First Due Academy TraumaEMREMTAEMTParamedic

Head Injury (TBI) — Utah 2025 Protocol

Prevent secondary brain injury. Hypoxia and hypotension DOUBLE mortality in TBI.

Steps by Cert Level

ALL: BP target SBP >110mmHg — permissive hypotension does NOT apply to TBI. O2 target SpO2 >94%. ETCO2 target 35–45mmHg.
ALL: Assess GCS, pupils (unequal = herniation sign), motor deficits, mechanism.
PARAMEDIC: GCS ≤8 or inability to protect airway → intubate. RSI per airway protocol.
PARAMEDIC: HERNIATION SIGNS (Cushing's triad: HTN + bradycardia + irregular respirations, blown pupil, posturing): brief hyperventilation ETCO2 30–35mmHg only. Mannitol 1g/kg IV or Hypertonic saline 250mL 3% NaCl IV.