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Objective: To determine whether improvement in the care of victims of major trauma could be made by using the revised trauma score as a triage tool to help junior accident and emergency doctors rapidly identify seriously injured patients and thereby call a senior accident and emergency specialist to supervise their resuscitation., Design: Comparison of results of audit of management of all seriously injured patients before and after these measures were introduced., Setting: Accident and emergency department in an urban hospital., Patients: All seriously injured patients (injury severity score greater than 15) admitted to the department six months before and one year after introduction of the measures., Results: Management errors were reduced from 58% (21/36) to 30% (16/54) (p less than 0.01). Correct treatment rather than improvement in diagnosis or investigation accounted for almost all the improvement., Conclusions: The management of seriously injured patients in the accident and emergency department can be improved by introducing two simple measures: using the revised trauma score as a triage tool to help junior doctors in the accident and emergency department rapidly identify seriously injured patients, and calling a senior accident and emergency specialist to supervise the resuscitation of all seriously injured patients., Implications: Care of patients in accident and emergency departments can be improved considerably at no additional expense by introducing two simple measures.