For some time, Victoria has been a significant leader in the development and implementation of innovations to improve the care and outcomes of major trauma patients. To achieve the world-class trauma system that exists in Victoria today, a ministerial taskforce was established in 1997 to provide advice to the State Government on a best practice model that would be responsive to the needs of major trauma patients. This taskforce undertook a review, with extensive consultation and provided recommendations for a comprehensive and integrated system of trauma management. The Review of the Trauma and Emergency Services 1999 (RoTES) report led to the VSTS being established in 2000. The ROTES Report found that improvements to reduce trauma morbidity and mortality could be achieved by enhancing trauma patient management at all stages4. The RoTES report made more than 100 recommendations, which provided a framework for an integrated system of care for major trauma patients. Today, implementation of these recommendations is substantively complete. Since its implementation the VSTS has continued to evolve and adapt to improve the delivery of trauma care. The system is subject to a process of continuous improvement through outcomes measurement, monitoring, analysis and reform. Information from the Victorian State Trauma Registry is regularly used to review system performance and inform system improvements, new policy initiatives and trauma prevention project work5.