Injuries to arteries and veins can be life-threatening secondary to bleeding. Ambulance personnel, medical first responders, will attempt to achieve immediate and definitive control of the bleeding vessel using a tourniquet or other device. Upon arrival at the hospital, the surgical team will evaluate the patient and create a care plan. Aside from the injured vessel, the surrounding skin, muscle, and bone may be involved. The approach to wound care is dictated by the receiving facility’s location, metropolitan hospital or combat medical tent, and the available resources. Given the rise in gun violence and advancement in weaponry, the injury patterns seen in civilian and combat environments have become identical. We will convene a group of international experts in civilian and military trauma to share their clinical and surgical experiences regarding vascular injuries. Afterwards we will create a combined retrospective database from our home institutions encompassing the three phases of care: pre-hospital, within the care facility, and discharge. This database will be used to answer questions and create guidelines that will optimize the care of injured patients regardless the environment.