This document provides guidance on managing massive hemorrhage through a massive hemorrhage protocol (MHP). It outlines the steps to take when massive hemorrhage is suspected, including alerting appropriate teams, taking initial blood samples, and administering MHP 1 which includes 4 units of red blood cells, 4 units of fresh frozen plasma, and other components as needed. It describes continuing the protocol with MHP 2 if bleeding persists and adjusting component ratios based on repeat lab tests. The goal is to maintain hemoglobin, platelets, coagulation factors, calcium, temperature, and pH within target ranges to resuscitate the patient and control bleeding through various medical and surgical interventions while closely monitoring for complications and standing down the protocol once