EMS systems can safely deliver blood in the field, and when they do, patients who would otherwise die are surviving
Whole blood in the field is no longer theoretical; it is operational, measurable and increasingly expected. In this EMS One-Stop episode, host Rob Lawrence brings together two of California’s leading medical directors — Drs. Clayton Kazan and Kevin Mackey — to compare and contrast their prehospital blood programs.
From concept to deployment, both systems demonstrate how data, relationships and persistence can translate innovation into lives saved.
This discussion goes beyond theory. It addresses real-world barriers — regulation, blood bank skepticism, funding gaps — and pairs them with practical solutions.
The result is a clear message: EMS systems can safely deliver blood in the field, and when they do, patients who would otherwise die are surviving. For agencies considering similar programs, this episode provides a roadmap grounded in experience, outcomes and operational reality.
Notable quotes
- “When there’s someone who wants to see your program, talk about your program.” — Kevin Mackey
- “I kind of never believed it really possible to put it on a paramedic truck until I saw what the military was able to do.” — Clayton Kazan
- “If the five minutes matter, why wouldn’t we want to do it 5, 10, 15, 20 minutes sooner?” — Clayton Kazan
- “Never say ‘no,’ never say ‘die.’” — Kevin Mackey
- “They’re never tired of trying to find new ways to save people’s lives.” — Clayton Kazan
Episode timeline
00:00 – Opening message. “Never say ‘no,’ never say ‘die’” sets the tone for program development and persistence
01:00 – Series introduction. Rob frames the episode as part of a broader national discussion on blood in EMS
02:00 – Guest introductions. Dr. Kazan and Dr. Mackey outline their EMS and medical backgrounds
03:20 – Program overviews. LA County: April 2025 launch, 11 squads, 58 transfusions; Sacramento: December 2025 launch after 15-month build
05:20 – Origins and catalysts. Influence from San Antonio and New Orleans programs; leadership support as a trigger
07:00 – Military influence. Translation of battlefield success into civilian EMS feasibility
08:50 – Building the business case. Data-driven forecasting using ePCR systems
11:00 – Overcoming resistance. Regulatory hurdles, skepticism and blood bank concerns
15:00 – Survivor stories. Real-world saves that validate the programs and influence policymakers
18:00 – Funding realities. Grant-based models, no current reimbursement, cost-benefit framed in life-years saved
21:45 – Equipment and logistics. Cold chain, monitoring systems, delivery devices and operational considerations
24:40 – Training and deployment. Targeted rollout using heat maps and trauma incidence data
27:45 – Early challenges. Blood recirculation, cold chain validation and system integration issues
31:50 – QA/QI and research. 100% case review and participation in multi-county data collaboratives
34:10 – Patient populations. Primarily trauma, with emerging medical indications
36:00 – Sustainability and scaling. Political engagement and expansion planning
38:15 – Rapid fire lessons learned. Transparency, persistence, relationships
42:50 – Myths and realities. Frontline providers embrace innovation; capability concerns disproven
44:00 – Final takeaways. Appreciation, relationships and system-wide collaboration as keys to success
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