Hemorrhage and coagulopathy are the leading causes of preventable death in war and trauma injuries, constituting approximately 50 percent of deaths in the first 24 hours. The importance of damage control resuscitation by establishing a permissive hypotension, minimizing crystalloid use, and early implementation of blood products is well understood today. The aim of the present review is to highligt the role of massive transfusion protocols with balanced blood component ratios. Physicians dealing with trauma must quickly and accurately predict when a massive transfusion protocol (MTP) should be activated. There have been several validated transfusion scores developped for this purpose. Earlier balanced blood transfusion by using massive transfusion protocol, may be more effective in resuscitating coagulopathic patients. Transfusion ratios approaching 1: 1: 1 of packed red blood cells (PRBCs) to fresh frozen plasma (FFP) to platelet have been shown to improve the survival of the severely injuried patient. Trauma institutions should develop and regularly activate MTPs for trauma and war surgery in proper indications.

Keywords: massive transfusion, war, terror