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

“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

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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The EMS One-Stop Blood on Board series moves to the federal level in Episode 3, exploring how the National Highway Traffic Safety Administration Safe Streets and Roads for All (SS4A) grant program is opening new funding pathways for prehospital blood programs.

Host Rob Lawrence is joined by three leaders directly involved in building regional blood capability through federal funding.

Rather than focusing solely on clinical practice, this episode examines the realities of applying for, winning and administering federal grant funding. The guests discuss building regional coalitions, engaging blood banks, developing standardized protocols, navigating compliance requirements and preparing operational rollouts.

From Missouri’s $4.6 million demonstration grant, to Kansas City’s regional planning initiative, this episode provides a practical roadmap for EMS leaders looking to transform roadway safety funding into lifesaving trauma care capability.

Impactful quotes

“Don’t be afraid of applying for a big, scary federal grant.” — Mark Heath

“EMS is the perfect partner to try to understand how to address the post-crash care component of a safety action plan.” — Julie Stilley

“If you’re going to do it as a region, you’ve got to hang together.” — Jason White

“The data points on the backside will set you free.” — Mark Heath

“If my blood is closer to the next address over, just because there’s a river in the way doesn’t mean we can’t get across the bridge.” — Mark Heath

“What started initially as an absolute ‘no’ became, ‘Wait, let me listen to you some more.’” — Julie Stilley

“The juice is worth the squeeze.” — Rob Lawrence

“Firefighters and EMS are cowboys, and blood banks are accountants.” — Mark Heath

“Cowboys do marry accountants.” — Jason White

“Run, don’t walk, to your local blood bank.” — Mark Heath

“It’s your blood in your community and going into you on your ambulances.” — Mark Heath

“We’re moving toward reducing mortality and reducing long-term injury.” — Julie Stilley

Additional resources

Episode timeline

00:00 – “Free money is free money”. Chief Mark Heath opens with encouragement for agencies considering federal grant applications and urges smaller communities not to be intimidated by the process.

00:44 – Introduction to Episode 3. Rob Lawrence recaps Episodes 1 and 2 of the Blood on Board series before introducing the SS4A grant focus and the featured guests.

02:07 – Meet the guests. Julie Stilley introduces her role at the University of Missouri and reveals her project’s $4.6 million award. Jason White and Mark Heath outline the Kansas City regional collaboration.

04:19 – Why apply for SS4A? Julie Stilley explains how frustration around operational barriers to blood implementation motivated her grant application.

05:38 – Understanding demonstration grants. Discussion on the difference between planning and demonstration grants, and how post-crash care fits into regional traffic safety action plans.

06:51 – Building regional coalitions. Jason White discusses Kansas City’s existing regional EMS partnerships and how those relationships became the foundation for the grant application.

10:30 – Regional protocols and data. Mark Heath explains how Kansas City agencies standardized protocols, agreed on shared data points and committed to a coordinated regional approach.

13:04 – Pulling together the application. Julie Stilley outlines the process of bringing together planners, EMS leaders, trauma centers and blood banks to support the grant proposal.

15:02 – Equipment, compliance and logistics. Discussion shifts to blood warmers, storage systems, chain-of-custody monitoring and the operational realities of safely carrying blood products in the field.

18:25 – Planning grants and future implementation. Jason White explains how the Kansas City effort uses a planning grant to build toward larger implementation funding opportunities.

23:22 – Busting myths about blood. Mark Heath describes how data and national experience changed his thinking about whether whole blood matters in urban EMS systems with short transport times.

27:19 – The reality of grant administration. Julie Stilley and Jason White explain federal reimbursement structures, compliance requirements and why strong administrative partners are essential.

31:37 – Sustainability and reimbursement. Discussion on long-term funding, legislative advocacy and the need for reimbursement models for prehospital blood administration.

33:43 – Final lessons learned. The guests share advice on partnerships, blood bank relationships, data collection and not being afraid of “big scary federal grants.”

