In the past two years several guidelines for suggested components of emergency medical systems for children have been suggested, and for the first time, specific standards of pediatric trauma care have also been formulated. The American Academy of Pediatrics new Provisional Committee on Emergency Medicine has been charged with the responsibility of developing national standards of emergency care for children and are currently at work on such a landmark document. We have had a functioning statewide system for the management of life threatening injuries in children for the past 10 years. In 1985, 320 children were admitted to our trauma center. The evolution, organization, and current status of the Maryland system is described in this report. Hopefully it may serve as one successful model which could be modified for use in other regions of the country.