The authors' experience with 29 patients with blunt injuries who sustained massive transfusions exceeding four blood volumes in the initial posttraumatic 12 hours was reviewed. The overall mortality was 62 per cent. Only one patient survived when the amount of transfusions exceeded 50 units. The most common bleeding sites were abdominal and pelvic. Half of the dead succumbed within the first 24 hours. Of those who died, seven died from brain injury, six from multiple organ failure (MOF), and five from uncontrollable bleeding. Initial shock was observed in 55 per cent of patients. The high mortality of patients with massive transfusions and MOF related to the duration of shock strongly promote the importance of initial volume resuscitation.