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Secondary injury from hypoxia and hypotension doubles TBI mortality. Maintaining SpO₂ ≥90% and SBP ≥100–110 is the cornerstone of field management. Corticosteroids and induced hypothermia are harmful in acute TBI. Hyperventilation is reserved only for suspected herniation, not routine care. Preventing hypothermia, providing oxygen, controlling bleeding, and rapid evacuation to neurosurgical capability further optimize outcomes. These measures form the foundation of neurologically protective trauma care.

IR markers are visible under NVGs but concealed from the enemy, allowing coordination without compromising security. White light exposes positions. Random movement creates confusion and risks fratricide. Delaying until daylight risks preventable deaths. Night rehearsals, IR tools, and noise/light discipline allow secure, effective casualty evacuation in limited visibility environments.

Junctional bleeding at groin/axilla/neck cannot be controlled with limb tourniquets. Hemostatic wound packing with sustained manual pressure is the lifesaving intervention. Specialized junctional devices may supplement if available. Oral fluids risk aspiration and are contraindicated. Proximal tourniquets above the heart are anatomically ineffective. Oxygen is helpful for perfusion but does not stop hemorrhage. After control, apply pressure dressing, reassess for rebleeding, prevent hypothermia, consider TXA, and coordinate rapid evacuation for surgical control.

Secondary brain injury is worsened by hypotension and hypoxia. Maintaining SBP ≥100–110 and SpO₂ ≥90 is the cornerstone of TBI management. Hypothermia and steroids are not recommended. Permissive hypotension is inappropriate in TBI. Field care focuses on oxygenation, perfusion, and hypothermia prevention, with rapid evacuation to neurosurgical facilities. Frequent reassessments and concise MIST communication ensure appropriate handoff and improved outcomes for TBI casualties.

TXA inhibits fibrinolysis, stabilizing clots and reducing trauma mortality if given early, ideally within 3 hours. Later use may worsen outcomes. Diazepam, dopamine, and atropine have no role in bleeding control. TXA complements tourniquets, wound packing, and damage-control resuscitation. Documenting timing and dose ensures continuity of care and maximizes benefit.