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at [email protected] to share ideas, suggestions and feedback. Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

About the sponsor

After traumatic injury, patients may enter the “Triad of Death” — a dangerous cycle of hypothermia, acidosis, and coagulopathy that can rapidly lead to fatal outcomes without timely intervention. That’s why Delta Development Team partners with Qinflow and Lifeflow to combat these life-threatening conditions with the Triad of Life. To learn how your team can put the Triad of Life into practice visit the link to get started.

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.

“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

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

Enjoying the show? Email [email protected] to share feedback. 

In this special EMS One-Stop update, Rob Lawrence is joined by returning guest Dr. Alex Isakov to break down the rapidly developing Andes Hantavirus outbreak linked to the expedition cruise ship MV Hondius. What began as a handful of unexplained respiratory illnesses aboard a South Atlantic voyage has evolved into an internationally monitored infectious disease event involving multiple countries, quarantine operations, public health investigations and the repatriation of exposed passengers to specialized containment facilities in the United States.

| MORE: Hantavirus outbreak aboard cruise ship sends Americans to biocontainment quarantine units

Dr. Isakov is professor of emergency medicine at Emory University School of Medicine and executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR). He also serves as EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC), where he helps lead national preparedness efforts for high-consequence infectious diseases.

In the episode, he explains how Andes Hantavirus differs from other hantaviruses already present in North America because it is capable of person-to-person transmission in limited circumstances.

The discussion covers transmission dynamics, incubation periods, PPE recommendations, public health monitoring and why experts continue to assess the overall public risk as low. Listeners are also directed toward the excellent educational resource hub on preparedness and response available through NETEC Hantavirus Resources.

00:00 – Introduction to the Special Edition. Rob Lawrence introduces the emergency update format and welcomes Dr. Alex Isakov to discuss the emerging Andes Hantavirus outbreak.

00:50 – Understanding hantaviruses. Dr. Isakov explains the difference between common North American hantaviruses and Andes Virus, emphasizing the rare person-to-person transmission capability.

03:13 – The cruise ship incident. Discussion of the outbreak aboard the MV Hondius, including onboard transmission concerns, severe illness development and international evacuation efforts.

05:16 – U.S. monitoring and quarantine. Review of quarantine operations in Nebraska and ongoing public health monitoring of exposed American passengers.

07:21 – Incubation and EMS risk assessment. Dr. Isakov outlines the prolonged incubation period and explains why frontline EMS encounters remain unlikely.

11:17 – PPE guidance for EMS personnel. Specific PPE recommendations are reviewed, including standard, contact and airborne precautions with eye protection.

13:17 – Looking ahead to World Cup 2026. The discussion turns to international travel, mass gatherings and why clinicians must maintain awareness of rare infectious diseases tied to travel history.

14:32 – EMS and public health resources. Dr. Isakov directs listeners to CDC, WHO and NETEC resources for ongoing guidance and EMS-specific updates.

In this episode of the Inside EMS podcast, host Chris Cebollero shares why he left the consulting and community paramedicine world to become chief of EMS and COO for EMS Team in Dayton, Ohio — a growing multi-state agency with “visions of world dominance.”

The conversation digs deep into servant leadership, workforce buy-in and the balance between supporting crews while still holding the line on professionalism and performance. Chris also lays out his vision for creating a sustainable culture built on accountability, engagement and shared ownership.

It’s equal parts leadership seminar, war story and reality check for anyone who’s ever tried to fix a fractured EMS system.

Additional resources:

How to lead without being that boss

Leadership lessons: How to turn failure into growth

Enjoying Inside EMS? Email [email protected] to share feedback. 

In this episode of EMS One-Stop, Rob Lawrence sits down with Kevin Hazzard to explore No One’s Coming, a gripping account of the 2014 Ebola outbreak and the extraordinary effort to rescue infected American aid workers from West Africa.

|WATCH NOW: FDNY’s future: AI, BWCs and pay parity with Commissioner Lillian Bonsignore 

What begins as a seemingly impossible mission evolved into a high-stakes, time-critical operation led by Phoenix Air — a team known for taking on the missions no one else will.

