A contrast CT scan should be obtained at 48 hours (and before aeromedical evacuation out of the Role 3 to assess for complications such as pseudonaneurysm formation on all patients undergoing non-operative management of splenic injury.4 Indicators of failure of non-operative management of the spleen include but are not limited to any need for blood transfusion and any hypotensive episode. For Grade I-III splenic injuries success rate of non-operative management with embolization reach 99-100%. Patients who fail non-operative management of the spleen require splenectomy at the Role 3 prior to aeromedical evacuation. It must be stressed that placing a patient in the aeromedical environment is akin to discharge from the facility without activity restriction and without the option of re-admission during the complete inter-facility transport between theaters which must be assumed to be a minimum of 12 hours. Additionally, the patient’s history should be discussed between the referring and accepting surgeons prior to evacuation. Patients with Grade III splenic injury and Traumatic Brain Injury (TBI) should undergo splenectomy due to the fact that hypotension with TBI will double mortality.5 Angiography and embolization for blunt injuries of other visceral organs may be used as an adjunctive procedure and should be determined on a case by case basis.