Trauma has become the leading cause of death in Americans age 50 years and younger, with the largest increases in trauma deaths over the past 2 decades noted among baby boomers and millennials.1
From 2000 to 2020, there was a 91% increase in trauma mortality in the US, rising to 268,926 deaths, and far outpacing the 17.8% population growth during that same time. Although motor vehicle mortality rates fell, deaths due to firearm-related injury, poisoning, and falls rose.1 In 2017, for the first time in modern US history, firearm-related deaths surpassed motor vehicle crash deaths.2
“Rates of penetrating trauma, gun violence, and stab wounds are going up,” said Megan Quintana, MD, FACS, a trauma surgeon at George Washington University Hospital in Washington, DC. “We saw a huge increase in our hospital after COVID—a lot of hospitals did—and it hasn’t returned to pre-COVID rates.”
Globally, an estimated 4.4 million people annually die from unintentional or violence-related injuries, one in three from road traffic injuries. For individuals aged 5-29 years, three of the top five global causes of death are related to trauma.3
“As infectious disease mortality has declined, trauma—particularly firearm violence and injury—has assumed a growing share of youth mortality,” said Joseph V. Sakran, MD, MPH, MPA, FACS, a trauma surgeon at Johns Hopkins Medicine in Baltimore, Maryland. “In the US, rising youth trauma is fueled by high firearm access, increasing mental health challenges, and systemic gaps in prevention and trauma care.”
Young Americans (1-19 years) are 18 times more likely to die from trauma than their peers in comparable high-income countries, due to a higher incidence of firearm and motor vehicle crash deaths in the US.4
Surgeons have long been leaders not only in treating trauma victims, but also in helping develop trauma systems, shape public policy, launch community and prevention programs to improve trauma outcomes, and/or help prevent or reduce trauma. Emerging science highlights the critical role clinicians play in prevention efforts.2 But much more needs to be done, and surgeons are urged to double down on their efforts inside and outside of the trauma bay.
New Source of Trauma
A growing cause of trauma injury among young people is the increased use of micromobility devices, such as e-scooters and e-bikes. Contusions, abrasions, fractures, and even deaths have spiked due to the ubiquitous availability of these vehicles.5
“Micromobility devices are a huge problem and are only getting worse,” Dr. Quintana said.
Given the nature of these “grab-and-go” devices, riders typically do not wear helmets and may know little about how and where to safely operate the vehicles, she said, arguing that these devices need to have their own injury codes to generate the data needed to address the problem through injury prevention, education and, potentially, regulations.
"Golden Hour"
“Trauma care must happen at a system level because of the nature of trauma, its unexpectedness, its devastation, its time dependence, and its multifaceted impact,” said L. J. Punch, MD, FACS, a trauma surgeon and medical director of Power4STL, a nonprofit organization committed to reducing the impact of trauma in the St. Louis, Missouri, region.
The “golden hour” is the time during which prompt medical intervention following a severe injury significantly improves survival chances and reduces long-term complications. It has played a crucial role in the evolution and function of trauma systems.
“Patients with life-threatening injury have the highest survival chances when they receive definitive surgical care within the first 60 minutes of injury,” Dr. Sakran said. Rapid assessment and interventions, such as airway management, hemorrhage control, and fracture stabilization during this window of time, can reduce death.
The term “golden hour” was popularized by a trauma surgeon named R. Adams Cowley, MD, FACS, founder of the University of Maryland Shock Trauma Center in Baltimore. He also developed an organized approach to trauma care that included a network of trauma centers, transport services, and enhanced communication that made Maryland a standalone model for delivering trauma care, Dr. Punch said.
The US trauma system grew out of a military-civilian medicine partnership. Its continued development, including creating verification requirements necessary for various levels of trauma centers, has been guided by the ACS Committee on Trauma (COT), among other organizations.
