Crossing the blood-brain barrier: neurotrauma in disasters and resource-limited settings

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in natural disasters, armed conflict, and other resource-limited settings, where advanced imaging, invasive neuromonitoring, and specialized neurosurgical care, common in high-resource environments, are often unavailable. This narrative review summarizes the global health impact of TBI in austere conditions and outlines key management strategies and ethical considerations relevant to these contexts. Evidence from civilian disaster responses, military conflicts, and global health guidelines highlight the need for adaptable, physiology-driven approaches that prioritize prevention of secondary brain injury through avoidance of hypoxia, hypotension, and uncontrolled intracranial hypertension. In settings with constrained resources, clinicians rely heavily on neurological examinations and local imaging capabilities for the initial diagnosis and management. Low-cost interventions, including hyperventilation, raising the head of bed, and hyperosmolar therapy are first-line measures in response to clinical deterioration, whereas damage control neurosurgery incorporating rapid hemorrhage control, hematoma evacuation, and infection prevention is reserved for severe cases with prolonged transport times. Neurotrauma in disaster and resource-limited settings remains a significant global health challenge. Meaningful improvements in survival and outcomes for patients with TBI can be achieved through early resuscitation, vigilant clinical assessment, and timely surgical intervention, even in the absence of advanced neuromonitoring. Adaptable, resource-appropriate strategies are essential to optimizing neurotrauma care in austere environments.