In our opinion, two developments have markedly impacted the care of patients injured in the recent conflicts in Afghanistan and Iraq: an increase in the incidence and profundity of penetrating injury3 and the impressive capability for expedited aeromedical evacuation. The emergence of the latter has decreased the time from in-theater injury to stateside ICU for injured American soldiers to < 48 h in some instances. This places lengthy transport of the injured (flight times ≥ 8 h) within the time period when VTE develops and prophylaxis is likely most essential, and the vagaries of wartime transport may compromise administration of prophylaxis. Moreover, the conditions of hypobaric hypoxia seen with air travel may increase risk of VTE independently of risk associated with prolonged immobility,4 further increasing the propensity of these patients develop clots. Although this hypobaric risk may be mitigated by low-molecular-weight heparin,5 and aggressive thromboprophylaxis in the trauma setting is certainly justifiable, as Holley et al1 note, the absence of data from the evacuation period remains problematic in developing a tailored and evidence-based approach to VTE prevention in this population.