Massive Hemorrhage Protocols have been developed to address life threatening hemorrhage in a standardized fashion. They have been shown to have particular value in the setting of military and penetrating trauma, and probably have value when hemorrhage is occurring with no available lab data to direct therapy. The goal of the protocol is to provide interventions and blood products in an organized and rapid fashion while therapy to stop the bleeding is enacted. Theoretically, the sooner the protocol is individualized to meet the patient’s needs the better the outcome. Early and rapid measures including the use of tourniquets, cautery, trauma laparotomy, thoracotomy, endoscopy, interventional radiology and other appropriate surgical intervention should be directed at cessation of hemorrhage.