Every unit of blood carried on an ambulance starts with a donor. Christina Ramos joins Ashley Claster to discuss how prehospital transfusion programs are saving lives in the field and why Group O donors play a critical role in expanding access to this lifesaving care.
Prehospital Transfusion: How EMS Brings Transfusions to the Scene
When severe blood loss happens, minutes matter. In this episode of Blood Type: Texan, host Ashley Claster sits down with Christina Ramos, Senior Manager of Client Relations at Carter BloodCare, to explore how prehospital transfusion programs are changing emergency care across Texas.
Most people associate blood transfusions with hospitals, but more EMS agencies are now carrying blood products on ambulances and helicopters, allowing lifesaving transfusions to begin before a patient ever reaches an emergency room. Christina explains how these programs work, the logistics required to safely store and transport blood in the field, and why blood donors are a critical part of making this care possible.
1:13 – What is a prehospital transfusion?
1:44 – Emergencies that may require blood before reaching a hospital
2:11 – How EMS treated severe blood loss before carrying blood products
3:06 – Real stories of blood transfusions at accident scenes
4:40 – How EMS decides when a patient needs blood
7:16 – Behind the scenes: storing and transporting blood safely
9:02 – The journey of a blood unit from donor to ambulance
11:27 – How many EMS agencies currently receive blood from Carter BloodCare
13:21 – Expanding prehospital transfusion programs across Texas
14:51 – Why having blood on ambulances matters
Schedule a blood donation appointment, find a donor center, or learn more about Carter BloodCare by visiting our website.
Blood Type: Texan is a podcast from Carter BloodCare exploring the people, systems, innovations, and decisions that help save lives across Texas. Disclaimer: AI-assisted tools were used to help draft these episode notes. Final content was reviewed and edited by the Carter BloodCare communications team.
Ashley Claster: Welcome back to Blood Type: Texan, the podcast from Carter BloodCare, where we explore the people, systems, and decisions that help save lives across Texas.
I'm Ashley Claster.
When most of us think about a blood transfusion, we picture a hospital. But in some emergencies, patients can't wait until they reach an emergency room. Today, we're talking about what happens when blood goes directly to the patient in the field, whether that's on an ambulance, a helicopter, or another emergency response vehicle.
Ashley: Joining me today is Christina Ramos, senior manager of client relations. Christina works closely with hospitals and EMS agencies to support prehospital transfusion programs and blood inventory management. She brings a unique perspective on the lifesaving impact of prehospital transfusion programs.
Christina, thanks for joining us.
Christina Ramos: Thanks, Ashley. Happy to be here.
Ashley: So, for listeners who may be hearing the term for the first time, what does prehospital transfusion actually mean, and where might blood products be carried before a patient reaches the hospital?
Christina: A prehospital transfusion is a transfusion that takes place at the patient's point of injury before they reach the hospital. Most of these transfusions take place in an ambulance, a helicopter, or another specialized emergency response vehicle.
The goal is really simple. When a patient is losing blood, replacing blood sooner can help stabilize them during transport to the hospital.
Ashley: What kinds of emergencies or situations are most likely to require a transfusion before there's time to reach an emergency room?
Christina: Patients suffering from severe blood loss. That could be from a variety of causes, including major accidents, penetrating trauma, falls, and women who experience bleeding after childbirth, either once they get home from the hospital or during a home birth.
Ashley: Before prehospital transfusion programs existed, what options did EMS agencies have when a patient was experiencing life-threatening blood loss? Because this is relatively new, right?
Christina: Yeah. Before these programs, EMS crews could give fluids and medications, but it's not the same as blood.
For example, red blood cells have oxygen-carrying capacity. Medications and fluids can't replace that. Historically, hospitals were often the first place a transfusion could begin. Offering transfusions in the emergency setting on ambulances and helicopters bridges that gap in lifesaving care.
Ashley: When you say fluids, you mean something like saline, essentially?
