Injuries are an important cause of mortality and morbidity. Although accidental injury rates have been declining throughout the twentieth century in the UK, this pattern has been variable. For example, in young adults aged 15-24 years there has been no improvement and, when deliberate injuries are included, the picture is worsening. Although there is little evidence that road traffic accident case fatality rates have been improving, there is some evidence that improvements in trauma care have been responsible for reducing injury death rates in children. Thus, although there have been considerable successes in the primary prevention of accidents, and the secondary prevention of injuries in accidents, there is an important role for tertiary prevention, that is in the prevention of avoidable outcomes through good trauma care.