The primary initial goal in the care of the trauma patient has always been control of hemorrhage. Under most circumstances this can be achieved by surgical control or more recently by other adjuncts such as angiography. However, in the massively injured patient a second form of bleeding commonly referred to as nonsurgical bleeding can pose a significant threat to life. The etiology of this nonsurgical bleeding is multifactorial; it results from a significant decrease in hemostatic components (platelets, fibrinogen, and coagulation factors) as well as unfavorable conditions for enzyme kinetics such as acidosis, hypothermia, and hypocalcemia. The end result is that the patient develops diffuse bleeding that cannot be controlled by surgical methods.