Karen Shoos Lipton, JD
American Association of Blood Banks
House Energy and Commerce Committee
Oversight and Investigations Subcommittee
September 10, 2002
Mr. Chairman and Members of the Committee, thank you for the opportunity to testify today regarding issues affecting the nation’s blood supply, and in particular the blood community’s efforts to ensure there is adequate blood available to treat all patients in need in the event of a domestic disaster. Today, I am speaking to you as Chief Executive Officer of the American Association of Blood Banks (AABB), the professional association representing approximately 1,800 institutions – including blood centers as well as hospital transfusion services – and 8,000 individuals involved in all aspects of blood banking and transfusion medicine. AABB’s members are responsible for virtually all of the blood collected and approximately 70 percent of the blood transfused in the United States.
Based on lessons learned from the September 11 attacks, the blood community recognized the need to develop a response plan to future domestic disasters and acts of terrorism. The AABB Interorganizational Task Force on Domestic Disasters and Acts of Terrorism was formed in December 2001 to help ensure that ¾ in the event of a national disaster ¾ blood collection efforts run smoothly and are managed properly, with the public receiving clear and consistent messages regarding the status of America’s blood supply.
The AABB is serving as the coordinating entity for the task force. Other task force members include: America’s Blood Centers (ABC), American Red Cross (ARC), Blood Centers of America/hemerica (BCA), Armed Services Blood Program Office (ASBPO), Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS), Food and Drug Administration (FDA), American Hospital Association, Advanced Medical Technology Association (AdvaMed), the Plasma Protein Therapeutics Association (PPTA), and the American Association of Tissue Banks.
The Task Force has identified three primary lessons learned from the September 11 disaster: 1) the need to control collections in excess of actual medical need, 2) the need to ensure that facilities maintain adequate inventories to prepare for disasters at all times in all locations across the country, and 3) the need for overall inventory management within the United States. Specifically, the Task Force recommends a minimum seven-day supply of red blood cells be maintained in order to prepare for a disaster. The Task Force is in the process of defining what constitutes a seven-day inventory.
In order to mitigate the problems created by collection in excess of actual medical need and to ensure the capability of the blood community to respond effectively in future disasters, the Task Force has developed a plan of action. In the event of a disaster, the AABB will immediately convene a meeting of task force representatives and establish contact with the local blood center(s) affected. Local blood center(s) will be responsible for ascertaining medical need based on casualty estimates, assessing available local supply and communicating that information to the Interorganizational Task Force. If applicable, the task force will identify sites with existing excess blood inventory and determine, along with the affected blood center(s), the need, if any, for blood shipment and the logistics of such shipments. In addition, the task force will be responsible for developing a single, consistent public message and will work with the Department of Health and Human Services (HHS) to disseminate this message to the blood community.
This plan of action is detailed in an Operations Handbook the Task Force has drafted to help blood collectors and hospitals prepare for and respond to potential disasters. The Handbook, which has been distributed in draft form to blood centers nationwide, contains information on preparation steps, activation (i.e., step-by-step response), training materials and reference materials (e.g., important phone numbers, etc.). The Handbook also contains a hospital supplement focusing on hospital transfusion services. In addition, the Handbook distinguishes between “traditional” disasters and biological events, which are likely to affect donor suitability more than demand for blood. The Task Force will incorporate comments on the draft into a final version of the Operations Handbook, which will be widely distributed this fall.
The Task Force also has been busy this year working on other related projects. This past winter, the Task Force created a test pilot to operate during the winter Olympics in Salt Lake City. Before the Olympics began, representatives of the Task Force met with the two blood suppliers for Salt Lake City. Both suppliers agreed to work together to assess medical need should a disaster occur and to work with the Task Force on a coordinated national response. Redundant lines of communication among the Task Force and the blood centers were established. In addition, since the major supplier in that area, the American Red Cross, already had an extensive disaster plan in place in Salt Lake, the Task Force plan was integrated into their plan through the creation and distribution of a shared document with specific instructions and defined communication lines should an event occur. Fortunately, our efforts were not needed, but this served as a valuable pilot in establishing a coordinated approach to disaster preparedness.
In addition, the Task Force has served as an effective mechanism for bringing together the blood community to discuss and develop positions regarding individual disaster-related issues that could affect the blood supply. For example, the Task Force wrote to the Department of Health and Human Services about a variety of issues relating to the blood supply that it felt should be carefully considered before the Department developed any new policies calling for widespread smallpox immunization. Immunization against or exposure to individual biological agents could adversely affect the blood supply by expanding, at least temporarily, the population of unsuitable donors. Because we are already faced with persistent, regional blood shortages, it is critical that the government carefully address the effects any bioterrorism policies could have on blood availability. Whenever possible, the AABB believes it is most effective and efficient for the entire blood banking community to speak with one voice on such important policy matters, and the Task Force enables us to do just that.
Importance of Blood on the Shelves
The AABB and the Interorganizational Task Force recognize that the provision of blood in response to a disaster requires that an adequate supply of blood be available in every community, every day. The blood on the shelf of the blood centers and hospitals in the affected area is the single biggest determinant of the success of the blood community’s first response to a disaster. Persistent seasonal and regional shortages of blood are the major barrier to responding to immediate medical need in any community. For that reason, the Task Force strongly believes that any planning for future disasters should include the recommendation that all blood centers have available a seven-day supply of blood at all times. Continuing and effective communication to the public through multi-year public education and awareness programs, of this real need is of critical importance to the public health of this country.
The government must play a role in ensuring the ongoing availability of blood. First, the government needs to support needed public awareness campaigns designed to highlight the importance of blood donations to the American public. Currently, the AABB is working with the American Red Cross and America’s Blood Centers to develop a multi-year, unbranded blood donation public awareness campaign, which we hope will be launched in the not-too-distant future. The federal government has funded public awareness campaigns about other public health issues, such as the currently funded program for organ, tissue and marrow donations. Blood donation, which touches millions of lives each year, clearly merits a similar commitment.
In addition, in order for us to accurately gauge whether the supply on the shelf will be adequate to meet patients’ blood needs in the future, it is crucial that the government support collection of long-term, quantitative blood supply and utilization data. Unfortunately, the government has not made any long-term commitment to collecting this necessary, representative data. Unless such a commitment is made and the government financially supports the collection of quantitative data sufficient to forecast future blood supply trends, we will continue to operate with only today in mind, and without any reliable picture of what the nation’s blood needs will be in the future.
Lastly, when making any blood related policies, including donor deferral policies, the federal government must carefully consider their potential impact on the blood supply, both national and regional. For epidemiologic and demographic reasons, different deferral policies may affect certain regions of the country more than others. If there is a supply problem in any part of the country, in any blood type, there is a shortage. Patient access to an available blood supply is clearly a safety issue as well as a public health priority.
The AABB thanks the Subcommittee for holding this hearing and hopes that you will act to ensure the federal government steps forward in supporting these critical initiatives aimed at promoting a safe, available blood supply.