Ambulances responding to crashes and shootings typically carry oxygen, drugs, defibrillators, and equipment to secure airways or ease lung pressure. Yet most do not stock blood, a critical resource for patients losing large volumes from injuries.

Drawing on experience from recent Middle East conflicts, the Pentagon health program will launch a test to see if separate payments for blood delivery by ambulance crews can increase its availability on the scene.

The Defense Health Agency five-year TRICARE pilot begins in January and will cover authorized ground and air services that give whole blood or components such as red cells or plasma to service members, dependents, and retirees when medically required.

Success could remove a key financial obstacle, prompting other payers to cover these interventions and bring blood closer to patients who need it most.

Donald Jenkins, a surgery professor at UT Health San Antonio, notes that many trauma victims still reach hospitals without receiving blood en route, especially in rural regions far from stocked facilities. He questions why full-volume replacement occurs only inside hospital walls when earlier transfusion might help.

Jenkins, a former Air Force surgeon, and other military trauma experts saw the value of forward blood use during deployments in Iraq and Afghanistan. Teams transfused patients on evacuation helicopters, at remote sites, and via walking blood banks that collected fresh units from screened personnel.

These methods reduced reliance on saline, which adds volume but weakens clotting and oxygen transport. A 2017 study of wounded troops showed those given blood during or soon after evacuation had higher survival at 24 hours and 30 days.

Holcomb, a University of Alabama surgery professor and retired Army surgeon, calls the TRICARE effort a strong example of moving military medical gains into domestic practice. More than 400 civilian ground EMS units now carry blood products, though this remains a small share of national services.

Ambulance regulation is split among states and localities, while Medicare pays mainly for transport rather than individual procedures. This structure often leaves providers absorbing extra costs for blood programs, limiting sustainability.

Research from Jenkins team found one in six pediatric patients receiving prehospital blood were unexpected survivors. Holcomb adds that non-trauma cases, such as hemorrhage during labor or gastrointestinal bleeding, also benefit, citing a Mayo Clinic review where over one-third of prehospital transfusions were for such conditions.

The TRICARE project will track whether separate payments improve outcomes, lower total care costs, and widen early blood access. Advocates expect the data to influence Medicare, Medicaid, and commercial insurers.

Beyond payment, safe ambulance storage demands strict temperature control, crew training, and coordinated supply rotation to avoid waste. Experts note that practical hurdles like funding and logistics, not clinical interest, have slowed wider rollout.

Holcomb views the TRICARE coverage as a major advance that could encourage other insurers to support prehospital blood programs.