For severe ongoing hemorrhage, it is recommended to transfuse blood products in a 1:1:1 ratio of packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets in instances when a large volume of fluid replacement is necessary. Large fluid volumes are defined as 4 or more units of PRBCs over one hour or 10 or more units over 12 to 24 hours (Neal et al., 2012). Excessive infusion of crystal-loids (ratio of crystalloid to PRBCs > 1.5:1) has been correlated with worse outcomes in trauma patients with severe hemorrhage and should be avoided (Neal et al., 2012). Transfusion of typed and cross-matched PRBCs is best but requires time to prepare. Instability of the patient’s condition can prompt transfusion immediately with blood type O (Rh-negative for girls and women of child-bearing age), until typed and cross-match is completed and appropriate blood type is available (Erber & Perry, 2006). Many hospitals have protocols for large transfusions. In light of fluid resuscitation with IV crystalloids and RBC transfusions, hemodilution of clotting factors and platelets as well as hypothermia can occur. Therefore it is prudent to transfuse plasma or platelets early in the resuscitation efforts and monitor temperature closely (Erber & Perry, 2006). Provided massive, ongoing hemorrhage is not present, using laboratory measures to guide transfusion is a reasonable approach (Faringer, Mullins, Johnson, & Trunkey, 1993). Be aware that treatment with anticoagulants is common in the elderly; in light of traumatic event and subsequent hemorrhage, reversal of anticoagulants may have also occurred, requiring increased vigilance in neuro assessment and cardiac monitoring (Erber & Perry, 2006; Faringer, Mullins, Johnson, & Trunkey, 1993).