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This presentation discusses the Massive Blood Transfusion protocol researched at, and adopted by, GF Jooste Hospital on the Cape Flats. GF Jooste Hospital receives a disproportionate volume of penetrating wounds from interpersonal violence – predominantly multiple gunshot wounds and stabbings to the thorax and abdomen. GF Jooste Hospital is indeed the world capital for stabbed hearts (according to the international literature). This protocol has subsequently been adopted by the Western Province Blood Transfusion Service and the Division of Emergency Medicine of the Universities of Cape Town and Stellenbosch as their official MTPs. GF Jooste Hospital needed to develop (or adopt) a practical working protocol independent of laboratory facilities in order to rapidly respond to massive blood loss. This protocol is the culmination of a thorough literature research, incorporating Level 1 evidence and consensus expert opinion. This presentation provides a workable system through which to institute a MTP, and describes haemostatic resuscitation through the use of fixed-ratio blood component therapy independent of the use of laboratory assays. The presentation discusses the definitions and predictors of Massive Transfusion, and explores demystifies and explains which of the various components to use when – fresh frozen plasma, platelets and cryoprecipitate. This talk also provides insight into the true cost of initiating a MTP, highlighting the real costs charged by the blood banks.