Christina: Yes.
Ashley: Okay, so that's very clearly different from blood.
Christina: Yes. Additionally, the plasma component of blood contains clotting factors and other components that help stop and control bleeding.
Ashley: Can you share a situation where having blood on a ground or air ambulance completely changed what happened for a patient before they reached the hospital?
Christina: We've heard some incredible stories from our EMS colleagues. They've told me about taking blood to the scene of a car accident where crews were using the Jaws of Life to remove someone trapped inside a vehicle. They were able to start the transfusion while the patient was still trapped and keep them alive until they could be extricated and loaded onto the ambulance for transport to the hospital.
We've also heard about patients who were unconscious because they were in shock from blood loss. Once the transfusion began, the patients regained consciousness and were speaking by the time they arrived at the emergency room. At the very least, the transfusion helped keep them alive long enough to reach the hospital and improve their chances of survival.
Ashley: Which the assumption is, without that blood, they might not have made it.
Christina: Correct.
Ashley: Okay. Wow. While they're actively trapped in the car. That really shows how on-scene these transfusions can be.
Christina: Yeah. If patients are in ditches or wherever the accident takes place, firefighters and emergency personnel can take the blood with them in a portable cooler. Those devices are designed to be transported into the field and taken directly to the point of injury.
Ashley: Wow. That's wild.
So if a paramedic is treating a critically injured patient, what factors help determine whether blood gets transfused immediately versus waiting until the hospital?
Christina: Paramedics and flight nurses look at the entire clinical picture and assess for signs of hemorrhagic shock due to blood loss. The decision to transfuse is guided by strict medical protocols, not guesswork, and there is physician oversight from the agency's medical director.
Ashley: So there are specific thresholds a patient has to meet before blood is administered?
Christina: Yes. There are different criteria that have to be met. Blood pressure is one factor. There are different criteria for adults and pediatric patients. Teams are trained to assess for hemorrhagic shock, which is shock caused by blood loss, and they administer blood when those thresholds are reached.
Ashley: So basically, they're professionals. They know what they're doing, and if they're using blood, it's because it's needed to save a life.
Christina: Right.
Ashley: We do have blood on ambulances locally. For example, the Fort Worth Fire Department carries our blood on its units, and that's only been in place for a little over a year. So this is still a relatively new concept in DFW, right?
What took the most convincing to get hospitals, EMS agencies, physicians, and blood centers aligned around prehospital transfusion programs? What finally got everyone to say yes?
Christina: It really wasn't convincing that needed to happen. The biggest challenges were logistical.
EMS agencies had never handled blood before, so they weren't familiar with all the regulatory requirements around storing blood, handling blood, and maintaining the necessary documentation. We spent a lot of time providing education on those requirements.
Ashley: What I hear you saying is that they already knew this needed to happen and understood it would benefit patients. The challenge was everything required to make it happen logistically.
Even the training. You have to teach someone how to administer a blood transfusion, and that's something many EMS providers or paramedics may never have done before.
Christina: Yeah. EMS agencies receive training on how to use blood warmers, administer blood, and complete the documentation hospitals need once the patient arrives.
The hospital needs to know exactly what was done in the field, and that includes blood transfusions.
Ashley: What has to happen behind the scenes to safely place blood products on a ground or air ambulance or other emergency response vehicle?
Christina: There are many behind-the-scenes checks in place to ensure blood remains within the safe temperature range and complies with all applicable regulations.
Blood has to be stored within a specific temperature range, monitored closely, and tracked from the time it leaves the blood center while it's in EMS possession. If they transfuse the unit, that's great. But if they return it to the blood center, we have to be able to prove the unit remained within the safe temperature range so we can return it to inventory and redistribute it to one of our hospital partners for use.
Ashley: Because we don't want to waste blood, right? If they don't use it, we're going to take it back, but only if we know it stayed within safe temperatures.
