Prehospital TBI - we do what we know until we know better - now we need to do better!
Kaleb Lachenicht
Transforming EM through patient safety systems, Just Culture development, and clinical excellence! Passionate about connection, building systems, and developing teams.
A new multicenter study (Maiga et al., 2025) has thrown a spotlight on what many of us in retrieval medicine already know from experience: Hypoxia, hypotension, and hypocarbia kill the brain-injured patient!
In a cohort of nearly 15,000 patients with traumatic brain injury (TBI), even a single episode of:
…was independently associated with significantly increased risk of emergency department death, in-hospital mortality, and poor neurologic outcome.
The scariest stats we have:
In the retrieval space, where prolonged prehospital times, complex extrications, and long flights are common, these findings are not just academic.
They’re a call to action.
✅ Are we oxygenating and ventilating well enough post-RSI? Are we really focusing on getting these right?
✅ Are we monitoring ETCO₂ on every TBI intubation? And taking into account the challenges with this monitoring modility in the face of hypo perfusion?
✅ Are we proactively preventing hypotension before the first sign of shock?
Everything that is bad on the ground is worse in the sky...
This study reinforces that excellence in prehospital neuroprotective care must be deliberate, rehearsed, and embedded in every protocol. We’re not just moving patients, we are having a direct effect on their long outcomes.
📖 Maiga AW, Lin H-HS, Wisniewski SR, et al. (2025). Adverse Prehospital Events and Outcomes After Traumatic Brain Injury. JAMA Network Open, 8(1):e2457506. https://doi.org/10.1001/jamanetworkopen.2024.57506
Experience as executive director/educator/researcher and patient-focused clinician holding UK registration as a Paramedic and as a Nurse with comprehensive experience within the UK, South Africa and the Middle East.
2moOne of the missing elements in the HPCSA RSI guidelines is an effective vasopressor. Adrenaline is not ideal something like phenylepdrine is a great prehospital drug with uses beyond RSI induced hypotension/vasodilation.