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INTRODUCTION The aim of our study was to evaluate if pre-hospital shock index (SI) can predict transfusion requirements, resource utilization and mortality in trauma patients. METHODS We performed a 2-year analysis of all adult trauma patients in the TQIP database. Shock index was calculated by dividing heart-rate over systolic blood pressure. Patients were divided into two groups pre-hospital SI ≤ 1 and prehospital SI > 1. Regression and ROC curve analyses were performed. RESULTS 144951 patients were included in the study. Mean age was 45 ± 34 years, 61% were male, 84.7% had blunt injuries and median ISS was 13 [9-17]. Overall 9.1% of the patients had a pre-hospital SI > 1. Patients with pre-hospital SI > 1 had higher likelihood of requiring massive transfusion (25% vs. 0.012%, p < 0.02), interventional-radiology intervention (6.2% vs. 1%,p < 0.001) or operative intervention (14.7% vs. 2%,p < 0.001) compared to SI ≤ 1. Similarly, patients with SI > 1 had higher mortality (12.3% vs. 5.2%, p < 0.001) and were more likely to be discharged to Rehab/SNF (34.6% vs. 21.4%, p < 0.001). CONCLUSIONS Pre-hospital SI predicts trauma-center resource utilization and can guide patient triage and trauma resource recruitment.