Yet, the full potential of a national trauma system with seamless sharing of data, best practices, and continuous improvement across military and state-based civilian systems has yet to be realized. The development of a US trauma system remains a patchwork of care with limited federal ownership.6
In an effort to ensure standardized, high-quality trauma care for all, surgeons are leading the effort to create a National Trauma Emergency Preparedness System (NTEPS) that would establish a trauma care infrastructure to manage the daily injured population in the US along with mass casualty events.7 Read more about the role of surgeons in supporting an NTEPS in the May 2025 Bulletin article, "All Surgeons Can Help Advance a National Trauma and Emergency Preparedness System."
“Building trauma systems—from the state level up to a national framework like NTEPS—creates a more standardized, equitable emergency care network. This network ensures that patients get the right care, in the right place, at the right time—ultimately helping to prevent avoidable deaths,” Dr. Sakran said.
In addition, Dr. Sakran and Dr. Quintana support the COT’s work on Regional Medical Operation Command Centers (RMOCCs).
“RMOCCs embody a civilian adaptation of military coordination frameworks,” Dr. Sakran explained. “By managing patient movement, aligning resources, and connecting critical care partners across the region, RMOCCs form the backbone of a resilient trauma response system.”
Filling the Gap in Post-Trauma Care
Surgeons are leading the effort to fill another gap in the trauma system—the lack of outpatient care after trauma patients leave the hospital.
“They have a ‘minor injury’ physically, so they don't need inpatient stay, but then there's frequently no dedicated aftercare in the outpatient setting,” Dr. Punch said.
According to Dr. Quintana, one example of this gap in the system is a low rate of return to clinical care for people who are discharged from the emergency department. In addition, patients often lack the knowledge or financial resources to pursue follow-up care, including physical therapy.
“The overall system is failing our patients,” she said.
Also, between 60% to 70% of people with “minor” gunshot injuries are sent home but do not return to work for physical or mental health reasons, Dr. Quintana shared.
“There’s a gap between the tremendous lifesaving care happens in the trauma center and the feeling of abandonment that comes when someone leaves the hospital,” Dr. Punch said, adding that patient-centered spaces for outpatient trauma are needed to provide care and track the long-term outcomes of trauma care.
“We need to not just save someone's life, but to make sure they heal,” he said. “That is how we prevent and reduce some of the trauma we're seeing in youth.”
Bullet-related injury affects the physical, emotional, social, and spiritual aspects of not only the patient but the people who love them, Dr. Punch explained. Sometimes the physiological, emotional, and social response to trauma can be worse than the physical injury—which is why care should extend to others besides the trauma patient.
This type of care is the focus of the Bullet Related Injury Clinic (BRIC) in St. Louis, Missouri, founded by Dr. Punch in 2020. The BRIC bridges care between emergency services and long-term trauma recovery for those suffering from bullet-related injury and includes support for guardians and caregivers.
BRIC was initially set up to treat the pain and wounds of people discharged from the emergency department on an outpatient basis. Now it's a “wraparound holistic care center in which the predominant service that's provided is actually mental well-being care,” Dr. Punch said.
The clinic has had more than 2,000 referrals, 950 successfully enrolled and treated patients, more than 200 bullet removals, and more than 5,500 visits.
Education Is Critical
Trauma care education includes programs such as the ACS Advanced Trauma Life Support® (ATLS®) program, which teaches physicians and other care providers a systematic, concise, safe approach for treating trauma patients. Community-focused education programs, such as ACS Stop the Bleed, also play an essential role in trauma care training.
“The ACS suite of education programs that informs community members, first responders, community surgeons, academic surgeons, and others on best practices has saved millions of lives,” Dr. Punch said.
Through the Stop the Bleed program, surgeons have empowered individuals to respond to bleeding emergencies, teaching basic bleeding control techniques like applying pressure, packing wounds, and using tourniquets.
“There's a medical component and a first-responder component that have revolutionized the management of bleeding, which is the leading preventable cause of trauma-related death,” Dr. Punch explained.
In July, the program reached the milestone of equipping 5 million people worldwide to help control bleeding and bridge the gap between injury and professional medical help.
Surgeons also get involved in multidisciplinary education efforts within their own hospitals, Dr. Quintana noted. For instance, she helped create a trauma skills curriculum for her hospital, including hands-on skills and discussions of traumatic brain injury, damage control resuscitation, thoracotomies, chest trauma, and other topics.
