Abstract
Evolution is a process of continuous change in which a concept or idea transforms into a different but typically more complex and sophisticated form. The Maryland Trauma System, from its beginning with one man and his vision to its current incarnation as a statewide trauma system, continues to set the global standard of clinical excellence and cutting-edge care for the severely injured and critically ill. The key component in maintaining this level of sophistication is achieved through strong collaborative relationships. As the Maryland Trauma System faces the ever-increasing challenges of health care, these established relationships and new ones on the horizon will be vital to continue the legacy of Dr R Adams Cowley. This article addresses the evolution of a vision and its implementation, the critical elements necessary to create a statewide system and charting the course through future challenges.