In a Mass Casualty Incident, Every Second Counts

The scene is chaotic by design. Volunteers act as injured patients while emergency crews assess casualties and establish treatment areas. Behind the scenes, another team determines how much blood is needed, prepares transport containers, and tracks each unit.

The scenario is only a drill, but for Austin-Travis County EMS and Central Texas blood bank We Are Blood, it represents months of preparation to ensure blood reaches patients during a real emergency.

In the spring, the two organizations launched a mass casualty incident whole blood deployment plan, designed to bring additional blood supplies directly to large-scale emergency scenes. A mass casualty incident is one that overwhelms EMS resources, which for ATCEMS typically involves eight to 10 or more injured people who cannot walk on their own. The plan was developed through months of testing, including simulations of emergencies such as active shooter incidents and aircraft crashes.

Although the protocol has never been activated, officials told the Chronicle the preparation itself is what matters most.

For several years, ATCEMS has carried blood products on many of its ambulances, allowing paramedics to begin lifesaving transfusions before patients reach a hospital. As the program expanded, the organizations recognized the need for a larger strategy: how to quickly provide blood when multiple patients require transfusions during the same emergency.

“You look back on your career, and there were people along the way that were unnecessary fatalities because, at the time, we did not have blood and the ability to transfuse,” said Joshua Todd, division chief of performance improvement for ATCEMS. 

While conversations about blood preparedness began years earlier, ATCEMS and We Are Blood began developing the mass casualty component of the program in earnest in fall 2025 before launching the plan in April.

Testing the system required more than a meeting around a conference table. The organizations conducted several exercises, including tabletop discussions and full-scale simulations, to test different parts of the response.

Full-scale exercises placed responders into simulated emergencies where volunteers used moulage – the application of mock injuries – to create realistic wounds. During one aircraft crash drill, teams practiced the response from the initial call through scene management.

“We have volunteers acting as casualties that get moulaged with injuries and blood,” Todd said.  “There’s a multidisciplinary response to go to the crisis site and take those physical volunteers and treat them and move them from A to B.”

For the blood response team, the exercise begins before arriving at the emergency site. Once activated, responders determine how much blood is needed, coordinate with We Are Blood, and prepare transport containers with the appropriate supplies. 

Patrick Eaves, an ATCEMS captain, said the exercises highlighted the importance of small details. “We learned a lot about the easiest ways for us to track where the blood units go,” Eaves said. “We kind of got inundated with various people saying, ‘Hey, we need blood,’ so it helped us to polish off the communication side of things.”

The response also depends on keeping blood products viable from the moment they leave We Are Blood until they reach patients. Each unit must remain within specific temperature ranges, be tracked throughout an emergency, and accounted for if returned unused. 

The organization designed a system flexible enough to adapt to different emergencies. We Are Blood can package blood into multiple transport containers that remain temperature-controlled for up to 24 hours, allowing supplies to be distributed while preserving the products’ integrity.

While much of the planning happens behind closed doors, the program ultimately depends on something more familiar to the everyday individual: people who donate blood before an emergency happens.

“It’s truly the blood on the shelf at the time of the disaster that saves lives,” said Justine Garza, vice president of business development at We Are Blood. Those donations come from people who gave blood days or weeks earlier, allowing enough time for the blood to be tested, processed, and delivered to ambulances and hospitals before it’s ever needed.

Behind every transfusion is a network of people working long before an emergency begins. Todd said that collaboration has reshaped how emergency response operates across Central Texas. “There are people walking around the city of Austin that would not be alive without the lifesaving transfusions they received,” he said.

Garza said both organizations continue to evaluate the plan and revisit the protocol after training exercises or real-world experiences reveal opportunities to improve.

While no one hopes the plan is ever needed, both organizations see preparedness as an ongoing commitment. If disaster does strike, they hope the public never notices the months of planning behind the response – only that the blood needed to save lives is already there.

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