Traumatic brain injury (TBI) is responsible for causing global deaths exceeding 1.27 million per year. Various aspects of traumatic brain injuries have been studied worldwide in order to reduce the mortality and morbidity statistics. One such strategy has been to manage these patients at the scene of the accident itself. This pre hospital strategy has been shown to reduce the mortality in severely head injured patients. The pre hospital “team” consists of paramedics, nursing personnel and occasionally clinicians who are trained in resuscitation as well as managing initially the traumatic brain injury. Though definitive treatment for TBI is started in the intensive care at the trauma unit, primary management of these patients at the accident site itself has its advantages. This article reviews the current practices, pros and cons and the future directions in pre hospital care for TBI.