The transfusion of high ratios of plasma and platelets to packed red blood cells, known as hemostatic resuscitation, in patients requiring massive transfusion has become a standard of care in many trauma systems. This is a result of multiple retrospective analyses from both military and civilian databases that showed an association between high-ratio transfusion and improved survival. This very well-done study by Dr Inaba and his colleagues from the University of Southern California raises critical questions concerning the safety of hemostatic resuscitation.