In the USA, the leading cause of death in those younger than 45 years is trauma, accounting for over half of deaths in that age group. Trauma costs the USA up to US$600 billion each year and yet despite these sobering figures this epidemic goes largely unrecognised. Last week, at their 2016 Clinical Congress, the American College of Surgeons (ACS) announced a commitment to achieving zero preventable deaths from trauma. If realised, this goal would save one in five civilians and a quarter of military personnel currently killed by trauma, an estimated 30 000 lives per year in the USA alone. “The trauma network is highly geographically variable, and where you are in the country determines how likely you are to survive and do well”, trauma surgeon Robert Winchell told the Congress. States prioritise and fund trauma to different levels—for example, there are no consistent national protocols for pre-hospital care.