Abstract <p>Hybrid operating rooms have been increasingly adopted in trauma centers to enable integrated surgical and endovascular care in hemorrhagic emergencies, but practical guidance on their operational implementation from the interventional radiology perspective remains limited. We describe our experience implementing a trauma hybrid operating room at an American College of Surgeons-verified Level I trauma center, addressing room design, zoning for rapid transitions between laparotomy and angioembolization, a mobile supply cart, and a pre-embolization checklist. We outline a training approach centered on radiation safety, sterility during procedural transitions, and simulation-based interdisciplinary coordination and discuss key implementation challenges, local activation criteria, and strategies to ensure timely access. This report focuses on operational design; institutional process metrics and clinical outcomes were not included. However, these operational lessons may be relevant to other centers seeking to develop or refine trauma hybrid operating room programs.</p> Graphical Abstract <p></p>