<\/p>\n
Fort Worth Fire Department Capt. Trent Robinson works to transfuse a gunshot victim with a unit of blood in the back of an ambulance in Fort Worth on a late fall evening in 2025. The department has initiated a mobile blood program, which has delivered blood to hemorrhaging patients in the field since April.<\/p>\n
Smiley N. Pool\/Staff Photographer<\/p>\n
Fort Worth Fire Department Capt. Trent Robinson logs the condition and temperature of a unit of blood carried in a cooler in his vehicle between calls.<\/p>\n
Smiley N. Pool\/Staff Photographer<\/p>\n
A sign on the door reads \u201cexpect fire, expect victims\u201d as Fort Worth Fire Department Capt. Trent Robinson heads for his vehicle at Fort Worth Fire Station 5.<\/p>\n
Smiley N. Pool\/Staff Photographer<\/p>\n
Fort Worth Fire Department Capt. Trent Robinson follows another medical unit into an apartment complex as he responds to a call in Fort Worth.<\/p>\n
Smiley N. Pool\/Staff Photographer<\/p>\n
Blood moves through tubing in the back of a moving ambulance as a Fort Worth Fire Department team works to transfuse a gunshot victim with a unit of blood.<\/p>\n
Smiley N. Pool\/Staff Photographer<\/p>\n
Fort Worth Fire Department Capt. Trent Robinson works to transfuse a gunshot victim with a unit of blood in the back of a moving ambulance in Fort Worth. The department has initiated a mobile blood program, which has delivered blood to hemorrhaging patients in the field since April.<\/p>\n
Smiley N. Pool\/Staff Photographer<\/p>\n
Fort Worth Fire Department paramedic Garrett Windham begins the cleanup of the ambulance after transporting a gunshot victim, who received a unit of blood in transit to the emergency room. The department has initiated a mobile blood program, which has delivered blood to hemorrhaging patients in the field since April.<\/p>\n
Smiley N. Pool\/Staff Photographer<\/p>\n
Fort Worth firefighter Michael Thornell repacks the Medic 1 bag next to a portable cooler used to transport blood after a gunshot victim was transfused with a unit of blood while being transported to the emergency room.<\/p>\n
Smiley N. Pool\/Staff Photographer<\/p>\n
Fort Worth firefighter Michael Thornell and Capt. Trent Robinson replenish a cooler with a new unit of blood at Carter BloodCare in Bedford. The department has initiated a mobile blood program, which has delivered blood to hemorrhaging patients in the field since April.<\/p>\n
Smiley N. Pool\/Staff Photographer<\/p>\n
Austin-Travis County EMS Commander Craig Smith (left) joined Austin firefighters as they extricated a patient from a motor vehicle accident in May. Blood is one of the few tools paramedics can use to treat severe internal bleeding at the scene of an accident. (Smiley N. Pool\/Staff Photographer)<\/p>\n
(Smiley N. Pool\/Staff Photographer)<\/p>\n
Austin-Travis County EMS Commander Craig Smith (left) works in the back of an ambulance in May. (Smiley N. Pool\/Staff Photographer)<\/p>\n
Smiley N. Pool\/Staff Photographer<\/p>\n
In late May, leaders with\u00a0Plano Fire-Rescue appeared before the City Council to make a rather unusual request for a new program that would help save more lives<\/a>.\u00a0<\/p>\n The department was working on an initiative to carry blood in the field to expedite transfusions for severely bleeding patients, which they expected to administer once a week. But there was no mechanism to charge for the blood, which was projected to cost around $35,000 a year.\u00a0<\/p>\n To offset those costs, the department was asking for a change in city ordinance to allow for the blood to be billed as a separate line item, on top of their standard transport fee, that would be paid by either the patient or their insurer. The department would only pay for blood it transfused and would bring unused blood nearing its expiration date to Medical City Plano Hospital.\u00a0<\/p>\n Article continues below this ad<\/p>\n Over the past few years, prehospital blood programs<\/a> have proliferated across North Texas and other parts of the country, as EMS providers seek to make their care more similar to that available in hospitals. In doing so, they have confronted an unavoidable challenge: how to make blood programs more financially sustainable.\u00a0<\/p>\n Fort Worth Fire Department Capt. Trent Robinson (center) works with fellow paramedics Garrett Windham (left) and Noah Burson to transfuse a gunshot victim with a unit of blood in the back of a moving ambulance in Fort Worth. The department has initiated a mobile blood program, which has delivered blood to hemorrhaging patients in the field since April.<\/p>\n Smiley N. Pool\/Staff Photographer<\/p>\n Plano\u00a0Fire-Rescue is already facing higher operating costs as it transitions to a new schedule that allows paramedics and emergency medical technicians longer breaks between shifts, said Dr. Mark Gamber, EMS medical director. That requires more staff, which are in high demand across the Dallas-Fort Worth area. Gamber said department leaders \u201cwant to be a good fiscal citizen within the city and try and cover our costs.