Traumatic brain injury (TBI) and acute spinal cord injury (ASCI) are uncommon in MWDs. These injuries are often catastrophic, with poor long-term outcome. Caring for affected MWDs is daunting and can tax resources. However, some CNS injuries are recoverable, so efforts to evaluate MWDs with TBI and ASCI should be made to determine the severity of injury and potential for successful outcome. Anticipate these injuries in MWDs exposed to building collapses, blast, and ballistics injuries.