Texas is taking prehospital whole blood to scale. In this second installment of the Blood on Board series, the conversation moves from pioneering local programs to a statewide initiative backed by legislation, trauma system collaboration and a $10 million investment in EMS blood capability.
Host Rob Lawrence welcomes Dr. Jeff Jarvis, chief medical officer and system medical director, Fort Worth Office of the Medical Director; Dr. C.J. Winckler, deputy medical director for the San Antonio Fire Department; and Jorie Klein, director of EMS-Trauma Systems Section, Texas Department of State Health Services.
From San Antonio’s early adoption to Fort Worth’s operational maturity and the Texas Department of State Health Services’ statewide rollout, this episode examines how Texas built one of the most ambitious prehospital blood programs in the country.
The discussion goes beyond clinical theory. The guests tackle implementation, logistics, blood stewardship, wastage concerns, rural access, legislative strategy and the realities of getting physicians, transfusion medicine specialists, EMS leaders and lawmakers aligned around a shared mission.
The episode also explores the expanding use of whole blood beyond trauma, including GI bleeds, obstetrics and surgical hemorrhage, while reinforcing the operational mantra repeated throughout the show: systems save lives.
| MORE: Blood on board: Lessons from Sacramento and LA County Fire
Impactful quotes
- “You can’t quarterback it from your office. You have to be engaged and be out there with them.” — Jorie Klein
- “Little did I know that it would take almost every waking minute of my life to get blood on an ambulance.” — Dr. C.J. Winckler
- “We’re not improving overall mortality yet, but we are improving mortality in the first six hours.” — Dr. C.J. Winckler
- “When you work together as a system, you can do amazing things.” — Dr. Jeff Jarvis
- “In the last 13 months, we’ve given 259 units to 211 patients.” — Dr. Jeff Jarvis
- “Our definition of wastage is anything that doesn’t go into a patient.” — Dr. Jeff Jarvisv
- “It turns out this stuff works.” — Dr. Jeff Jarvis
- “It’s all about communication and trust.” — Dr. C.J. Winckler
- “Five years ago, we knew those patients would not survive. Now we have new tools.” — Jorie Klein
- “My dad was saved by prehospital whole blood.” — Dr. C.J. Winckler
- “Talk to the clinicians who are giving this blood and ask them about the impact it’s making.” — Dr. Jeff Jarvis
Episode timeline
00:00 – Opening message. Jorie Klein outlines the central lesson for other states: engage frontline providers and avoid managing programs remotely.
00:40 – Introduction. Rob Lawrence introduces Episode 2 of the Blood on Board series, shifting focus from local systems to statewide implementation in Texas.
01:20 – Meet the guests. Jorie Klein, Dr. Jeff Jarvis and Dr. C.J. Winckler introduce themselves and their roles in Texas EMS and trauma care.
03:22 – The San Antonio origin story Dr. Winckler explains how military medicine, trauma surgeons and Texas delegated medical practice helped launch San Antonio’s whole blood program.
06:04 – Building the first protocols. Dr. Winckler discusses creating guidelines from scratch, operationalizing blood administration and securing funding support from city leadership.
08:52 – Going system-wide. San Antonio launches whole blood citywide in October 2018 without a pilot project.
10:13 – Ethics and evidence. Discussion shifts to mortality data, prehospital physiology and whether balanced blood resuscitation should already be considered standard of care.
12:14 – Fort Worth follows. Dr. Jarvis explains how San Antonio’s system inspired adoption in Fort Worth and highlights the importance of regional collaboration.
14:03 – Texas goes statewide. Klein explains the legislative process that resulted in a $10 million statewide prehospital whole blood initiative.
17:24 – Rural Texas and blood access. The conversation focuses on plasma options, rural hospital shortages and improving access for remote communities.
23:45 – The data discussion. Dr. Jarvis shares Fort Worth operational metrics, transfusion volumes and remarkably low wastage rates.
28:49 – Whole Blood Academy. Drs. Jarvis and Winckler discuss the National Whole Blood Academy and how Texas is teaching other EMS systems to replicate their success.
32:00 – Trust, logistics and blood stewardship. Dr. Winckler explains the importance of relationships between EMS and transfusion medicine physicians, emphasizing operational discipline and trust.
36:20 – What comes next? Dr. Klein discusses statewide reporting, future funding requests and sustaining the Texas model long term.
40:15 – Final lessons for other states. The guests close with advice on advocacy, clinician engagement and building support from the ground up.
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