\u201d\u00a0<\/p>\n While the cost of medical care provided at hospitals is itemized, federal and private insurance reimbursements for ambulance-based care is billed as a flat fee. Blood is expensive and has a short shelf life, necessitating its regular use or replacement. Carter BloodCare, a blood bank based in North Texas, charges $647 per unit, said Ryan Strutton, EMS battalion chief for Plano Fire-Rescue.\u00a0<\/p>\n Article continues below this ad<\/p>\n \u201cThe blood is actually a substantial amount of what our flat transport fee is,\u201d said Strutton at a city council meeting on May 26. \u201cIt would be a loss every time we give the blood. With the ordinance, we\u2019re able to recoup that money on top of the transport fee.\u201d\u00a0<\/p>\n Plano city leaders unanimously approved the fire department\u2019s request. The program is expected to debut this summer.\u00a0<\/p>\n Three years ago, very few EMS providers in North Texas carried blood in the field, despite research indicating that rapid transfusions could reduce potentially preventable bleeding deaths<\/a> in critically injured patients. Without access to lifesaving blood products, paramedics are limited in their ability to treat hemorrhaging patients, a 2023 investigation by The Dallas Morning News<\/a> found. As a result, patients routinely bled out from injuries they could have otherwise survived<\/a>, dozens of trauma surgeons and paramedics told The News.\u00a0<\/p>\n Read “Bleeding Out,” a new series examining how gaps in the American health system fail to address preventable deaths. This series was produced in partnership with the San Antonio Express-News and with support from the USC Annenberg Center for Health Journalism.<\/p>\n michael-hogue<\/p>\n At the time, first responders in the Dallas-Fort Worth area lagged behind<\/a> other parts of Texas in improving the standard of care for patients bleeding from shootings, car crashes, accidents and medical conditions. Administering blood on ambulances was already routine in San Antonio and Austin<\/a>.\u00a0<\/p>\n Article continues below this ad<\/p>\n Since then, North Texas has made significant strides toward catching up.\u00a0<\/p>\n In early 2025, the region\u2019s two largest EMS providers, Dallas Fire-Rescue<\/a> and the Fort Worth Fire Department<\/a>, both launched prehospital blood programs. In its first year, the Dallas program was credited with saving dozens of lives<\/a>; in Fort Worth, paramedics administered more than 150 units of blood<\/a> over the span of eight months. In recent months, EMS providers in Arlington and McKinney have also begun carrying blood.\u00a0<\/p>\n Cost was initially a barrier for Arlington EMS, which is operated by AMR, or American Medical Response, a private contractor. Arlington EMS leaders had been interested in carrying blood for years, but it took them time to design the program responsibly and build it into its operating costs, said Chris Weinzapfel, EMS operations manager.\u00a0<\/p>\n The organization does not receive subsidies from the city for its 911 services; its operations are supported by what it collects from patients and insurance providers. The organization had to account for the fact that federal fee schedules still don\u2019t fully cover the cost of particularly expensive interventions such as blood transfusions.\u00a0<\/p>\n When Arlington EMS launched its program in October, the organization decided to buy its blood outright from Medical City Arlington Hospital. Call volumes indicated the blood would be used one to three times a week.<\/p>\n Article continues below this ad<\/p>\n If just one life was saved, Weinzapfel said, that would be \u201cworth the weight in gold.\u201d Early numbers from the program suggest far more lives than that have already been spared. From mid-October to early May, paramedics transfused 66 units of blood into 56 patients.\u00a0<\/p>\n File Photo.<\/p>\n Smiley N. Pool\/Staff Photographer<\/p>\n Losing money<\/p>\n Still, Weinzapfel said, a better solution would be for the federal government to create a funding mechanism in support of the best possible care for patients on the way to the hospital, not just after they arrive. \u00a0<\/p>\n In early 2025, the Centers for Medicare and Medicaid Services adopted a regulatory rule that added blood transfusions to its fee schedule for critical medical care provided on ambulances. While the change signaled the federal government\u2019s recognition that transfusions were becoming a part of advanced care on ambulances, it did not increase the actual dollar amount reimbursed to EMS providers.