Bleeding out is the leading cause of death at the scene of mass casualty situations like Orlando, followed by brain injury.

Rasmussen also noted that the approach to the administration of blood products has seen changes in recent years. Military experience, noted Rasmussen, now suggests that plasma and platelets should be given first. Earlier approaches would be to administer saline initially. "When someone loses 20 to 30 percent of their blood volume from a gunshot wound," he advised, "we don't give them ... saline solutions. We try to give plasma, platelets, and packed red blood cells right away."

In a 2012 Journal of Trauma Acute Care article, this approach showed itself to be significantly better than earlier ones. The authors found that “high transfusion ratios of fresh frozen plasma and PLT to red blood cells were correlated with higher survival but not decreased blood requirement.”

Using blood products rather than whole blood also lets that supply be rationed more effectively, noted M. Margaret Knudson, a professor of surgery at the University of California San Francisco, speaking to Vox, explaining that "not only does it save some of the blood by using products judiciously,” but this approach gives you a better way to “direct what you give."

Military experience has also led to changes in emergency surgery – most importantly a new emphasis on so-called “damage-control” surgery rather than extensive all-encompassing operations. "We do these abbreviated surgeries whenever we can," said Knudson. Then later, additional surgery may be performed in a more orderly environment.

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