Donald D Trunkey (universally known as just ‘Don’) was made an honorary fellow of the Royal College of Surgeons in 1986. This accolade was bestowed on him not for his prowess in surgical technique, nor for advancing fundamental research in the laboratory, although he was adept and productive in both these areas, but for what would today be called health services research. His investigation of the need for speedy delivery to injured patients of high quality surgical services prior to and on arrival at accident and emergency centres revealed huge inadequacies in treatment both in the USA and worldwide. His recommendations for improving the delivery of such services have been widely adopted and have saved countless lives. For this he has been called ‘the father of organised trauma care’. The summarised record of his achievements between 1970 and 2015 is held in the archives of the Oregon Health and Sciences University and fills 74 pages. He was born on 12 June 1937 in Oakesdale, Washington State, the son of Doug Trunkey, a blacksmith and machine shop owner. His initial education was at St John’s High School, where he was a valedictorian. He studied medicine at the University of Washington, qualifying MD in 1963, following which he undertook a rotating internship with J Englebert Dunphy at the University of Oregon. He then spent two years in Army service in Germany, during which time Dunphy moved to San Francisco to head their trauma services. At the end of his Army service, Don returned to again work under the supervision of Dunphy in San Francisco. Increasingly he felt committed to a career in academic general surgery with a major interest in trauma surgery. To consolidate this, he spent a year as a National Institutes of Health fellow with Tom Shires in Dallas, undertaking basic science research into trauma. He rose to become chief of surgery at San Francisco General Hospital, a position he held for eight years, subsequently returning to Oregon in 1986, where he established their trauma system. It was during this time that Operation Desert Storm occurred in the Middle East and he volunteered to head the surgical services of an Army hospital in Saudi Arabia, where he applied his critical thinking to improve the management of war injuries amongst the soldiers. He became the McKenzie professor and chair of surgery at Oregon Health and Science University in 2001. His career as a pioneering academic trauma surgeon, whose research into systems of delivery of trauma care services were to give him an international reputation, took off during his time in San Francisco, where he was soon challenged by the apparent disparity in outcome following injury in the then two systems of care for injured patients in San Francisco and its neighbour Orange County. Trunkey and his colleagues J G West and R C Lim looked at the death rates from motor vehicle accident injuries in these two adjacent counties with similar populations but widely different geography and health care delivery. San Francisco County was a densely populated urban community with hospital accident and emergency services provided by a single large university hospital. Orange County, in contrast, had 31 hospitals providing such services in hospitals scattered throughout the county. The revolutionary finding of the studies was that two thirds of non-central nervous system related deaths and one third of central nervous system related deaths from injury were judged to be preventable in Orange County against one such death in San Francisco. The research was published in *Archives of Surgery* in 1979 and aroused major interest in the USA and subsequently in the UK (‘Systems of trauma care. A study of two counties.’ *Arch Surg*. 1979 Apr;114[4]:455-60). On the basis of these findings, Trunkey and his colleagues called for the centralisation of such cases into trauma centres. In the UK, the concept of such management was not entirely unknown as Eugene Hoffman in his 1976 Hunterian lecture recommended ‘major injuries should be admitted only to units where experienced resuscitation and surgical teams can treat them immediately’. Trunkey was appointed the *British Journal of Surgery* travelling fellow in 1987, hard on the heels of Graham Hill, who held the fellowship the previous year and had stated in his report ‘some way should be found to establish trauma centres within regions and to transport severely ill patients to them’. Trunkey’s report was devastating: ‘In general trauma care is fragmented, disorganised, and has an unacceptably bad outcome. Pre-hospital care of the accident victim is sub optimal. The patient is usually taken to the nearest hospital without regard to surgical availability.’ Faced with such opinions, it was predictable that in 1987 a report would recommend: ‘there is a need to review and concentrate services for trauma’. Whilst this was taking place the Royal College of Surgeons, under the auspices of its Commission on the Provision of Surgical Services, produced a working party report on the management of patients with major injuries (*Commission on the Provision of Surgical Services. The Management of Patients with Major Injuries.* London, The Royal College of Surgeons of England, 1988). Contained in this report were the results of UK studies of preventable deaths with methodology similar to that used by Trunkey, West and Lim. The results were published in the *BMJ*, showing near identical findings and led to the tardy but effective introduction of trauma systems used in the United Kingdom today (‘Retrospective study of 1,000 deaths from injury in England and Wales.’ *Br Med J [Clin Res Ed]* 1988;296:1305). Another aspect of Trunkey’s work was his criticism of the US health services, expressed in papers with titles such as ‘Dysfunctional care in a dysfunctional healthcare system’ (2006). He was a critical friend of the NHS and expressed his views in a paper with the intriguing tile of ‘The medical world is flat too’ (*World J Surg*. 2008 Aug;32[8]:1583-604). Given he was such an outstanding academic surgeon, it will be asked why he wasn’t awarded the distinction of being president of the American College of Surgeons (ACS). The intriguing answer is to be found in an interview with Frederick Luchette published in *The American Association for the Surgery of Trauma 75th Anniversary 1938-2013* (Chicago, Illinois, The American Association for the Surgery of Trauma, 2013). In 1980, Don was appointed to the American College of Surgeons’ committee on trauma, a body which he felt was dysfunctional. In trying to modernise it he fell foul of the board of regents in general, and the executive director of the college in particular, whom Don described as ‘a control freak’. As a result, he was disciplined by the board and told that he would never hold office in the ACS and never serve on the board of governors, and so it remained. However, Trunkey continued working hard to get the ACS committee on trauma to change, particularly in relation to seeing ATLS (advanced trauma life support) established and subsequently be translated into other languages and disseminated worldwide. The beneficiary of this was the Royal College of Surgeons: an instructor course was held in the College in 1988, the first ATLS instructor course held outside the United States. However, Don’s career continued to flourish and he received numerous accolades, including the presidency of the American Association for the Surgery of Trauma (in 1986). Most notably, in 2009 he was made president of the American Surgical Association, the most prestigious appointment for an American academic surgeon. The year before, in 2008, he and Basil Pruitt, an American burns surgeon, jointly received major recognition for their services to trauma victims by being given the King Faisal international prize. Don was also made an honorary member of the British Association for Accident and Emergency Medicine. Donald Trunkey, in addition to being a notable surgical academic, was a widely read and cultured man with whom it was a delight to converse. Throughout his professional life, he was supported by his indomitable wife Jane (née Henry) and their two children – Derek and Kristi. They, and his surgical admirers across the world, were delighted when the American College of Surgeons relented and in 2018 honoured him and his life’s work with the rarely awarded title of ‘icon in surgery’. He died on 1 May 2019 in Post Falls, Idaho at the age of 81.