ABSTRACTWe are reporting a case of a patient who was brought to our emergency department after having sustained a penetrating buttock trauma and we are discussing about the importance of good Inter-hospital collaboration to provide patients with early access to Major Trauma Centres with a specific focus on Northern Ireland protocols.Our patient is a 54-year-old lady who fell from a stepladder onto the metallic base of an artificial Christmas tree causing the stem of the tree to impale her through her right buttock into her pelvis.Despite the impressive mechanism of injury, there was no immediate life-threatening bleed and the patient was subsequently transferred to the local Major Trauma Centre for expert surgical management but suffered significant delays due to suboptimal communication and lack of clear transfer pathways.Current literature recognises that penetrating gluteal trauma should be considered a life-threatening injury and this case highlights learning points around the management of penetrating trauma in terms of investigations, early transfer and definitive surgical treatment.We discuss about the initial management, imaging and surgical considerations for this case. We also discuss about the current recommendations for early transfer between smaller centres to Major Trauma Centres and the Northern Ireland specific protocols that have been introduced by the Northern Ireland Major Trauma Network. We focus on the Call and Send protocol and on the NIMTN Major Trauma Triage Tool.