Safe blood is a scarce resource, especially in low- and middle-income countries. Over 50% of blood is donated and utilized in high-income countries such as the United States, Canada, Europe and Australia. Although the number of hemorrhage-related deaths each year is unknown, at least 5 million people annually die from trauma-related injuries, overwhelmingly due to hemorrhage. While all blood transfusions carry the potential risk of a transfusion transmissible infection, the unavailability of blood in hemorrhagic emergencies results in almost certain death. Here, we outline three potential domains for interventions: enhancing delivery systems, increasing salvage of blood in operating rooms, and walking blood banks. To truly scale surgical systems and meet the needs of the patients in those systems, it is imperative that we increase access to safe blood now.