Hemorrhagic shock is one of the leading causes of preventable death in military trauma patients. Literature shows that pre-hospital transfusions of blood products within the combat environment have shown to have a greater likelihood of survival. This has produced a challenge in the pre-hospital setting to have a standardized method of predicting the patient’s need for a massive transfusion. In the last few years, the development of a Massive Transfusion Protocol (MTP) has become the standard to quickly deliver blood products to actively bleeding patients. Every minute waiting to administer blood products increases mortality by 5%.

While initiating an MTP saves lives, it can result in a waste of limited blood products. This has led to developing criteria to score whether an MTP activation is needed. Currently, the American College of Surgeons recommends in the civilian trauma setting to use the Assessment of Blood Components (ABC) score, which requires a trained provider to complete a FAST exam. The most evidence-based literature shows that the shock index (SI) scoring system is more efficient to calculate and more sensitive compared to the ABC score. The SI score is the ratio of heart rate to systolic blood pressure and signifies hypovolemia and circulatory failure when the score is greater than 0.7. The current recommendation is to implement the shock index as the new standard criteria for initiating massive transfusion in the combat and pre-hospital setting.

Date of publication

Fall 12-4-2023

Document Type

MSN Capstone Project



Persistent identifier



Masters of Science in Nursing Administration