There's basically a little alarm that sounds if the cooler or storage device goes out of range. An alarm goes off, and they can immediately address it. You had to train them how to use that equipment, too.
Christina: We had to train them on how to document temperature excursions when they occur.
It's hot in Texas, so if a cooler is left open, temperatures can start to rise. The equipment is designed to alert staff before temperatures go outside the acceptable range so they can take corrective action, whether that's closing the cooler lid or investigating another issue.
The cooler itself provides audible alarms, but it can also send alerts to dispatchers, supervisors, and leadership team members who are signed up to receive notifications, allowing them to identify and address trends before they become a problem.
Ashley: That's cool. That's really cool.
Okay, so we have donors. They donate blood, we collect it, test it, and then it's ready to go out the door. Can you walk us through the journey of a unit of blood assigned to EMS from the moment it leaves Carter BloodCare until it's either used or returned?
Christina: Like you said, once blood has been donated, tested, and labeled, it goes to our distribution department for shipment.
When our distribution team receives an order, the EMS agency can either come onsite and bring its cooler to our distribution center, where we'll stock it with units, or we can deliver the units directly to the EMS agency. It really depends on their preference.
From there, those units are either placed on a supervisory vehicle for a ground EMS agency or stored at the air base in a blood refrigerator until they receive a call.
For air EMS, the units are transferred into a cooler and carried on the helicopter. For ground EMS, supervisory units typically respond to higher-acuity calls where blood may be needed because, like we said, not every patient will require a transfusion.
If they don't use the blood, once the unit reaches about half of its shelf life, they let our team know they need a replacement. We coordinate the exchange, provide a fresh unit, and return the unused unit to our distribution center.
We verify that it remained within the required temperature range and was handled appropriately. If everything checks out, we're able to redistribute it to a hospital for use.
Ashley: Basically, a hospital is more likely to use it because hospitals use blood more frequently.
With EMS, it's more of a just-in-case situation, and there's no guarantee it will be used. That's why we'd rather move it to a hospital before it expires.
Christina: Correct. Hospitals generally have a higher likelihood of utilizing the blood.
Most of the hospitals receiving returned units are Level I, Level II, or sometimes Level III trauma centers.
Ashley: What's something people are often surprised to learn about prehospital transfusions, either from the EMS side or the hospital side?
Christina: I think people are often surprised by how tightly regulated the blood industry is.
Even something as simple as storing blood in a cooler requires extensive documentation, monitoring, and quality checks. One of the biggest misconceptions is that you can simply put blood in a cooler, place it in the back of a vehicle, and it's ready to go.
That's definitely not the case.
Ashley: There's a lot more that goes into it.
Let me ask you this. We're a Texas-based organization serving North, Central, and East Texas. Are you able to give us a rough estimate of how many EMS agencies are currently using our blood?
Christina: Right now, we're servicing around 40 different bases, and we have inquiries from approximately 15 additional agencies that are working through the implementation and onboarding process.
Ashley: They want blood on their ambulances, too, but now they have to go through all of the logistics you mentioned earlier.
Christina: Yes.
Ashley: Man, that's a lot of work. How long does that process typically take?
Christina: It depends.
It depends on whether the agency already has its equipment onsite and whether testing has been completed to ensure the equipment functions properly under real-world conditions, whether that's in the Texas heat or during a winter cold snap.
It also depends on whether the agency already has its policies and procedures in place.
Many air medical programs are staffed primarily by flight nurses, and some of those nurses have ICU experience and have administered blood before. In some ground EMS agencies, providers may not have prior experience with blood transfusions.
Because of those factors, I've seen implementation take anywhere from a few weeks to several months.
Ashley: Either way, we definitely want it done correctly because, in the end, the number of lives being saved has to be in the hundreds by now, right? At least?
Christina: It's hard to estimate, but I would assume it's probably more than that simply because we're servicing so many bases.
And with roughly 8 million people in the DFW area, there are a lot of potential patients who could benefit from these programs.
