ABSTRACT
Traumatic brain injury (TBI), which particularly affects the young population, is an important cause of morbidity and mortality worldwide and represents a public health problem with increased socioeconomic consequences. Initial resuscitation of TBI, focused on prompt, specific management, has resulted in a significant decrease in mortality from 50% to less than 25% over the last few decades. Accumulated evidence has shown that the vital and functional outcome following TBI depends on the magnitude of the initial biomechanical impact (primary injury) as well as the presence and severity of the systemic and intracranial insults that appear minutes, hours, or days following the traumatic event. These subsequent insults magnify or produce new brain lesions, commonly referred to as secondary brain injury. Primary treatment of severe TBI begins at the site of the injury and includes maintenance of blood pressure, oxygenation, and ventilation, all avoidable risk factors independently related to an unfavorable prognosis. Additionally, all prehospital interventions should be carried out as fast as possible. Prehospital management of neurotrauma patients focuses on limiting secondary brain injury by instituting interventions for airway management and prevention of hypoxia, hypocapnia, hypercapnia, and hypotension. The availability of trained and experienced emergency teams is crucial.
