Changing landscape of global trauma care In 2020, the World Health Organization (WHO) released a report entitled “Urgent Health Challenges for the Next Decade.” Developed by global health care experts, the report covers topics such as extreme weather conditions, conflicts, and unfair health care delivery. It also “reflects a deep concern that leaders are failing to invest enough resources in core health priorities and systems.”[1] This work echoed the Sendai Framework for Disaster Risk Reduction 2015–2030 which was adopted by United Nations (UN) Member States on March 18, 2015 at the Third UN World Conference on Disaster Risk Reduction in Sendai City, Miyagi Prefecture, Japan. The Sendai Framework outlined seven global targets to be achieved between 2015 and 2030.[2] 1. Substantially reduce global disaster mortality by 2030 2. Substantially reduce the number of affected people globally by 2030 3. Reduce direct disaster economic loss in relation to global gross domestic product (GDP) by 2030 4. Substantially reduce disaster damage to critical infrastructure and disruption of basic services, among them health and educational facilities, including through developing their resilience by 2030 5. Substantially increase the number of countries with national and local disaster risk reduction strategies by 2020 6. Substantially enhance international cooperation with developing countries through adequate and sustainable support to complement their national actions for implementation of this framework by 2030 7. Substantially increase the availability of and access to multi-hazard early warning systems and disaster risk information and assessments to people by 2030 The urgent necessity for these actions is due to health care system challenges resulting from more frequent and extreme natural and man-made disasters. Two events—the Indonesia earthquake and tsunami of 2004, and the 2010 Haiti earthquake—were among the deadliest natural disasters in human history. In addition, in 2005 Hurricane Katrina in the United States led to the deaths of more than 1800 people and displaced over one million. In 2021, over 2200 persons died after another Haiti earthquake; over 12,000 were injured.[3] Apart from natural disasters, experts predict innovative and more numerous terrorist attacks in the post COVID pandemic period.[4] Already there was an uptick in the number of terrorist activities from 2015 including: the London Bridge vehicular ramming, the Norway terrorist attack, the Paris attack, Brussels airport, Nairobi mall, and the Sri Lanka Easter Sunday multi-site suicide bombings. The prospect of more such attacks provides a grim picture of what the world will encounter in the future.[5] The rising tension among world superpowers with the recent conflict in Ukraine adds to the longstanding conflicts in Syria, Yemen, South Sudan, Mali, the Democratic Republic of the Congo, and Israel to name just a few. These wars and conflicts will result in mass migrations and greater burden to the health systems in neighboring countries. Today, Turkey is home to more than 3.6 million Syrian refugees, who constitute the vast majority of over 4 million refugees and asylum seekers currently living in the country, making Turkey the world's largest host of refugees.[6] Another WHO report also described more frequent attacks on health care facilities and workers in disaster and conflict zones prompting them to take special action. The report mentioned: “Nearly 1000 attacks on health care workers and medical facilities in 11 countries were recorded in 2019, leaving 193 medical staff dead. Despite stricter surveillance, many health care workers remain vulnerable.”[7] Along with these conditions and with changing population demographics, future trauma systems will need to cater to a more elderly population with multiple co-morbidities and rehabilitative challenges. A recent report from the British Orthopedic Association highlighted some of the challenges in this domain.[8] To begin designing how future trauma systems, especially in low- and middle-income countries (LMICs) could be developed, the current special issue on trauma in Emergency and Critical Care Medicine will profile 4 mature trauma systems with varying configurations and accomplishments. This special issue will also highlight pre-hospital trauma care systems in Asia and identify challenges for the future. Global trauma system diversity Mature trauma systems in North America, Europe, and Australia have proven to save lives and reduce morbidity following severe trauma.[9] Though the basic structure of these trauma systems are similar in pre-hospital, institutional, and rehabilitative components, there are major differences between each system in how trauma care is delivered.[10] In North America, pre-hospital services are provided by paramedics, while in some European countries, physicians run ambulance services. In Israel, the trauma care is fully integrated into a civilian-military system.[11] When considering that many countries lack standard trauma care systems, LMICs are challenged by the lack of support and massive funding needed to establish and maintain such systems. With this backdrop, we call for the development of safe, efficient, affordable, and sustainable trauma systems for LMICs. Need for research platforms representing the true burden of trauma worldwide Although a great deal of research emanates from mature trauma systems, there is a dearth of published research from LMICs. The reasons for this are multifactorial and include the lack of political will, policy and governance, financing, and stakeholder perceptions to mention a few. If trauma care delivery is to be increased for a greater majority of the world's population, there should be more robust research from LMICs where 90% of the world's trauma burden exists. We believe greater research output can be achieved through partnerships between high-income country academic centers and LMIC health institutes supported by a global body connecting, facilitating, and advising on focused research activity. Model future trauma systems With evolving global economic and geopolitical systems and a changing climate, future trauma systems must be dynamic. New trauma systems must evolve according to the needs and resources on the ground and be driven by input from local experts. Systems that work best in one context may not do so in another. Also, systems that work best now may not deliver the same level of excellence in the future without incorporating dynamic changes into current health care systems. Conflict of interest statement The authors declare no conflict of interest. Author contributions Ratnayake AS, Li Y, and Kushner AL wrote the paper. Funding None. Ethical approval of studies and informed consent Not applicable. Acknowledgements None.