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assive bleeding is a leading preventable cause of death following trauma, childbirth and surgery. 1-3 There were 5.1 million deaths after traumatic injury worldwide in 2010, mostly affecting young people, accounting for nearly 10% of all deaths. 4 In the United States, it is estimated that up to 20% of such deaths are the direct result of preventable hemorrhage. 4-7 Management of unstable hemorrhagic shock is centred on stabilizing the patient with prompt transfusion of blood components, and rapid identification and treatment of the source of bleeding. Patient outcome is dependent on the availability of rapid definitive surgical intervention, support of a transfusion medicine and clinical laboratory, prompt access to hemostatic agents and care provided by a high-performing interdisciplinary team. 8 In the trauma literature, protocolized delivery of massive transfusion streamlines the complexities

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