The state established the system in 1970, largely at the behest of the late R. Adams Cowley, who founded the Maryland Shock Trauma Center in Baltimore and is often described as the father of shock-trauma medical care in this country.

Cowley was best known for his theory of the crucial "golden hour" — an hour of opportunity in which he said the lives of severely injured people could be saved if they were treated by trauma specialists.
—Philip P. Pan, "The Sky's No Limit For State's Medevac," The Washington Post, February 26, 1998

Much of modern emergency medicine grew out of the field hospitals — celebrated in the "M.A.S.H." television program — of the Vietnam and Korean wars.

"Those MASH units are the predecessors of our modern-day trauma centers. The doctors in those units were saving people who would have died in World War II," Krentz said. "Then they came home and they saw that people were dying in the streets of essentially the same kinds of injuries."

Their experiences produced the concept of paramedics and nurses trained for critical on-the-scene treatment and constantly improving transportation times between injury and hospital, he said. Time is always the enemy because patients in or near shock can die if not treated within "the golden hour" after the injury.
—Robert Locke, "New Techniques Developed For Treatment Of 'Epidemic'," The Associated Press, January 18, 1982