTS OF FSHARP
1. Oxygen Carrier
Its function would be to partially replace erythrocyte function. It would not necessarily be a complete artificial red blood cell, but rather a system capable of transporting oxygen to hypoxic tissues during hemorrhagic shock.
The major challenge is avoiding the historical errors of HBOCs: vasoconstriction, renal toxicity, inflammation, hypertension, oxidative stress, and poor tissue oxygen unloading.
2. Platelet-Like Component
A true artificial combat blood product requires hemostasis. Blood pressure and oxygen alone are not enough.
The product must help form clot, adhere to vascular injury sites, and support primary hemostasis.
This is one of the most innovative areas of the program.
3. Plasma Component
Plasma provides coagulation factors, proteins, oncotic pressure, and biochemical support. Integration of dried plasma or plasma analogues is essential to approximate functional whole blood.
4. Field Reconstitution System
The operational idea is that the product could be transported dry or stabilized, probably in dual-chamber systems or equivalent rapid-mixing systems.
The tactical objective is clear:
to allow a military medic to carry transfusion capability in a backpack, without refrigeration, without a blood bank, and without a complex cold-chain logistics system.
RAPIID: THE TRANSITION TOWARD REAL-WORLD USE
In 2026, DARPA announced RAPIID:
Resuscitation and Prevention of Ischemia-Induced Dysfunction.
RAPIID seeks to transform FSHARP advances into a real, scalable, manufacturable, and regulatory-viable system.
Its goals include functional prototypes, industrial production, additional preclinical studies, human trials, FDA regulatory interaction, administration systems, use guidelines, and operational deployment.
DARPA has proposed fiscal year 2029 as the horizon for an initial deployable capability, always conditioned by safety, efficacy, regulation, and production.
Official DARPA RAPIID URL:
https://www.darpa.mil/research/programs/rapiid
DARPA 2026 announcement:
https://www.darpa.mil/news/2026/rapiidly-transitioning-shelf-stable-blood-substitutes-battlefield
LESSONS FROM UKRAINE
The war in Ukraine has demonstrated that rapid medical evacuation is not always possible. Drones, persistent artillery, mines, aerial surveillance, electronic warfare, and prolonged fire zones can delay evacuation for hours or even more than a day.
In this context, military medicine again faces the oldest physiologic problem in trauma:
the hemorrhagic patient needs oxygen, coagulation, volume, temperature, calcium, and surgery, but may not receive them in time.
This scenario explains why research into stable blood, lyophilized products, platelet substitutes, far-forward whole blood, and bio-artificial systems has regained strategic relevance.
SPACE, MARITIME, AND EXPEDITIONARY MEDICINE
The potential utility of a stable bio-artificial product is not limited to the battlefield. It could also apply to lunar or Martian missions, submarines, military ships, offshore platforms, polar bases, jungle, desert, mountain environments, humanitarian medicine, and natural disasters.
A prolonged space mission cannot depend on conventional blood banks. Neither can an isolated ship. Neither can a remote oil platform. Therefore, research into stable blood products has military, civilian, aerospace, maritime, and humanitarian value.
SUMMARY TIMELINE
1914–1918. Early modern wartime transfusions.
1930–1945. Progressive development of blood banking.
1950–1970. Expansion of crystalloids, colloids, and volume strategies.
1989. FDA approval of Fluosol-DA.
1990–2010. Development and partial failure of HemAssist, PolyHeme, Hemopure, and other HBOCs.
2010–2020. Resurgence of whole blood in military trauma.
2021. DARPA advances FSHARP.
2026. DARPA announces RAPIID as a transition phase.
2029. Estimated target for initial capability, conditioned by safety, regulation, and production.
WHY THIS TIME COULD BE DIFFERENT
The difference between FSHARP/RAPIID and classical projects is that the current approach is not limited to “artificial hemoglobin.”
The modern approach attempts to combine oxygenation, hemostasis, volume, coagulation, thermal stability, ease of reconstitution, and real tactical usability.
The goal is not merely to survive transport to the hospital. The goal is to sustain the casualty when immediate transport does not exist.
This connects directly with Prolonged Casualty Care, Remote Damage Control Resuscitation, special operations, maritime warfare, islands, submarines, the Arctic, Africa, jungle, desert, offshore platforms, and expeditionary medicine.
WHAT DOES NOT YET EXIST
As of 2026, there is no universally approved, massively deployed “powdered blood” product that replaces human blood in combat.
Robust human clinical trials, FDA authorization, industrial production, real stability under extreme conditions, doctrine of use, training, pharmacovigilance, affordable cost, and direct comparison with human whole blood are still required.
Scientific enthusiasm is legitimate, but clinical integration requires caution.
POTENTIAL IMPACT ON TCCC, TECC, AND PCC
If FSHARP/RAPIID works in humans, it could modify several doctrinal echelons.
In TCCC, it could be incorporated as a far-forward resuscitation product for hemorrhagic shock when LTOWB or fresh whole blood are unavailable.
In TECC, it could have value in mass-casualty incidents, terrorism, rural environments, tactical law enforcement, prolonged rescue, and EMS systems far from hospitals.
