As trauma is the leading cause of death for persons 1 to 24 years in Japan, the trauma system must be established to save lives and to reduce serious sequelae. However, the trauma system has not been evaluated since 2000. In May 2002, it revealed that the deaths of about 40% of expired trauma patients who arrived at emergency centers with some vital signs were probably preventable. This result increased the awareness of the need for establishing the trauma system. Then, the Japan Prehospital Trauma Evaluation and Care program for emergency medical technicians was developed, the doctor helicopter system was promoted, the Japan Advanced Trauma Evaluation and Care program for physicians was developed, and the trauma registry program was started. The extension of the procedures that can be performed by Japanese paramedics should be extended with the establishment of a medical control system. However, the key to securing quality regional trauma care is to designate a trauma care hospital as a trauma center and to transport severely injured patients there as rapidly as possible.