Trauma is a leading cause of death and morbidity worldwide, with the impact being most severe on the young. In the United States, injury represents nearly 60% of all deaths in those 1–44 years of age and confers an estimated in $4 trillion in annual costs (Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) fatal injury data, 2019; Centers for Disease Control and Prevention. The economics of injury and violence prevention. https://www.cdc.gov/injury/features/health-econ-cost-of-injury/index.html ). The development of a trauma system to ensure access to complex and specialized life-saving care has been a major means of reducing these deaths. In this chapter, we discuss the advent of the American trauma system and ongoing gaps in trauma care.