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Alistair Nichol explains the use of hypothermia in the treatment of traumatic brain injury (TBI). TBI is a major cause of mortality and long-term morbidity. It leads to terrible outcomes and is a major cause of health burden across the globe. Prophylactic hypothermia presents a promising treatment to address this hidden epidemic. The pathophysiology of TBI is exceedingly complex. Evidently, one drug will likely not be the answer. This leads Alistair to discuss hypothermia as a treatment for TBI, which has huge potential benefit. As Alistair explains, it acts in many different places, in many ways, across many time periods. Could this be the ‘drug’ to give? The questions then become, when should you give it, how should you give it and how low should you aim? Alistair recommends inducing hypothermia as early as humanly possible. In the case of TBI, this means at the roadside if practical. How low should you go? Given the effect of hypothermia on coagulation, and the propensity for trauma patients to bleed, this