By Lauren Caruba | Investigative Reporter Published Nov. 29, 2023 SAN ANTONIO — The way Dr. Donald Jenkins sees it, what saves lives on the battlefield could save lives on streets across America. During nearly 25 years in the Air Force, Jenkins operated on troops with devastating wounds from bombs and bullets — ones not so different than those that ordinary people sustain from cars, gun violence and random accidents. Injuries he saw from rollover crashes in combat zones are similar to those from high-speed highway wrecks. Gunfire tears through tissues and vital organs the same if it comes from an enemy combatant or a licensed gun owner. From his deployments, Jenkins knew that a single factor — bleeding, and how well it was controlled before patients landed on his operating table — dictated survival. Those who received blood quickly, especially on the way to the hospital, were more likely to remain stable during surgery and recover. Without it, death could come in a matter of minutes. The same is true for everyday Americans, who regularly bleed to death before doctors can repair their injuries. But unlike in combat zones, where military medics usually have blood on hand, in the U.S. there haven’t been any broad or comprehensive efforts to give blood to hemorrhaging patients before they arrive at a hospital. The best most paramedics can offer their patients is saline and medications that slow bleeding. Why not treat them the same, Jenkins wondered years ago, after he left the military and began a new medical career as a civilian. If patients needed blood when they arrived at the hospital, surely they needed it before then, too. Why not give patients blood as soon as possible, when they need it most? Five years ago, in San Antonio, a city with strong military ties, Jenkins finally got the chance to test his idea to put blood on ambulances and helicopters across the region. Today, Jenkins’ theory has turned into one of the country’s most innovative and pioneering models of advanced care, an example of how access to blood soon after a traumatic incident can save lives, some of the nation’s leading trauma researchers say. Across the U.S., a growing number of EMS providers have replicated parts of San Antonio’s blood program, helping critically injured patients in cities like Austin, New Orleans, Seattle, Oklahoma City and Pittsburgh and in South Florida — often with advice from San Antonio’s trauma leaders. “We have very openly exported all of our ideas, our protocols and our data,” said Jenkins, a trauma surgeon with UT Health San Antonio and University Hospital. “We’re not looking for a patent. We’re not looking to make money off of this. We just want to see people live.” Since the South Texas program’s start in 2018, more than 2,100 patients have received blood transfusions on the way to a hospital. Many were car crash and shooting victims, including a 37-year-old mother of two in San Antonio who was clinically dead after a car crash when blood revived her. There were also patients bleeding from pregnancy complications and other medical problems. We’re not looking for a patent. We’re not looking to make money off of this. We just want to see people live.” Dr. Donald Jenkins Early research from the program has found trauma patients who received transfusions before reaching a hospital were more likely to survive the immediate aftermath of their injury, which medical experts consider to be the most critical period. Longer term survival rates remain the subject of study. Already, there have been remarkable success stories, lives that likely would have otherwise been lost, according to the paramedics who treated them. They include a South Texas man who severed arteries in his arm while working with a tool at home and an oil field worker in his early 20s who suffered a partial leg amputation while working with a malfunctioning drill. “We’re providing the patients with what they need, when and where they need it,” Jenkins said. Every day, trauma physicians and paramedics confront a deadly public health crisis. Traumatic injury is a major cause of premature death, killing around 150,000 Americans each year, including more children and adults under age 45 than any other cause. In 2021, Texas led the nation in deaths from motor vehicle crashes and guns, federal data shows. A yearslong investigation by The Dallas Morning News and the San Antonio Express-News has found tens of thousands of these injured patients are dying from wounds they could have survived had they received crucial treatments sooner. Some of the nation’s most respected researchers estimate that, each year, 31,000 Americans bleed to death from survivable injuries, with lifesaving transfusions usually out of reach until patients arrive at a hospital. In more than 140 interviews, the news organizations found paramedics are unequipped to fully treat severe internal bleeding and patients receive drastically different care depending on where they are injured. After decades of inadequate federal funding for research and little attention by elected officials, outcomes for these patients remain poor and have stagnated over the past decade, the investigation found. Federal officials have failed to adopt major reforms that could save lives, even after being confronted in 2016 with growing evidence that large numbers of injured patients are needlessly dying every day. ‘Liquid gold’ The idea for San Antonio’s blood program began in a war zone in October 2001, on Masirah Island off the coast of Oman. There, Jenkins was the first surgeon to enter the combat zone, standing by as special forces parachuted into southern Afghanistan. Over the next two weeks, he treated dozens of injured troops. Back home, hospitals had stockpiles of dozens of blood components — oxygen-carrying red blood cells, circulation-promoting plasma and clot-facilitating platelets. Jenkins and the military medical team made do with what they had, tapping service members to give blood. When he gave this fresh blood to wounded troops, he was stunned by how quickly it worked. Before his eyes, they
