Traumatic brain injury encompasses a broad spectrum of severity, but these share in common the potential to have a lifetime of impact upon patients. Whether dealing with the athlete sustaining a concussion to the comatose multisystem trauma patient, EMS professionals must be prepared to accurately and quickly assess, treat and transport to the most appropriate facility. The treatment modalities and technologies available to prehospital providers have evolved over the decades and continue to expand as research continues. Annually, 1.5 million patients are treated in US emergency departments for head injury. Among those approximately 52,000 will die of their head injury. The financial cost to society, patients and their families related to direct and indirect association with head injury over a lifetime can be overwhelming. As prehospital providers, rapid assessment and appropriate treatment may be able to limit the extent of injury and reduce the lifetime disability.