Introduction: Decompressive Craniectomies (DC) are a controversial treatment for increased intracranial pressure resulting from traumatic head injuries. The technique has been around for approximately 5000 years, but only now are researchers beginning to unlock its true potential. This article aims to summarize history, review current knowledge and identify the implications of pre-hospital emergency care.  Methods: An electronic search was conducted using the databases; Medline (via EBSCOHost), BioMed Central and Cochrane Database of Systematic Reviews.Results: 131 articles were identified. Articles that were excluded from analysis; those unavailable as full text, not available in English and review articles. 19 articles were included in analysis. Conclusion: Decompressive Craniectomies is a comparable treatment to alternative techniques. Until recently mortality rates have been misinterpreted and unfairly reported due to the severity of brain injuries patients had already suffered. Timing of DC is a crucial factor of patient outcome, and it is of popular belief that the best chance of optimal recovery relies on a reduced injury to treatment time.