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Background In patients with major hemorrhage, balanced transfusions and limited crystalloid use is recommended in both civilian and military guidelines. This transfusion strategy is often used in the non-trauma patient despite lack of supporting data. Aim of the study was to describe the current transfusion practice in patients with major hemorrhage of both traumatic and non-traumatic etiology in Central Norway and discuss if transfusions are in accordance with appropriate massive transfusion protocols. Methods In this retrospective observational cohort study, data from four hospitals in Central Norway was collected from 01.01.2017 to 31.12.2018. All adults (≥18 years) receiving massive transfusion (MT) and alive on admission were included. MT was defined as a transfusion of ≥ 10 units of packed red blood cells (PRBC) within 24 hours or ≥ 5 units of PRBC during the first three hours after admission to hospital. Clinical data were collected from the hospital blood bank registry (ProSang) and electronic patient charts (CareSuite PICIS). Patients undergoing cardiothoracic surgery or extra corporeal membrane oxygenation treatment were excluded. Results A total of 174 patients were included in the study, of which 85.1% were non-trauma patients. Three quarters of all patients received plasma:PRBC in a ratio ≥ 1:2 (good practice), with no difference between the trauma and the non-trauma group (p=0.58). For the ratio of platelets:PRBC, 59.2% were transfused with ≥ 1:2 (good practice). There was no difference in blood transfusions between the trauma and non-trauma group (2273 mL versus 2309 mL, p=0.898). Mean fluid infusion of crystalloids in all patients were 6350 mL, with no difference between trauma and non-trauma group (p=0.137). Thirty-seven per cent of all patients received tranexamic acid, 53.4 % received calcium and fibrinogen was administered in 9.2%. Conclusions Most patients with major hemorrhage in Central Norway have a non-traumatic origin. Most patients are transfused with a high ratio of 1:2 plasma: PRBC and platelet:PRBC which is considered good practice. Crystalloids were administered liberally and there was a general underuse of adjunct medications such as tranexamic acid, calcium and fibrinogen.