Prehospital Kcentra for Hemorrhagic Shock

Inclusion Criteria: 1. Trauma patients age 18 years or greater, or weight \> 50 kg if age unknown 2. Systolic blood pressure \< 70 mmHg 3. Suspicion of hemorrhagic shock based on mechanism of injury 4. EMS transport to a participating trauma center Exclusion Criteria: 1. Age less than 18 2. Unknown time of injury 3. Out-of-hospital cardiopulmonary resuscitation 4. Known history of thromboembolic disorders or stroke or suspicion by EMS of a recent stroke 5. Known oral anti-coagulant use to include warfarin and novel anti-coagulants 6. Severe hypothermia (\<28°C) 7. Drowning or asphyxia due to hanging 8. Burns more than 20% total body surface area 9. Evidence of devastating blunt traumatic brain injury to include fixed and dilated pupils, asymmetric pupils and extrusion of brain matter 10. Isolated blunt or penetrating head injury 11. Isolated spinal cord injury 12. Ground level (same level) falls 13. Inability to obtain intravenous access 14. Inability to administer randomized therapy within 4 hours of ambulance notification 15. Known transfers and inter-facility transfers 16. Known Do Not Resuscitate (DNR) prior to randomization 17. Known or suspected pregnancy 18. Known prisoners 19. Patients who have activated the "opt-out" process