Is there an indication for pre-hospital trepanation in patients having a TBI?

Traumatic brain injury (TBI) can be a severe injury. In case of a severe traumatic brain injury the patient should arrive in a trauma center within 60 minutes. Computed tomography scan of the brain has to be performed quickly in order to assess the extent of intracranial injury. In case of posttraumatic unconsciousness, direct transport to a trauma center with neurosurgical care is recommended. If required after the computed tomography an operation should be performed. Glasgow-Coma-Scale (GCS) under 9, intubation and ventilation should be performed. Sometimes there is a discussion if pre-hospital trepanation or exploratory burr hole should be performed. The authors illustrate with clinical cases, that there is no indication for pre-hospital trepanation in military missions or in the civilian emergency medical service. Trepanation without diagnostic is life-threatening for the patient. Critical bleeding of the scalp must be stopped in pre-hospital settings.