Incident Summary: “The patient arrived at the Forward Surgical Team (FST) site 30 minutes after being wounded in the right thigh. A tourniquet had completely arrested the bleeding from the injured superficial femoral artery. The surgeons at the FST decided to repair the artery onsite and the 3 hour surgery was reported to have gone well. The patient had received 4 units of packed red blood cells and a reverse saphenous interposition graft had been used to repair the injured superficial femoral artery. However, when the proximal and distal clamps were removed, the patient began to bleed profusely from all his wound sites. Plasma was not available. Fresh whole blood was called for but could not be quickly obtained. The patient was emergently evacuated from the forward surgical team to the combat support hospital but arrested in flight and could not be resuscitated. He was pronounced dead shortly after his 45 minute flight to the combat support hospital.”