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A core tenet in the care of patients with brain injury is prevention of secondary brain injury. In the immediate postinjury period, the patient’s physiology must be carefully managed to adequately perfuse and oxygenate the brain. Maintaining optimal oxygenation, ventilation, blood pressure, and temperature is critical to maximize patient outcomes. 1 Even a single instance of deviation from the optimal ranges can lead to additional irreversible brain injury and increase the risk of death. We know the data, but historically have had difficulty changing practice to achieve these targets. How can trauma systems manage patients with brain injury in a way that ensures these physiologic evidence-based goals are met? The trauma care continuum takes place in a series of taskand decision-dense environments. Decisions should be driven by data and we should use a learning health-care system designed to provide evidence …