Illinois pioneered a regionalized trauma system in the 1970s that became the nationwide model for emergency medical services (EMS)/trauma systems. Yet the Illinois trauma system has changed little since the 1970s, and its policies are already outdated. Despite national trends of growing costs in health care, which put pressure on the system, Illinois has held onto an antiquated model and relied on the “goodwill" of hospitals to remain in the system. More recently, Maryland and Georgia have created trauma systems that consider trauma a “public service,” and losses incurred by trauma centers are fully compensated by the state. The objective of this paper is to consider how the Illinois trauma system could meet its original goal of providing quality care to patients in emergency situations while also becoming financially viable.