More than half of trauma patients are not receiving good care, experts say.
About 800 trauma patients end up transferring hospitals
The National Confidential Enquiry into Patient Outcome and Death looked at the care given to 795 patients, many with head injuries from falls and crashes.
It found medical staff in 200 hospitals in England, Wales and Northern Ireland often did not appreciate the severity and displayed little urgency.
It said care would improve if services were centred at fewer sites - something which is already government policy.
NCEPOD said many of the problems identified in nearly 60% of patients treated across 200 hospitals were associated with staff being too inexperienced.
In particular, they found patients were not always given essential tests such as CT scans or assessed by hospital consultants, especially during the night.
Researchers said most hospitals would only deal with one trauma patient a week and this meant staff did not get the necessary experience to keep skills up to date.
They also said about 800 trauma patients each year needed to be transferred to other hospitals - often in an "ad hoc" manner - because of a lack of specialist facilities such as neurological services.
Ambulance crews were also criticised for failing to always unblock airways and alert hospitals of incoming cases.
But the researchers said in hospitals which dealt with more than 20 cases a week the care was classed as good.
The report said this in itself was a good argument for centralising services in regional centres.
This is already a government policy, but it is proving controversial because of the aim of a whole host of other services such as maternity and A&E being centralised as well.
Campaigners say such a move would lead to many local hospitals being stripped of key services.
Report author Dr George Findlay said: "The number of patients seen has a direct bearing on the experience and ability of clinicians to manage challenging cases.
"It is not possible for all hospitals to have a trauma team on call with the necessary experience, organisation and support structures.
"We need to look at how we can organise trauma care on a regional basis."
The Royal College of Surgeons said care urgently needed to improve.
A spokesman said: "Our mortality rates are among the worst in the developed world, and yet trauma care remains a low priority for the government.
"This a national health service and what we need is a national trauma system."
Health Minister Ben Bradshaw said: "We have argued for some time that it is not the proximity of the nearest A&E that matters to most trauma victims but the care they receive from ambulance and paramedic staff and the quality of care they receive once they arrive at hospital.
"Concentrating trauma treatment in specialist centres can arouse opposition from some people concerned about 'downgrading' of their local A&E facilities, but what the opponents often fail to recognise is that lives will be saved and the quality of care improved, as this report makes clear."