Injury is one of the most common causes of death and hospitalisation of children older than 1 year. Appropriate and timely trauma care is needed for injured children. This project considered the whole trauma care system in New South Wales, beginning with pre-hospital identification of the severely injured child. It determined how each care process contribute to a child’s trauma journey and health and quality of life outcomes. The resulting empirical evidence will accelerate the design of methods to implement and evaluate sustainable strategies that will improve paediatric trauma care and health outcomes. The specific aims are to: 1. Systematically evaluate existing paediatric care pathways from time of injury to definitive care and their impact on health outcomes. Specifically: a. patient health-related quality of life at 6 and 12 months post-injury; b. the appropriateness of the processes and delivery of care; c. health service delivery costs and the relative costs of different modes of pre-hospital and inter-hospital patient transport – rotary, fixed wing, and road; 2. Identify and prioritise aspects of the paediatric trauma care system that require change, and develop recommendations and a strategy to implement effective, acceptable, feasible change; 3. Implement the strategy; 4. Evaluate the impact of the implemented changes on select patient and health service outcomes.