Prehospital transportation and optimal utilization of resources

Prehospital guidelines for the management of severe traumatic brain injury (sTBI) outline issues of injury prevention, initial evaluation, early treatment goals, and triage concerns and call for specific resuscitative efforts and neurologic assessments. All of these measures are aimed at the avoidance of secondary insults contributing to secondary injury cascades in the brain following TBI. Several factors including regional geography, topography, weather patterns, available modes of transportation, and the locales of health-care institutions and trauma centers must all be taken into account when devising transportation and prehospital treatment strategies to improve patient outcomes. Controversies regarding best type of transportation, direct-to-trauma center versus closest hospital transport, still exist, but data are emerging to support transporting sTBI patients to the highest-level trauma center available as soon as possible. Telemedicine services will aid better coordination of care in the future.