Trauma remains a leading cause of death in all ages. Haemorrhagic shock accounts for 80% of deaths in the operating theatre and up to 50% of deaths in the first 24 h after injury. Exsanguination is an important cause of mortality for trauma patients, and the successful management of severely injured patients is a team effort. This oral presentation is intended to provide a better understanding of the priorities in specific situations. Blood Transfusion support and communication in acute trauma can be challenging and demanding on the resources of the blood transfusion services and staffing. The need for large volumes of blood components for some patients cannot be underestimated, particularly those with the greatest risk of mortality. The possibility of death can arise before or within minutes of their arrival to the hospital. Hospitals must have a major haemorrhage protocol in place and this should include clinical, laboratory and logistic responses. Protocols should be adapted to specific clinical areas with planned simulations to test the effectiveness of the major haemorrhage protocol. Fibrinolysis can occur in an accelerated fashion, destabilising effective coagulation in many clinical situations associated with massive haemorrhage. Patient management should be guided by laboratory results, near-patient testing, but led by the clinical scenario. Effective teamwork and communication remains an essential part of this process.