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These are red flags for rising intracranial pressure and impending herniation. The priority is rapid evacuation to neurosurgical capability. Supportive care includes oxygenation, SBP ≥100–110, hypothermia prevention, and brief hyperventilation if necessary. Steroids worsen outcomes. Hypotension accelerates brain injury. Ignoring symptoms results in death. Recognizing and responding decisively to these signs is lifesaving in TBI management.

Femur fractures bleed heavily and cause extreme pain. Traction splints align the bone, reduce bleeding, and relieve spasm. Analgesia improves comfort. Pelvic binders are for pelvic fractures, chest seals for thoracic injuries. Pain medication alone without stabilization fails to control hemorrhage. Combining splinting with analgesia maximizes survivability and casualty stability during evacuation.

Research demonstrates even a single hypotensive episode (SBP <90 mmHg) or hypoxia (SpO₂ <90%) doubles TBI mortality. These factors cause secondary injury by reducing cerebral perfusion and oxygen delivery. While vomiting, confusion, headache, and photophobia reflect injury severity, they are less directly tied to mortality outcomes. Thus, preventing hypotension and hypoxia is paramount in tactical casualty care. Management focuses on oxygen supplementation, balanced resuscitation, hypothermia prevention, and rapid evacuation to neurosurgical capability.

Pelvic fractures can cause massive retroperitoneal bleeding. Applying a pelvic binder over the greater trochanters reduces pelvic volume and hemorrhage. Upright positioning worsens hemodynamics. NSAIDs are contraindicated. Once applied, the binder should remain until higher care; repeated removal risks rebleeding. TXA, hypothermia prevention, and balanced resuscitation complement binder use. Rapid evacuation to surgical intervention is essential.

TXA reduces mortality when administered early, ideally within the first 3 hours after injury. Later use can increase complications. TXA stabilizes clots, supporting other hemorrhage control methods. It is not dependent on fluids and should not be delayed until evacuation. Proper documentation ensures continuity of care. TXA is a cornerstone of damage-control resuscitation in tactical trauma care.