Expanding Access to Blood Products

To expand access to blood products in emergency settings, America’s Blood Centers is asking Congress to establish a demonstration project through the Center for Medicare & Medicaid Innovation examining the use of pre-hospital blood.

Blood provided to patients as quickly as possible after trauma can save patients’ lives. Unintentional injury is the leading cause of death among individuals ages 1-44. Hemorrhage is the leading cause of preventable death following a severe injury, and sadly, up to 56% of those victims die before ever reaching the hospital. When trauma occurs, time is of the essence. The faster a patient receives the necessary care, the more likely they are to survive.

Patient access to blood transfusions before they reach a hospital can have dramatic survival improvements

One study found up to 5% increased odds of mortality for every minute of delay in access to blood.

The National Academy of Sciences has recommended that achievement of zero preventable deaths after traumatic injury should be the goal of a national trauma system. The Department of Transportation prioritized improving post-crash care by including it as one of the objectives within the National Roadway Safety Strategy.

Initiation of a blood transfusion is associated with significantly improved survival for trauma patients, especially those with prolonged transportation time.

Significant barriers impede the expansion of access to pre-hospital blood transfusions

Reimbursement: Medicare payments are currently insufficient to support the use of blood by Emergency Medical Services (EMS) providers (with a single unit costing more than half of the reimbursement for the highest level of EMS care). Current funding relies heavily on grant funding or a hospital or EMS absorbing the cost of storing and transfusing blood.

Scope of Practice: State and local licensure requirements can vary regarding the type of care a paramedic is allowed to provide.

Blood Supply: Pre-hospital blood use is of non-crossmatched blood, so having access to blood that is less likely to be reactive in a variety of patients is essential. The most common blood components provided for pre-hospital use is Low Titer Type O Whole Blood, Type O Positive red blood cells, and Type A liquid plasma. Ensuring the availability of these high demand products is a continual challenge for blood centers. One study found a lower bound of 54,160 additional whole blood units would be required to meet the needs for the pre-hospital setting.

Up to 56% of hemorrhage victims die before ever reaching the hospital. Hemorrhage is the leading cause of preventable death following a severe injury.

One study found up to

increased odds of mortality for every minute of delay in access to blood.

The Value of Blood

Learn more about the value of blood to the U.S. healthcare system through ABC's Value of Blood white paper. It examines the current resilience of the U.S. blood supply while highlighting areas that warrant further support.

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Statistics & Research

Download ABC's U.S. Blood Donation Statistics and Public Messaging Guide, a first of its kind guide is designed to provide the latest look at America’s blood supply and its donors, including social media resources.

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Letters and Comments

View the latest letters and comments from ABC as we work to advance our advocacy agenda, strengthen the blood supply, and support the important role of community blood centers across the nation.

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2023 Advocacy Agenda

Promoting the value of blood to patients, communities, and the healthcare system.

America’s Blood Centers (ABC) urges the Administration, Congress, and industry stakeholders to promote the value of blood to patients, communities, and the healthcare system through the following actions:

Streamline product licensure to allow blood centers to adapt to changing donor needs.

The pandemic has dramatically impacted the way blood is collected. As schools and workplaces moved virtual or limited who is allowed on site, blood drive cancellations threatened the stability of the blood supply. To meet the needs of donors, blood centers are now opening new locations to adapt to these enduring changes but face over a year wait while FDA reviews blood product licensure submissions and completes a site inspection. Until the new facility receives FDA approval, blood products manufactured (utilizing the same procedures already approved at other facilities operated by the same blood center) cannot be shipped across state lines, even though all products are already acceptable for distribution in the state of manufacture. To ensure a safe and available blood supply, blood centers need to quickly be able to fully utilize these new locations.

Expand the pool of blood donors and available blood by funding local awareness efforts to recruit new and previously deferred donors made eligible by recent FDA eligibility changes.

Recent changes in deferral criteria made by the FDA will safely make many more Americans eligible to donate blood. These changes include the removal of indefinite deferral for geographic exposure to bovine spongiform encephalopathy, including those receiving blood donations in those locations and a proposal to move from a time-based deferral for men who have sex with men (MSM) to a universal individual risk assessment for all donors. These changes come at a critical time when only 3% of Americans donate blood. Congress should support local blood center efforts to recruit these potential donors and educate the public about these changes.

Ensure blood transfusions are available to patients when and where they need blood.

Due to the work of blood centers throughout the U.S., blood has always been available to patients when they need it most. Unfortunately, due to some payment policies, blood transfusions are not equally available to all patients. As a result of bundled payments in the Medicare Hospice program and for care received in an ambulance, blood transfusions are not broadly available to patients in the hospice or pre-hospital setting. As a result, patients in need of palliative transfusions do not enroll in the hospice benefit resulting in greater Medicare expenditures with lower quality end of life care. And while extensive evidence shows benefits to receiving as soon as possible after a traumatic injury, the majority of patients do not receive their first transfusion until they arrive at a hospital, regardless of the amount of time required for transportation. By fairly reimbursing providers for the cost of providing this life preserving care, patients are assured the care they need when and where required.