One of the earliest exercises was developed by a cooperation between the University of Washington (USA), Seattle and the ALAS Foundation in Argentina, developing a protocol of care for the management of TBI without ICP monitoring, as part of the Best-Trip trial. This study was published in 2012 and the non ICP arm of the study was managed under an imaging/clinical exam protocol build on a consensus of Latin American experts (mostly ICU physicians) through a Delphi method. This protocol was based on a three tier therapy approach ranging from basic ICU management to last stage rescue therapies such as barbiturate sedation or hypo-thermia [16].