Massive transfusion protocols (MTPs) are activated in the setting of uncontrolled hemorrhage. This session will help the audience identify potential unintended adverse medical and operational consequences of MTPs. It will begin with an engaging clinical case presentation and debrief. The 1st speaker will examine potential medical risk including: 1) misappropriate activation 2) immunohematologic complications 3) risk of transfusion-associated circulatory overload and 4) product appropriateness. The 2nd speaker will address ways to monitor and audit MTPs to find opportunities for institution-wide, patient-focused process improvement. Discussion will include: 1) what quality metrics should be captured and reviewed and 2) what is an effective quality management program that addresses communication and engages stakeholders outside of the laboratory. Last, we explore whether triggering one protocol for all patients is appropriate given the various clinical settings that require MTPs.