Acute neurological issues in the austere/military environment

PURPOSE OF REVIEW: Substantial effort has been put into research and development to advance traumatic brain injury (TBI) care in tertiary care facilities, but the largest volume of TBI worldwide is unquestionably managed initially in the far-forward, austere environment with resource constraints. RECENT FINDINGS: Proper diagnosis of the underlying lesion in the absence of CT is a significant hurdle to providing targeted interventions in austere TBI, but adjunct diagnostic devices, such as quantitative pupillometry, near-infrared spectroscopy, optic nerve sheath ultrasound and trans cranial doppler ultrasound are allowing for enhanced diagnostic capability in the austere setting. SUMMARY: Treatment nihilism is present in cases of severe TBI even in highly resourced environments. It is likely that this is even more prevalent in far-forward, austere environments. There are diagnostic aids and interventions that are possible in austere severe TBI, and the critical care provider in this setting may be able to diagnose the underlying pathophysiology and render life-saving care until transport to a higher level of care is available.