Severe head injuries are a real public health problem because of their frequency and potential severity. The objective of this study was to evaluate the degree of application of the recommendations for the control of ACSOS during the prehospital management of severe head trauma by the interventional physicians. Sixty (85.7%) of the ACSOS accessible in the pre-hospital setting (PAS, PAM, SpO2, GAD, temperature) were controlled by the SMUR teams, 10 (14.5%) ACSOS accessible in the pre-hospital setting (PAS, PAM) were not controlled by the SMUR teams.The reduction of morbidity and mortality in severe head trauma requires the medicalization of pre-hospital management, the main objective of which is to control secondary cerebral aggressions.