Pragmatic, Randomized Optimal Platelet and Plasma Ratios

Inclusion Criteria: * Subjects who require the highest trauma team activation at each participating center, * Estimated age of 15 years or older or greater than/equal to weight of 50 kg if age unknown, * Received directly from the injury scene, * Initiated transfusion of at least one unit of blood component within the first hour of arrival or during prehospital transport, and * Predicted to receive a MT by exceeding the threshold score of either the Assessment of Blood Consumption (ABC) score or the attending trauma physician's judgment criteria Exclusion Criteria: * Received care (as defined as receiving a life saving intervention) from an outside hospital or healthcare facility (Procedures and care given at an outside health facility cannot be documented or controlled resulting in a high variability of standards of care and clinical outcomes.) * Moribund patient with devastating injuries and expected to die within one hour of Emergency Department (ED) admission * Prisoners, defined as those who have been directly admitted from a correctional facility * Patients requiring an emergency thoracotomy * Children under the age of 15 years or under 50 kg body weight if age unknown * Known pregnancy in the ED * Greater than 20% total body surface area (TBSA) burns * Suspected inhalation injury * Received greater than five consecutive minutes of cardiopulmonary resuscitation (CPR with chest compressions) in the pre-arrival or ED setting * Known Do Not Resuscitate (DNR) prior to ra…