Trauma care in North Queensland has significant challenges, owing to the vast geographical distances (48.6% of major traumas are transferred from other health services) and delays to trauma care as well as the unique demographics of our population (16.4% of these trauma patients are indigenous). The establishment of a trauma centre in Townsville University Hospital (TUH) has allowed for the centralisation of the care of major trauma in the region. This paper aims to provide an insight into the type, severity and volume of major trauma seen in North Queensland as well as present a case of the management of major liver trauma in the region. An 18 year-old female was stabbed multiple times in right thoracoabdominal region resulting in significant injury to right side of the liver. The patient was brought into a peripheral hospital in a haemodynamically unstable condition following an assault with a large knife. The patient was initially managed with two damage control operations and angioembolisation of the right hepatic artery to control major haemorrhage. Following initial stabilisation, the patient was transferred to TUH for major trauma care. After correction of the patient’s physiology, the patient was taken back to the operating theatre for definitive management in the form of a right hepatectomy. Despite the major injuries sustained, the patient proceeded well and was discharged 30 days post injury. This case highlights the nature and severity of major trauma seen in North Queensland, while emphasising the capacity of this rural trauma centre to provide appropriate trauma care to this unique population.