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During the 2019 Annual STACS Conference, Dr. Bellal Joseph, MD FACS Professor & Chief of Trauma and Acute Care Surgery presents an emerging necessity to identify when to call for neurosurgeon intervention versus an acute care surgeon with patients presenting Traumatic Brain Injury symptoms. Dr. Joseph highlights the severe shortage of neurosurgeons nationwide along with the increased prevalence of TBIs. Traumatic Brain Injuries (TBIs) are a silent epidemic and the number 1 killer in trauma care. Dr. Joseph discusses previous studies that showed that 90% of TBIs are non-operable and could be managed by acute care surgeons. This would not only reduce hospital costs for both the patient and the hospital but also minimize the waiting period for the patient. Dr. Joseph introduces the Brain Injury Guidelines (BIG) which categorizes TBIs into 3 categories to help identify which patients truly require the intervention of a neurosurgeon and which could be handled by the first available staff member.