The regulator of the emergency medical ambulance service is involved in the various steps of the initial management of severe head trauma patients: handling calls, basic life support, prehospital advance life support, transport and hospital admission. The management is rapid (helicopter transports) coherent and adapted (adherence to the guidelines for severe head injury), and considers of local difficulties (geographical, possibility of admission to trauma centres), with the aim of improving the outcome of severely head-injured patients.