The Neurosurgical Society of Australasia through its Trauma Committee has a long involvement in the problem of neurotrauma. The management of acute neurotrauma in rural and remote locations is of particular interest and is part of a general policy which includes education, prevention, organization of an integrated neurotrauma system and support for the Early Management of Severe Trauma (EMST) programme instituted by the Royal Australasian College of Surgeons. The management of acute neurotrauma requires a consultative approach especially in the multiple injured patient and where transfer or retrieval is necessary. As acute neurotrauma may present to general practitioners, rural surgeons or emergency departments in country hospitals, a set of guidelines has been developed to assist in the early management of acute neurotrauma. These guidelines have been previously published by the Neurosurgical Society of Australasia and the Royal Australasian College of Surgeons. They have been extensively used since 1992 by rural health and distance education groups, Royal Flying Doctor Service Emergency Management of Severe Trauma Course of the Royal Australasian College of Surgeons and by overseas education programs for neurotrauma care. This revision updates the guidelines and makes them accessible through the Journal. Reprints are available for practitioners in rural and remote settings, trauma course participants and others. Copyright 1999 Harcourt Publishers Ltd.