If an event triggers Article V and NATO is drawn into defensive combat operations, there could well be more dead and wounded than the West has encountered before. Most casualties will result from combat trauma and require both surgery and blood transfusion to survive. Under NATO’s split “collective-individual” responsibility system, should national blood logistic systems be unable to deliver; and with NATO unable to exercise overall coordination, serious consequences for individual morale, the will to fight, and overall combat capability will occur, producing dire strategic outcomes. This article focusses on NATO blood supply logistics and highlights current deficiencies, using Estonian Defence Force blood supply logistics as its working example. The article’s principal argument is that blood supply logistics has “tactical-level” effects which have critical flow-on strategic effects on issues such as force preservation and morale. Blood supply logistics is a complex issue urgently requiring concerted NATO, multinational, and national attention.