Howard Garrison Advocacy Fellow
Krystal Rivera
Krystal Rivera is graduate student at the University of Alabama at Birmingham.
Describe your interest in participating in the program:
Rivera: In Puerto Rico, violent trauma rates soar to over 3.5 times higher than the mainland U.S. average. Yet, a single, understaffed Level II trauma center is tasked with serving 3.2 million people. My work as a resuscitation fluid researcher focuses on bridging this resource gap. I develop endothelial-protective alternatives to cold-storage blood products and bulky crystalloids so that trauma policy can finally reflect the island’s realities. My interest in the Howard Garrison Advocacy Program stems directly from my work as an NIH F31 fellow and PhD candidate studying intravascular hyaluronan and traumatic injury.
As a first author in Shock Journal, I demonstrated that fresh frozen plasma (FFP) preserves vascular endothelial integrity more effectively than standard crystalloid resuscitation. This highlighted how fluid composition decisively shapes barrier function, microcirculatory perfusion, and downstream organ injury. However, FFP’s clinical benefits are constrained by donor dependence, storage-related degradation of protective factors, and complex cold-chain logistics. These constraints are severely magnified in geographically isolated, under-resourced settings like Puerto Rico.
Supported by my NIH F31 predoctoral fellowship, my dissertation addresses a critical question with direct policy relevance: Can intravascular hyaluronan serve as a novel resuscitation fluid that mimics the endothelial-protective features of FFP while reducing reliance on fragile donor networks and cold-chain infrastructure? If hyaluronan can stabilize the endothelial barrier and limit vascular leak during shock, it could become a highly scalable alternative in trauma care. This has profound implications for medical systems facing supply-chain vulnerabilities and long transport times.
The Howard Garrison Advocacy Program is the precise bridge I need to translate these mechanistic insights into actionable health policy. I am eager to learn how to frame endothelial biology, fluid cost-benefit, and hyaluronan-based innovations in terms that resonate with legislators, hospital administrators, and community leaders. I want to speak fluently about survival curves rather than Western blots, and transport times rather than endothelial resistance. Through this training, I aim to effectively communicate why “cheap” crystalloids carry hidden costs in clinical complications, and how investing in novel fluid infrastructure protects vulnerable populations.
My long-term goal is to serve as a research director at a trauma center and shape trauma policy across Puerto Rico. This role demands dual fluency in experimental design and systemic advocacy. I must be able to design clinical trials around hyaluronan resuscitation while simultaneously arguing for legislative infrastructure that reaches rural municipalities, not just tertiary hubs. The program’s structured training in interdisciplinary communicating, legislative engagement, and coalition building will provide the exact tools required to connect trauma researchers with policymakers.
By joining this program, I will become a scientist whose work does not stop at publication. I am personally and scientifically committed to leveraging mechanistic insight and advocacy training to ensure that modern, research-informed trauma care becomes an equitable reality for every patient in Puerto Rico, regardless of where they are injured.
How do you plan to use the knowledge and experience gained through your participation in the Howard Garrison Advocacy Program?
Rivera: The Howard Garrison Advocacy Program will serve as my operational playbook for transitioning from an academic researcher to an impactful science policy leader in Puerto Rico. My immediate goal is to apply the program’s legislative engagement training to bridge the gap between biomedical discovery and territorial healthcare infrastructure. I plan to participate in policy briefings and draft evidence-based memos that show territorial lawmakers how strategic investments in synthetic, shelf-stable resuscitation fluids can bypass the island’s chronic blood product shortages and fragile supply chains. Furthermore, I will use the program’s coalition-building frameworks to establish a formal network connecting the island’s single Level II trauma center with rural municipal clinics. I will organize stakeholders around shared metrics, such as local transport times, intensive care unit bed capacity, and long-term disability costs. I will advocate for updated emergency procurement protocols. I want to equip advocates with the data needed to challenge the budgetary reliance on cheaper, less effective fluids that ultimately burden our healthcare system with preventable clinical complications.
Ultimately, leveraging this training with my NIH F31 fellowship, I will step into the role of a trauma center research director who can effectively champion institutional change. I will use the skills gained to secure diverse funding streams, present clinical trial data directly to hospital boards, and testify before legislative committees. By mastering the tools of systemic advocacy, I will ensure my work on endothelial protection directly shapes public health mandates, transforming trauma care equity across every municipality on the island.
Using no more than 250 words, describe your research as you would to a non-scientist.
Rivera: When you suffer a severe injury, like a car accident or a gunshot wound, your blood vessels face a hidden, life-threatening battle. The inside of your vessels is lined with a protective sugar coating called the endothelium. This coating prevents dangerous fluid leaks, controls blood clotting, and regulates inflammation.
Remarkably, a primary ingredient in this lining is hyaluronan, the same hydrating sugar used in skincare products for its plump, moisture-locking properties. During trauma, this protective sugar layer gets violently stripped away. This causes “vascular leaks,” where fluid escapes the bloodstream, blood pressure drops, and vital organs fail. Helping the body maintain this barrier is the top priority to ensure a patient survives long enough to reach the hospital.
Currently, paramedics use standard IV fluids called crystalloids. However, these fluids do not protect the lining; they actually wash more of it away. My previous research showed that fresh frozen plasma protects this fragile barrier. Unfortunately, plasma is scarce due to donor shortages and competing demands from cancer therapies. That is where my current work comes in. I am testing whether we can use hyaluronan as an IV-resuscitation fluid. Because it is a sugar, we can mass-manufacture it without relying on blood donors or specialized freezers. By injecting hyaluronan directly into the bloodstream, we can patch the leaky vessel walls, stabilize blood pressure, and keep trauma patients alive. Hyaluronan is the unexpected hero that could bring modern, lifesaving trauma care to the most remote communities.
Briefly describe any past or present participation in additional career exploration activities, experiences, and/or programs.
Rivera: My career exploration has focused on bridging the gaps between bench science, clinical application, and public understanding. This trajectory is highlighted by my participation in the annual Shock Society conference, where I first engaged with international trauma experts as an oral presenter and later as a selected poster presenter. Delivering an oral presentation to elite researchers sharpened my ability to deliver high-stakes, data-driven arguments, a skill directly transferable to legislative advocacy. To explore science communication for broader audiences, I authored a feature story for The Medizine Magazine, a student-led publication at UAB. This experience taught me to strip away academic jargon and distill complex medical concepts into compelling, accessible narratives for the wider community.
Concurrently, I have explored academic leadership through targeted mentorship. Over the past two summers, I mentored high school students, introducing them to foundational laboratory methodologies. Within the university, I actively guide a medical student and a transitioning MD/PhD student through the complexities of translational research. This diverse mentoring portfolio requires me to constantly adapt my communication style, whether I am teaching foundational biology to a high schooler or discussing clinical study designs with medical peers. Together, these experiences in high-level presentation, public science writing, and multi-tiered academic mentorship have strengthened my desire to step beyond the laboratory niche. They have prepared me to use the Garrison program’s framework to drive structural healthcare changes in under-resourced settings.
Krystal Rivera is a member of The Shock Society.