The treatment of severely injured patients is a challenge for preclinical and clinical treatment concepts, causing financial aspects of increasing importance for the German health care system. A total of 32,500 polytraumatized patients (PTS III and IV) are managed in trauma center levels I-IV in Germany. Trauma center levels I or II are by definition capable of supporting the full range of treatment for the severely injured. With the baseline calculation of 64,000 DM per patient and 104 polytrauma treated per year in the Berlin Virchow Clinic, 6.66 million DM primary costs must be spent for treatment. The total annual costs of this center are nearly 24 million DM for emergency cases and 7 million DM fixed costs per year, for a trauma center level I. In Europe the distribution of trauma center levels I or II is sufficient and can be specified with 1 center per 1 million inhabitants. Nevertheless, the european air medical service could support more intensive use of these central trauma institutions. This was shown by comparing the number of polytrauma patients and the number of trauma centers. Less then half of these patients are treated in levels I or II trauma centers. The financial pressure on the health system and the rising quality must lead to better utilization of trauma centers. To meet this goal a annual treatment rate of 300-400 polytrauma patients should be aimed at. The claim of the American College of Surgeons that a trauma surgeon should treat 50 severely injured patients per year would then be possible.