Paramedics in North Texas want to carry blood. Who’s going to pay for it?

In late May, leaders with Plano Fire-Rescue appeared before the City Council to make a rather unusual request for a new program that would help save more lives. 

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. 

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. 

Over the past few years, prehospital blood programs 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. 

Plano Fire-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 “want to be a good fiscal citizen within the city and try and cover our costs.” 

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. 

“The blood is actually a substantial amount of what our flat transport fee is,” said Strutton at a city council meeting on May 26. “It would be a loss every time we give the blood. With the ordinance, we’re able to recoup that money on top of the transport fee.” 

Plano city leaders unanimously approved the fire department’s request. The program is expected to debut this summer. 

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 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 found. As a result, patients routinely bled out from injuries they could have otherwise survived, dozens of trauma surgeons and paramedics told The News. 

At the time, first responders in the Dallas-Fort Worth area lagged behind 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. 

Since then, North Texas has made significant strides toward catching up. 

In early 2025, the region’s two largest EMS providers, Dallas Fire-Rescue and the Fort Worth Fire Department, both launched prehospital blood programs. In its first year, the Dallas program was credited with saving dozens of lives; in Fort Worth, paramedics administered more than 150 units of blood over the span of eight months. In recent months, EMS providers in Arlington and McKinney have also begun carrying blood. 

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. 

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’t fully cover the cost of particularly expensive interventions such as blood transfusions. 

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.

If just one life was saved, Weinzapfel said, that would be “worth the weight in gold.” 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. 

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.  

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’s recognition that transfusions were becoming a part of advanced care on ambulances, it did not increase the actual dollar amount reimbursed to EMS providers. 

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 published last year. As a result, EMS providers lose money on every transfusion they perform. 

That mismatch prompted trauma specialists — many of them from Texas — to organize a federal lobbying effort for a legislative fix that would make it easier for paramedics across the country to carry blood products. 

In late April, advocates held a two-day conference 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. 

The speakers included several physicians and patients from Texas, including Dr. Kate Krause, a Dallas emergency medicine physician who received an urgent transfusion from Dallas Fire-Rescue paramedics last year when she was bleeding out from a postpartum hemorrhage. 

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 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.   

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. 

“This is the most affordable way there is to save lives,” Jenkins said. “Period.” 

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. 

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’t use into the hospital’s inventory. Like in Arlington, the fire department only pays for blood that it transfuses. 

“They saw the need, and they wanted to step in and be a part of it,” said Ben Jones, EMS battalion chief for the fire department. 

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. 

EMS leaders in Plano had been considering a blood program for years, but it didn’t seem as urgent. The city had easy access to multiple trauma centers within a few minutes’ drive. 

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.

Data like that, Gamber said — along with pressure from seeing an increasing number of peers transfusing in the field — helped push the Plano program to the finish line. 

The message, Gamber said, was indicative of a sea change in a field that previously considered transfusions performed outside of a hospital to be too logistically difficult and risky. 

Over the past eight years, Gamber has attended numerous ceremonies for patients who benefited from blood programs. A few months ago, he attended one for a Frisco mother who passed out in a puddle of blood when she was in the third trimester of her pregnancy. She had been diagnosed with placenta previa, where the placenta blocks the cervix, significantly raising her risk of maternal hemorrhage. 

The patient received multiple units of blood on the way to the hospital, where doctors performed a crash Cesarean section. She and her baby both survived. 

“This is the ultimate juice is worth the squeeze,” Gamber said. “It’s worth all the trouble of getting it set up.”