Ashley: Do you feel Carter BloodCare donors are making a significant difference?
Christina: I do. I definitely think they're making a positive impact on patient outcomes for people experiencing these types of injuries away from a hospital setting.
Ashley: Looking ahead, what would it take for more communities across Texas to have access to prehospital transfusion programs?
Christina: As prehospital transfusion programs continue to expand, we would need to grow our donor base to support that increased demand.
The blood products most commonly carried by EMS agencies are Group O whole blood and Group O red blood cells. Those products are already a critical part of the blood supply used throughout hospitals and trauma centers.
To expand access, we would need to increase our Group O donor base as well.
Ashley: So what you're saying is we don't currently have enough Group O donors to serve all of the EMS agencies that would like to carry blood?
Christina: Right. And that demand also includes our acute-care hospital partners.
Group O red blood cells are among the most requested products because they're universally compatible for emergency transfusions.
Ashley: And they're also the only blood products used for premature babies, right?
Christina: Yes.
Ashley: All right, Texans, I'm talking to y'all.
If you have Type O-positive or Type O-negative blood, we need your donations so we can continue supplying hospitals and expand access to blood on ambulances. That blood could save you, your family, your neighbors, or someone you've never met.
More coverage means more places have blood available before a patient reaches the hospital.
Christina: Right.
Ashley: Let's zoom out and think about the bigger picture. Why do you think having blood on ambulances is so important?
Christina: I think it's important because it bridges the gap between the time of injury and arrival at the hospital.
Even after patients arrive at a hospital, there's often some delay before transfusions can begin. Being able to start that process at the point of injury instead of after transport and hospital admission can have a significant positive impact on patient outcomes.
Ashley: Especially if you live far from a hospital, right?
If you're in a rural area, it's going to take a lot longer to reach a hospital than if you're in downtown Dallas.
Christina: Absolutely. Even in urban areas, traffic can significantly delay transport times.
Think about your commute to work. Heavy traffic can affect emergency vehicles, too.
Ashley: Oh my gosh, I never even thought about that.
Something as simple as being stuck in traffic for 15 minutes could mean a patient needs blood before they arrive at the hospital. Then once they get there, the physicians and hospital teams take over from there.
What would you say to Type O donors listening right now?
Christina: If you're a Group O donor, especially a male donor or a female donor who has never been pregnant, there's a high likelihood your blood could be used to support prehospital transfusion programs and help expand access to this lifesaving care.
Ashley: All right. You heard her.
You've officially been asked to donate blood with Carter BloodCare. Help your fellow Texans. Help fill those ambulances.
Christina, thank you so much for joining us today.
Christina: Thank you, Ashley.
Ashley: See you next episode.
And Christina will be back to join me for a future conversation about what happens when hospitals face a blood inventory crunch.
Thank you so much for sharing your insight and helping us better understand both the journey of blood before it reaches a hospital and the complex planning, logistics, training, and decision-making that make prehospital transfusion possible.
One of the biggest takeaways from today's conversation is that blood doesn't save lives by chance. It takes planning, partnerships, logistics, and, of course, volunteer blood donors to make sure blood is available wherever and whenever patients need it.
If you enjoyed this episode of Blood Type: Texan, please subscribe, follow, and share it with a friend or colleague. This is a new podcast for us, and we're excited to keep bringing you stories from across the blood community.
This is our fourth episode, and if you're eligible, please consider donating blood and scheduling an appointment. Every donation helps support patients across the communities Carter BloodCare serves.
You can learn more, find a donor center, or schedule an appointment at CarterBloodCare.org.
Thanks for listening, and we'll see you next time on Blood Type: Texan.
New episodes are released on the first Friday of every month.
And remember, every unit carried into the field begins with someone choosing to donate blood.
I'm Ashley Claster. Have a great month.
Disclosure: AI was used to help identify transcription errors and improve readability. All edits were reviewed and approved with human oversight.