I have just been through this with both my parents within the last few weeks who were in an auto accident. Their treatment and injuries were different, though they both came into the hospital as "traumas."
My father had a dislocated hip and needed surgery to repair the socket in his pelvis. He was not bleeding when he came into Emergency. The blood issue came about because of the hip repair surgery which happened a few days later. The surgeon was great. He asked my dad if several treatments were okay, mentioning that he thought other JWs had accepted them, but asked my dad to do any research he needed to do, including talking to the HLC, to determine if these treatments would be okay with him. Dad accepted a cellsaver during surgery (recycles your blood), an internal tourniquet to block blood flow temporarily to the surgery site and Epigen for several days before surgery to build up his red blood cell count. He was respectful, gave dad options, and worked with him to find solutions. The blood loss during surgery was minimal and dad is recovering well. The key was that this was PLANNED surgery.
My mom came into Emergency actively bleeding. This is much more dangerous because there is no time for planning or research. She was upset that the HLC hadn't told the doctors what was acceptable and what their medical plan was. She clearly knew nothing other than NO BLOOD! When she finally talked with the HLC and they made their "recommendations, " she was angry with the trauma doctor that told her that her need was acute and these interventions take time to work, so they wouldn't be useful to her. Her hemoglobin dropped into the 7s and continued to drop into the 6s until she refused to have anymore blood drawn, both because she didn't want to know and she thought she couldn't afford to lose even a vial of blood. The only thing she would accept was iron. The nurse told us that her refusal of blood was causing lots of issues with fainting and fatigue. This would just make her recovery all the more slow. She has been recovering much more slowly than my dad. Her hemoglobin numbers are slowly coming up, but she talked to a JW friend of hers who is a nurse and told her that she lost about half of her red blood cells and it would take several months for her to build them back up. This was the first person whom she actually believed about her medical condition and it shook her up.
So, I guess the point I'm making is that there are different scenarios with the blood issue. If there is planned surgery, there is time to work out mutually agreed upon solutions between the surgeon and the patient. If you come into Emergency actively bleeding, then the JW acceptable treatments don't have time to work and all a doctor can do is point out the dangers of not accepting blood. There's no time to have a debate and a critical patient does not have the ability, likely, to weigh options and make decisions in such a fast-paced emergency type situation.
Also, the surgeon who worked with my dad told me, pointing to my year old nephew, that if he needed blood, he'd have a court order in a minute.