Background: – A lot of patients of head injury are transferred to tertiary care centres for management by neurosurgeons. They are evacuated either by road or air. Many a time these patients arrive in a clinicoradilogical deteriorated state. Methods: – All patients of moderate and severe head injury that were transferred in from peripheral hospitals for management by Neurosurgeon between Jan 2017 to Dec 2017 were analyzed for their clinical status at the time of evacuation to their clinical status on arrival. Results:– 20 patients deteriorated, 19 required intervention, one was already intubated and his CT showed only increased edema, of the 19, 11 required surgery, 03 re–surgery, 5 required intubation and no surgery. Conclusion: – Neurosurgeons are not available at all hospitals thereby leading to the early evacuation of the patients. The frequent movements and travelling either by road or air can have fluctuations in the ICP and hypoxia/hypotension/hyper–hyothermia during travelling can aggravate secondary insult to brain. Although what effect these ICP fluctuations have on the brain is not confirmed but these are better avoided.