In Prolonged Casualty Care, its impact could be enormous because PCC requires sustaining physiology for hours or days.
In maritime and offshore medicine, it could be especially useful aboard ships, oil platforms, delayed evacuations, and environments without blood banks.
In humanitarian medicine, earthquakes, hurricanes, civil conflicts, field hospitals, and remote missions could benefit significantly.
COMPARISON WITH THE CURRENT SYSTEM
The current system works, but it depends on logistics.
Human whole blood: biologically excellent, logistically limited.
LTOWB: highly effective, but requires donors, cold chain, and titer control.
Walking Blood Bank: excellent in trained units, but requires screening, discipline, and compatibility.
1:1:1 component therapy: useful in hospitals, complex in the field.
Freeze-dried plasma: very useful, but does not transport oxygen.
Cold-stored platelets: promising for trauma, but still subject to logistical and regulatory limitations depending on the system.
Historical HBOCs: transport oxygen, but have had safety problems.
FSHARP/RAPIID: promise multi-function integration, but are not yet a clinical standard.
CONCLUSION
“Powdered blood” should not be understood as technological fantasy or as an already available solution. It should be understood as the result of more than a century of attempts to solve one of medicine’s most difficult problems: temporarily replacing a complex liquid organ under conditions of trauma, hypoxia, coagulopathy, and logistical collapse.
The history of blood substitutes teaches humility. Fluosol, HemAssist, PolyHeme, Hemopure, perfluorocarbons, HBOCs, dried plasma, artificial platelets, and cultured blood have shown that blood is not easily replaced.
However, FSHARP and RAPIID represent a new conceptual generation. They are no longer simply trying to “carry oxygen.” They seek to approximate the critical functions of whole blood: oxygenation, volume support, coagulation support, and survival through battlefield logistics.
As of 2026, the real standard remains human blood: LTOWB, fresh whole blood, walking blood banks, plasma, platelets, red blood cells, TXA, calcium, temperature control, and damage-control surgery.
But if DARPA succeeds in turning FSHARP/RAPIID into a safe, effective, scalable, and authorized product, we may be witnessing one of the most important changes in military medicine since the modern introduction of blood transfusion in war.
It will not replace hemorrhage-control doctrine. It will not replace the surgeon. It will not replace human blood when human blood is available.
But it could fill the most lethal gap in modern war:
the casualty who needs blood now, in a place where human blood cannot arrive.
MAIN SOURCES, URL AND DOI
DARPA. FSHARP — Fieldable Solutions for Hemorrhage with bio-Artificial Resuscitation Products.
URL: https://www.darpa.mil/research/programs/fieldable-solutions-for-hemorrhage-with-bio-artificial-resuscitation-products
DARPA. RAPIID — Resuscitation and Prevention of Ischemia-Induced Dysfunction.
URL: https://www.darpa.mil/research/programs/rapiid
DARPA. RAPIIDly transitioning shelf-stable blood substitutes to the battlefield. 2026.
URL: https://www.darpa.mil/news/2026/rapiidly-transitioning-shelf-stable-blood-substitutes-battlefield
Chen JY, Scerbo M, Kramer G. A review of blood substitutes: examining the history, clinical trial results, and ethics of hemoglobin-based oxygen carriers. Clinics. 2009.
DOI: 10.1590/S1807-59322009000800016
URL: https://pubmed.ncbi.nlm.nih.gov/19690667/
Cannon JW. Hemorrhagic Shock. New England Journal of Medicine. 2018;378:370-379.
DOI: 10.1056/NEJMra1705649
URL: https://pubmed.ncbi.nlm.nih.gov/29365303/
Leibner E, Andreae M, Galvagno SM, Scalea T. Damage control resuscitation. Clinical and Experimental Emergency Medicine. 2020.
URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC7141982/
Joint Trauma System. Damage Control Resuscitation Clinical Practice Guideline.
URL: https://jts.health.mil/assets/docs/cpgs/Damage_Control_Resuscitation_12_Jul_2019_ID18.pdf
Chang RK et al. Prescreened Whole O Blood Group Walking Blood Bank: A Model for Maritime Prolonged Casualty Care. Journal of Special Operations Medicine. 2024.
URL: https://pubmed.ncbi.nlm.nih.gov/38408045/
Chen L, Yang Z, Liu H. Hemoglobin-Based Oxygen Carriers: Where Are We Now in 2023? Medicina. 2023.
DOI: 10.3390/medicina59020396
URL: https://www.mdpi.com/1648-9144/59/2/396
EAST Practice Management Guideline. Whole Blood Resuscitation for Injured Patients Requiring Transfusion. 2024.
URL: https://www.east.org/education-resources/practice-management-guidelines/details/whole-blood-resuscitation-for-injured-patients-requiring-transfusion-a-systematic-review-metaanalysi
TCCC / Deployed Medicine / Joint Trauma System. Damage Control Resuscitation and Tactical Combat Casualty Care resources.
URL: https://tccc.org.ua/en/guide/damage-control-resuscitation-cpg
DrRamonReyesMD
EMS Solutions International
Updated June 2026
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