The purpose of this review is to evaluate the current state and recent developments of trauma systems in Europe. The introduction of a pilot trauma system in the United Kingdom seemed to halve the mortality rate in 6 years. This improvement was thought to result, at least in part, from improved patient care. A comparison of United States and French trauma systems suggested equivalent outcomes among patients who survive to reach the hospital. Epidemiologic studies from Europe show an incidence of 30 to 52 per 1,00,000 per year of major trauma (Injury Severity Score above 15), the vast majority of injuries caused by blunt trauma. The total economic costs of traffic accidents in European countries vary from approximately 7,500 US dollars to 1,20,000 US dollars per injury. There is little original research on trauma systems in Europe, although some positive effects on mortality of trauma system creation are reported. The level of trauma system development in Europe shows great country-by-country variation. It seems to be in a more advanced stage in the central European countries and less developed in other countries, including the Scandinavian countries, the Baltic states, the United Kingdom, and the Mediterranean countries. In general, specialized trauma surgery training is more advanced in countries with a higher level of trauma system development.