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PGS, For modest blood loss, saline may be fine, but for really massive blood loss, PolyHeme would still play a vital role. Volume replacement with saline doesn't replenish the oxygenation function of the missing hemoglobin, so in cases of really massive blood loss, the patient dies anyway. So PolyHeme could ultimately be approved by the FDA for use in severe blood loss cases. Then it would be up to paramedics to decide whether to also use it "off-label" in less serious blood loss situations, though then as you said, cost/reimbursement would be a bigger factor. The market for PolyHeme may not be as large as hoped, but it does fill a gaping hole in the available treatment of massive blood loss, so a favorable view of PolyHeme by the FDA might not be that surprising. As we know, the military needs it also.