Amidst the SARS-CoV-2 or “COVID-19” pandemic, the need for trauma care remains a critical public health responsibility. Anticipating augmentation of social determinants of violence, “end stage” presentations of surgical pathologies from delayed care, and demands on surgeons and surgical intensivists, readiness, adaptability, and leadership in trauma centers are paramount. This Surgical Perspectives centers around an urban, Level-1 trauma center’s experience in meeting the challenge to maintain trauma care access and capability during the COVID-19 pandemic.