Understanding Massive Transfusion Protocols

Massive transfusion protocols are critical in emergency departments, yet there is considerable ambiguity surrounding when to activate them. The general consensus is to push the button after administering a specific number of uncrossed blood units, often suggested as three, as this threshold serves as a cognitive stop point. If a patient's condition does not improve after this initial transfusion, further massive transfusion protocols can be activated. The challenge lies in existing poor decision rules, which are often ineffective and not significantly better than basic clinical judgment.