To avoid preventable trauma death(PTD), initial management, including resuscitation, is crucial in traumatic brain injury(TBI)care. PTD is defined as a case in which the percentage of probability of survival exceeds 50%, but the patient unfortunately dies without appropriate treatment. To diminish cases of PTD, a standardized approach has been established with several training courses and guidelines. However, 20% of all patients with TBI experience PTD. In our study, PTD cases accounted for 26.2% of all cases of so-called "talk and deterioration." Additionally, anti-coagulation/anti-platelet users comprised 26.8% of all PTD cases. Thus, to eliminate PTD, measures against anti-coagulants are important. Moreover, quick decision making regarding treatments preceding the rapid-changing pathophysiology is also essential in TBI care. In addition to securing airway management, providing oxygen support, and stabilizing circulation, timely administration of a neutralizer for anti-coagulative drugs and use of tranexamic acid(a drug for anti-fibrinolysis)is crucial. In this chapter, the pearls of initial TBI management are mentioned, with focus on the "first hour" of treatment.