Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. 
Massive transfusion, the administration of 10 to more than 100 units of red blood cells (RBC) in less than 24 hours, can be a life saving therapy in the treatment of severe injury.  The rapid administration of large numbers of RBC, along with sufficient plasma and platelets to treat or prevent coagulopathy, is frequently a disorderly process.  Patient care and collaborative research might be aided with a common protocol.  The authors polled trauma organizations and trauma centers to find examples of massive transfusion protocols.  The goals and ease of use of these protocols were evaluated.  Massive transfusion protocols exist at a relatively small number of large and well-organized trauma centers.  Most of these protocols are designed to treat pre-existing and/or ongoing coagulopathy.  The evidence would suggest that prevention of coagulopathy is superior to its treatment.  Simple ratios such as 1:1:1 RBC:plasma:platelets have the benefit of ease of use and the relatively higher plasma and platelet doses appear to be associated with improved outcome.  Such a standard protocol can foster multicenter research on resuscitation and hemorrhage control.  The fixed volume ratios might allow the number and rate of administered units of RBC to be used as surrogates for blood loss and primary treatment effect.