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The objective of this proposed study is to systematically define the clinical and logistical issues surrounding traditional open vascular surgery and catheter-based hemorrhage control. The hypothesis is that minimally invasive, device-driven and expert-led NCTH control techniques improve survival compared to traditional open vascular surgery. This project will achieve the following aims: 1) Determine current practice patterns for the treatment of patients with NCTH among 4 clinical sites using a retrospective study design (Phase 1a); 2)Conduct a 2-day Delphi Panel meeting of military and civilian experts to gain consensus regarding anatomic, technology, credentialing, competency, and training issues for catheter-based hemorrhage control (Phase 1b); 3) Conduct a prospective 4-site observational study to test the hypothesis that less-invasive device-driven and expert-led hemorrhage control techniques are associated with improved survival in NCTH patients and strengthen the evidence base to inform future development of catheters, devices, and training required for surgeons for catheter-based hemorrhage control (Phase 2). At the end of Y4, enrollment and data cleaning in the prospective study has been completed, and analysis has been initiated for the 318 enrolled and eligible. We have requested an EWOF to use remaining funds for further analysis.