EPIC & Treating Traumatic Brain Injuries

Doctor Treating Brain Injury Patient

The human brain is a complex and fragile organ that controls how we think, feel, and connect to the greater world. Tragically, over 2.8 million Americans sustain mild to severe brain injuries each year. Many of these survivors suffer unique symptoms, including physical, cognitive, and behavioral side effects and disabilities. Traumatic brain injuries (TBI) are particularly devastating because they can result in permanent neurological damage.

In the past, many believed there was little prehospital care providers could do for patients with traumatic brain injuries. Fortunately, the University of Arizona, the Arizona Department of Health Services, and over 130 fire departments have developed a massive public health initiative called Excellence in Prehospital Injury Care Project, or “EPIC.” This project was originally funded by the National Institute of Neurological Disorders back in 2012. As of this year, over 11,000 paramedics and EMTs have been trained to treat patients with traumatic brain injuries.  

The “Three H-Bombs”

The EPIC initiative teaches first responders to treat and prevent the “Three H-Bombs” – hyperventilation, hypoxia, and hypotension – in emergency situations.

Patients with the following symptoms can benefit from the EPIC treatment program:

  • GCS of 14 or less
  • Loss of consciousness
  • Post-traumatic seizures
  • Multisystem trauma requiring intubation


Before EPIC, EMS was trained to hyperventilate TBI patients by placing an airbag over their mouths or directly into their windpipes. However, recent studies have proven that internal carbon dioxide levels fall during hyperventilation. In other words, the old method constricts the brain’s blood vessels (vasoconstriction) and deprives it of blood and oxygen, ultimately increasing patient mortality. Dr. Ben Bobrow, UA Distinguished Professor of Emergency Medicine, asserts that “the ‘golden hour of trauma is way too long for TBI. It’s all about the platinum 10 minutes.” After this short window of opportunity, brain cells start to die and can never be recovered.

Now, per EPIC, EMS is trained to use ventilation rate timers and pressure controlled BMVs. They also carefully monitor EtCO2 to keep it between 34-45 mmHg.


Cerebral hypoxia occurs when a patient’s brain tissue is deprived of oxygen. To prevent this scenario, first responders are taught to place high-flow oxygen on patients as quickly as possible. The EPIC program recommends keeping the SpO2 as close to 100% as possible through the early application of O2.


A single episode of prehospital hypotension – or low blood pressure – can double the mortality rate of patients with traumatic brain injuries. To prevent hypotension, prehospital care providers need to be extremely careful when administering pain medications and sedatives to patients. EPIC suggests an initial 1000 mL bolus followed by additional 500 mL boluses as needed to maintain systolic blood pressure greater than 90 mmHg.

The Future of Prehospital Treatments

Dr. Dan Spaite, a UA professor and the Virginia Piper Distinguished Chair of Emergency Medicine, was the lead author of the EPIC study, which evaluated 21,000 patients while adjusting for TBI severity. He believes that EPIC can save thousands of lives annually: “What EPIC found was that prehospital care is powerfully synergistic with critical care and surgical care in the hospital…We actually now have a vast implementation that shows not just incremental, but actually monumental changes, so the reality is this will probably – in the next 5 years this will probably completely change brain injury emergency care all over the world.”

The study found that patients who were treated with the new protocol before reaching a hospital survived at twice the rate of those who didn’t.

Schedule a Consultation Today

Contact the lawyers at the Scarlett Law Group if you require legal representation after an accident. Our award-winning legal team has over 25 years of experience and a history of recovering multimillion-dollar settlements and verdicts. Our principal attorney, Randall H. Scarlett, has dedicated his career to helping accident survivors recover compensation in brain injury cases.  If you’re ready to pursue justice and restitution, turn to one of the leading personal injury trial firms in California.

Contact the Scarlett Law Group at (415) 688-2176 to schedule a consultation today.

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