\u00a0<\/p>\n Article continues below this ad<\/p>\n Units of blood and their associated equipment can range from $500 to upwards of $1,000 per transfusion, according to a national survey of EMS providers<\/a> published last year. As a result, EMS providers lose money on every transfusion they perform.\u00a0<\/p>\n That mismatch prompted trauma specialists \u2014 many of them from Texas \u2014 to organize a federal lobbying effort for a legislative fix that would make it easier for paramedics across the country to carry blood products.\u00a0<\/p>\n In late April, advocates held a two-day conference<\/a> in Washington, DC, that brought together medical experts, patient advocates, federal regulators and legislative aides. A series of panels explored the importance of blood programs, their costs and design, and policy recommendations.\u00a0<\/p>\n Kate Krause whose life was saved by a transfusion shares her story with Marshal Isaacs, medical director for the Dallas Fire-Rescue, left, and Interim Assistant Chief Scott Pacot, right, during a Dallas City Council meeting, Wednesday, Aug. 20, 2025, in Dallas. Dallas Fire-Rescue paramedics, Marcus Toop, background from left, Joshua Mihalyi and Justin Lovvorn help to save the life of Krause, who is an emergency medicine physician, with an on-scene blood transfusion.<\/p>\n Chitose Suzuki\/Staff Photographer<\/p>\n The speakers included several physicians and patients from Texas, including Dr. Kate Krause, a Dallas emergency medicine physician who received an urgent transfusion<\/a> from Dallas Fire-Rescue paramedics last year when she was bleeding out from a postpartum hemorrhage.\u00a0<\/p>\n Article continues below this ad<\/p>\n The hope, said Dr. Donald Jenkins, a trauma surgeon with University Hospital in San Antonio who also spoke at the conference, is that federal lawmakers will follow the suit of Texas legislators, who last year allocated $10 million<\/a> in statewide funding for prehospital blood. That money is being distributed through regional trauma advisory councils. Some North Texas providers that are not yet carrying blood, including the Irving Fire Department, are interested in seeking a share of that funding. \u00a0\u00a0<\/p>\n Jenkins recognizes federal policymaking is slow. In the meantime, he said, there are other solutions advocates are exploring. One of them is to have hospitals underwrite the cost of blood products transfused into patients during their transports. In doing so, Jenkins said, hospitals would actually save money, because those patients arrive in better condition.\u00a0<\/p>\n \u201cThis is the most affordable way there is to save lives,\u201d Jenkins said. \u201cPeriod.\u201d\u00a0<\/p>\n Trauma nurse Kathrine Lozano administers a unit of blood to a patient in trauma center at John Peter Smith Hospital in April 2023, in Fort Worth.<\/p>\n Smiley N. Pool\/Staff Photographer<\/p>\n \u2018Juice is worth the squeeze\u2019<\/p>\n Even if they are not fully paying for blood transfused in the field, a growing number of Texas hospitals are helping facilitate prehospital blood programs.\u00a0<\/p>\n When the McKinney Fire Department began carrying blood in February, it partnered with Baylor Scott & White Medical Center-McKinney. The hospital supplies paramedics with blood and rotates any units they don\u2019t use into the hospital\u2019s inventory. Like in Arlington, the fire department only pays for blood that it transfuses.\u00a0<\/p>\n \u201cThey saw the need, and they wanted to step in and be a part of it,\u201d said Ben Jones, EMS battalion chief for the fire department.\u00a0<\/p>\n A Parker County Hospital District Life Care EMS ambulance headed for the Medical City Weatherford emergency room in 2022. Weatherford does not have a trauma center to treat badly injured patients who need medical care as soon as possible.<\/p>\n Smiley N. Pool\/Staff Photographer<\/p>\n For Gamber, an emergency physician who serves as EMS medical director for not only Plano but also Frisco, which was an early leader in creating a blood program in 2018, it has been rewarding to observe the growing interest in improving care for bleeding patients across North Texas.\u00a0<\/p>\n EMS leaders in Plano had been considering a blood program for years, but it didn\u2019t seem as urgent. The city had easy access to multiple trauma centers<\/a> within a few minutes\u2019 drive.\u00a0<\/p>\n A few months ago, Gamber received a text from a trauma surgeon. It included an article from a trauma journal showing the risk of mortality increased 15% for every minute that hemorrhaging patients waited for transfusions. That statistic, the surgeon wrote, justified the efforts of Gamber and other EMS providers to replace lost blood as soon as possible.<\/p>\n Data like that, Gamber said \u2014 along with pressure from seeing an increasing number of peers transfusing in the field \u2014 helped push the Plano program to the finish line.\u00a0<\/p>\n<\/p>\n
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