Hazzard traces the origins of this unconventional organization, from transporting explosives and nuclear materials, to pioneering aeromedical evacuation of the world’s most dangerous infectious patients.

The conversation moves beyond storytelling into operational reality. With no established protocols, limited knowledge of Ebola and widespread public fear, crews were forced to improvise, adapt and execute under intense pressure.

The episode examines the intersection of EMS readiness, public health hesitation and leadership under uncertainty. At its core, this is a study in preparation, risk tolerance and professional duty — illustrating how a small group of individuals stepped forward when systems hesitated, reinforcing the enduring EMS principle: when the call comes, you answer.

Key quotes from Kevin Hazzard

Episode timeline

00:00 – Opening context: Ebola outbreak severity and mission stakes

01:00 – Introducing Kevin Hazzard, author background

03:30 – Origins and evolution of Phoenix Air

08:00 – High-risk missions (including Libya nuclear extraction)

14:30 – Transition to EMS and infectious disease transport

16:00 – Development of the biocontainment system

20:00 – Ebola mission planning and execution challenges

27:00 – U.S. reception, EMS transport and public reaction

31:00 – Leadership lessons and EMS preparedness gaps

35:00 – Reflections on readiness, resilience and future threats

Enjoying the show? Email [email protected] to share feedback. 

This week on Inside EMS, it’s a no-holds-barred breakdown of HBO’s The Pitt — and surprisingly, it earns a solid thumbs up from the field. The show nails the feel of emergency medicine: nonstop chaos, overlapping patients and that mental grind that never lets up. The set, the medicine and the team dynamics all hit close enough to make even seasoned providers nod along.

But let’s not pretend it’s perfect. The guys call out the usual TV sins — compressed timelines, back-to-back disasters and docs who never miss on the first try. But, there is a botched 12-lead that sparks a real-world debate about electrode placement, patient modesty and doing the job right when it matters most.

Where The Pitt really shines? The emotional weight. Burnout, breaking points and the slow unraveling that comes with the job — it’s all there, and it hits hard.

Have you watched the show? What are your thoughts? Let us know in the comment field below.

“At some point you're so saturated by fear and emotion and being strong through somebody else's grief and trying to be on 24/7, you can't afford a bad moment.”

“I think they do a great job of displaying the emotional toll that a career in medicine takes on the people who practice it.”

Enjoying Inside EMS? Email [email protected] to share feedback. 

In this episode of EMS One-Stop, Rob Lawrence sits down with Dr. Maria Koeppel to explore a topic that has long existed in the shadows of EMS culture — alcohol use among providers.

| MORE: First responders and alcohol – how much is too much?

Drawing on NIH and FEMA supported research, Koeppel outlines how EMS clinicians may be engaging in higher-risk drinking behaviors than the general population, with patterns influenced by stress, exposure and workplace culture.

What emerges is not a story of individual weakness, but one of systemic pressure — where both major traumatic incidents and the accumulation of low-acuity, high-frequency calls contribute to a steady burden of stress that many providers attempt to manage off-duty.

The conversation moves beyond statistics into culture, leadership and generational change. Koeppel highlights how traditional “crew bonding” through alcohol — what one participant termed “hydraulic debriefing” — may be giving way to a new, more wellness-focused approach among younger clinicians.

At the same time, gaps in education, policy and peer support remain evident across EMS systems. For leaders, the message is clear: alcohol use is not a fringe issue, but a workforce health, safety and performance issue that requires thoughtful engagement, cultural awareness and proactive support structures.

“Over 50% of firefighters surveyed had binge drank in the last 30 days — about twice the rate of the general population.”

“EMS providers tend to drink a little bit more frequently than the general population — and that’s tied directly to stress.”

“It’s not just the big trauma calls — it’s the micro-stressors that add up over time.”

“A third of clinicians in our sample engaged in high-risk drinking behaviors.”

