After stabilization an optimal therapeutic strategy influences outcome in polytraumatized patients. A trauma team leader in early clinical course is necessary to optimize diagnostics and planning of further treatment. Special training systems like ATLS can help to standardize management of trauma patients. In most German trauma centers an orthopaedic trauma surgeon is the team leader in the emergency room during early clinical course of patients with multiple injuries. After identification of most threatening injuries he must decide next diagnostics steps and planning of further treatment within a short period of time. Especially in patients with abdominal bleeding and severe brain injury time is the most critical factor. If he is not able to treat these injuries alone, physicians from other specialties must be involved. The trauma team leader must be aware of different treatment concepts like early total care and damage control orthopaedics.