Resuscitation of massively traumatized patients is physiologically complex, time-dependent, and a significant resource management matter often associated with poor survival rates. Retrospective medical evidence accumulated from combat trauma admissions to the Joint Theater Trauma Registry (JTTR) 2003-2007 supports swift replacement blood products when total blood volume losses of 30-40% or greater has occurred. Replacement plasma, packed red blood cells, and platelets in a ratio of 1:1:1 significantly reduces trauma-related coagulopathy. Clinical management specifically avoiding acidosis and hypothermia, in conjunction with administration of specific blood products, or fresh whole blood, will blunt the emergence of  the ‘lethal triad.’ Limited Level 1Trauma Center prospective evidence based on massive blood transfusion of penetrating torso
injuries supports the JTTR data.