“Younger clinicians are at higher risk — but that risk declines with age as coping mechanisms develop.”

“Paramedics are at higher risk than EMTs, likely due to increased responsibility and patient exposure.”

“Some described going out after shift as ‘hydraulic debriefing’ — using alcohol to process the day.”

“Gen Z is driving a more sober culture — they’re choosing connection without alcohol.”

“Leadership isn’t just policy — it’s culture, awareness and how you care for your people.”

“Alcohol and coping has to be part of the conversation if we care about workforce health and patient safety.”

Enjoying the show? Email [email protected] to share feedback. 

Editor’s Note: Suicide is always preventable. If you are having thoughts of suicide or feeling suicidal, please call the National Suicide Prevention Hotline immediately at 988. Remember: You deserve to be supported, and it is never too late to seek help. Speak with someone today.

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This week on Inside EMS, host Kelly Grayson is joined by Texas educator John Puryear as they process the loss of a colleague to suicide — and to confront the uncomfortable truth: the mental health crisis in EMS is years in the making, and awareness alone isn’t cutting it.

From peer support to fatigue policies, Chris and Jon lay out what actually helps: real conversations in the rig, leadership that prioritizes mental health and seeking professional help. The message is clear: taking care of your mind is operational readiness. And if you’re not checking on your partner, you’re missing the fight that matters most.

Quotable takeaways

Additional resources:

Enjoying Inside EMS? Email [email protected] to share feedback. 

In this episode of EMS One-Stop, Rob Lawrence travels to New York City to sit down with Lillian Bonsignore, the 37th Commissioner of the Fire Department of the City of New York (FDNY). A 30-plus year veteran who rose through the ranks of EMS — from EMT in the South Bronx to Chief of EMS and now Commissioner — Bonsignore brings a ground-up understanding of the largest fire-EMS system in the United States.

She reflects on stepping into the role as “walking onto a fast-moving train,” immediately confronted with major incidents, severe weather and system pressures, while simultaneously building her leadership team and setting direction for the future.

| MORE: ‘We have to right the ship’: FDNY commissioner doubles down on EMS pay parity

The conversation explores the unique structure of FDNY, where the Commissioner operates as the executive leader “almost like CEO of the company,” while operational command sits with the Chief of Department.

Bonsignore is clear-eyed about the scale and demands of the system: over 2.2 million runs annually, with 1.6 million EMS-related, reinforcing her long-held position that EMS must be treated as an essential service with appropriate funding and career pathways.

Drawing on her experience leading through the COVID-19 pandemic and responding on Sept. 11, 2001, she emphasizes resilience, communication and presence — being visible in stations, honest with staff and committed to supporting those who “leave their own families behind to go serve a stranger.”

Bonsignore also addresses criticism of her appointment directly and without hesitation, framing it as a misunderstanding of the Commissioner’s role and the realities of modern emergency response. She underscores that FDNY is both fire and EMS, and that her career — spanning 9/11 response, pandemic leadership and decades of frontline service — positions her to lead the entire enterprise.

Looking ahead, she speaks to the need for infrastructure investment, workforce stabilization, mental health support, and the thoughtful adoption of technologies such as AI and body-worn cameras. As FDNY approaches the 25th anniversary of 9/11 and the nation’s 250th year, her focus remains clear: support the workforce, strengthen the system, and prepare the department for the next generation of service.

“Walking into a position like this is like walking onto a fast-moving train.”

“I understand the ground level challenges that go on because I lived them.”

“The commissioner is the administrative level, almost like CEO of the company.”

“We’re responding to over 2.2 million runs a year … 1.6 million of those runs are EMS-related runs.”

“We have to stabilize our system … it’s time that EMS is finally treated as an essential service.”

“I will always tell you the truth. You may not like my truth, but I will give it to you.”

“The decision of a first responder is to leave their own families behind … to go serve a stranger.”

“They are literally your heroes … they will put their lives on the line for you.”

Enjoying the show? Email [email protected] to share feedback.