The Advanced Trauma Life Support (ATLS) course, developed by the American College of Surgeons, has revolutionised in-hospital management of major trauma patients and is now accepted as a standard of care in many countries worldwide. However, within Europe, there are significant differences in both the aetiology of trauma and the specialties involved in its initial management compared to the American model. Over the past 4 years, there have been a number of initiatives aimed at producing a trauma management course that was evidence based, practical and flexible enough to meet regional European needs and team oriented. Initial attempts tried to incorporate both pre- and in-hospital trauma care. This was eventually rationalised to the production of an in-hospital course and the first pilot course was run in Malta in November 2006. This article describes the evolution of the course, its current structure and plans for the future following the feedback received from candidates and instructors who participated in the first course.