Since 1975, more than one thousand children with life-threatening injuries have been preferentially transported to our statewide Regional Pediatric Trauma Center by helicopter or city ambulance. Initial care is provided by emergency medical technicians with special instruction in the handling of pediatric trauma. More than half the children admitted to our service were injured in motor vehicle/pedestrian or motor vehicle/bicycle accidents. Have care and outcome improved? This system provides for excellent first aid at the scene and more rapid radio-directed transport to the trauma center where in hospital management is provided by pediatric and surgical personnel experienced in the treatment of all aspects of childhood trauma. We have organized weekly trauma morbidity and mortality rounds and have established a trauma registry and index of severity. Pelvic fractures from blunt trauma had a mortality in this series of 1.4%, the lowest of any reported experience. Between January 1976 and December 1979, 46 children with coma of longer than 24 hours' duration were treated in the Pediatric Intensive Care Unit. The mortality rate was still high (38%) but employing intracranial monitoring and aggressive control of brain edema, 88% of the survivors had a good recovery without major motor or intellectual defects. The large volume of cases allows for development and evaluation of new techniques in trauma management and invaluable experience in the training of general surgical residents, pediatricians, and emergency physicians.