Background In the context of recent emphasis on developing trauma care systems globally, a Pan-India trauma care system is getting ready. Given the well known regional disparities in health systems in India, evaluation of its parts (states) becomes important if the sum of the parts (the Nation) needs to develop a system in an equitable way. Trauma System Maturity Index (TSMI) and other guidelines by WHO, along with Geographical Information System (GIS) provides an opportunity for such evaluation and evidence based policy making.

Methods A cross sectional analytical study was done to grade trauma care system maturity of 10 representative states in India. Four major components of trauma system were assessed, including pre-hospital care, education and training, facility based trauma care and quality assurance; using a structured schedule prepared in line with WHO TSMI and 7 major guidelines for trauma care by WHO. In addition to this, GIS based analyses were done to assess the geographical distribution of trauma care facilities. The GIS data was analysed using ArcGIS version 9.1 and data for TSMI analysed using SPSS version 17.0.

Results While most of the state trauma care systems were graded level 2 for prehospital care and quality assurance, almost all systems graded 1 for facility based trauma care. Host of variables within the components were analysed and critical areas were identified where in small initiatives would evolve the trauma system to next level of maturity grading. GIS based analyses showed that even with in the states the access to trauma care services is alarmingly inequitable. Better grade in TSMI translated as better outcome in terms of trauma related mortality.

Conclusions The trauma care systems in different states are in diverse phases of evolution and their TSMI grade reflects their system performance. Study also projects successful examples which can be adapted by other states and countries with similar policy environment.