Whole Blood in Trauma Patients With Hemorrhagic Shock

Inclusion Criteria: * Adult patients (\> 18 years) * Activating institutional trauma code for trauma patients with hemorrhagic shock. * Candidate for massive transfusion (Patient with an Assessment Blood Consumption (ABC) Score ≥ 2 or at the discretion of the treating physician) * Concurrent availability of whole blood or blood component therapy Exclusion Criteria: * More than 4 hours from trauma to hospital admission * More than 2 hours from hospital admission to randomization * Transfusion of more than one packed red blood cell unit prior to randomization. * Patients who have undergone surgery (laparotomy, thoracotomy, or sternotomy) before hospital admission. * In-extremis patients with devastating injuries (expected to die within 60 minutes). * Blood group other than to O or A and positive Rh factor * Severe traumatic brain injury in which neurosurgical intervention is futile (partial decapitation, massive intracranial hemorrhage, or transcranial gunshot wounds). * Burns over 20% of the total body surface area. * Suspected airway burn. * Cardiopulmonary resuscitation (CPR) before arrival at the ED. * CPR for more than 5 minutes before randomization. * Do not resuscitate order. * Incarcerated/prisoners. * Known pregnancy in the ED. * Patient or legal representative who refuse to participate in clinical research studies.