Transfusion emergency preparedness is increasingly becoming an integrated part of major incident planning. The spectrum of planning extends from the sophisticated healthcare system dealing with multiple casualties, to the isolated healthcare facility resuscitating the critically ill patient with massive haemorrhage. Transfusion preparedness should follow risk assessment and be nested within the wider emergency planning system. The response should be designed to deliver both safety and sufficiency of transfusion support and includes diagnostics, donation and distribution. The biggest transfusion risks in emergency situations are those of red cell ABO incompatibility and delayed provision. Sufficiency and supply may be compromised when communities are isolated and cannot access mutual support. Planning may need to consider local collection and testing of blood as a further resilience measure. Considerations include demand planning; inventory management and transfusion triage; a whole blood preparedness model; resilience and resupply and the human factor. We suggest a whole blood programme can simplify the whole vein‐to‐vein process for production, laboratory and clinical staff and can be integrated into a range of healthcare systems.