The ABCs of TBI. Evidence-based guidelines for adult traumatic brain injury care.

The images of Olympic athlete Nodar Kumaritasvili flying off his luge and contacting a fixed steel beam at the recent Winter Olympics in Vancouver, British Columbia, were shocking. But the resultant injuries and death of the young athlete were not surprising to EMS personnel who witnessed the incident, because training and experience with similar mechanisms of injury intuitively teach us that these types of patients are susceptible to traumatic brain injury (TBI). Worldwide, TBI is the leading injury cause of death and permanent disability. In the U.S. alone, 1.4 million cases of TBI present to emergency services every year. Many more cases go unreported and untreated. These TBIs lead to 235,000 hospitalizations and, ultimately, 50,000 deaths.(1) For instance, blunt trauma alone kills 1% of those affected, but when a TBI is also involved, the mortality rate increases to 30%.(2) Some 50% of those who die from TBI do so within the first two hours of injury, making emergent prehospital intervention critical.(3) Preventing secondary injury by proper prehospital management can save brain function and lives.