From the Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Canadian Forces Health Services, Toronto, ON, Canada. Address reprint requests to Jeannie L.Callum, BA,MD,FRCPC, CTBS, Transfusion Medicine and Tissue Banks, Sunnybrook Health Sciences Centre, B211, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5. E-mail: jeannie.callum@sunnybrook.ca 0887-7963/09/$ see front matter © 2009 Published by Elsevier Inc. doi:10.1016/j.tmrv.2009.06.007 IN 2006 IN the Journal of Trauma, Drs Malone, Hess, and Fingerhut recommended the adoption of 1:1:1 resuscitation (red blood cells [RBC]/fresh frozen plasma [FFP]/platelet). They recommended that such a protocol “be fully developed and examined in a clinical trial.” In the meantime they recommended its use during the “early chaotic phase of resuscitation to standardize blood product support.” They also stated “it should also encourage blood banks to remove impediments to rapid blood product delivery,” citing an article recommending 4 new blood transfusion “services” for trauma patients: (1) thawed FFP; (2) component delivery based on an algorithm; (3) delivery of acute transfusion packages (5 RBC, 5 FFP, 2 pools of platelets); and (4) activation of a transfusionmedicine specialist. Since that time, there has been a flurry of retrospective studies examining the effect of formula-driven resuscitation on the outcomes of trauma patients. In this edition of Transfusion Medicine Reviews, Stansbury et al review the available literature on 1:1:1 resuscitation in trauma patients in detail. They presented a balanced view of this topic and their article should be read by all blood bankers at trauma hospitals, especially before the introduction of formula-driven massive transfusion protocols. Unfortunately, formula-driven care has not been subjected to a prospective, randomized clinical trial (RCT). This editorial will present the major pro and con arguments in the debate between these 2 camps and examine each argument's validity. The major issues are summarized in tabular form in Table 1. However, unfortunately, this argument will not be