Palliative care is integral to providing comprehensive care for critically ill patients with traumatic injuries. Early palliative care assessment in this patient population has demonstrated improvements in quality of care without increasing in-hospital or intensive care unit (ICU) mortality (Mosenthal AC, Weissman DE, Curtis JR, Hays RM, Lustbader DR, Mulkerin C, et al. Crit Care Med, 40(4):1199–206, 2012). Building competency in palliative care assessment by the primary team can be challenging, therefore, early involvement of the palliative care specialists is important for directing goals of care (GOC) in critically injured patients and prioritizing patient wishes at the end of life. Communicating bad news, initiating palliative care assessment, determining GOC, and providing appropriate end of life care are all essential to high quality palliative care. These principles can and should be integrated into trauma, emergency general surgery, and critical care practices.