The trauma system in the United States is in the process of evolution. Although it is recognised that a systems approach to trauma care is ideal, this concept has yet to be realised fully due to political, financial and geographic considerations. The pre-hospital controversies of in-the-field care, resuscitation, and transport are still debated. In-hospital care is governed by a trauma service using the guidelines of the American College of Surgeons (ACS). Speciality care is usually delivered as a consultative service at the request of the trauma service. Co-ordination by the trauma surgeon assures appropriate timing and amount of care by the specialities. Problems facing the delivery of trauma care are malpractice, reimbursement for speciality trauma care call and the need to extend the system to all trauma patients.