Objective To explore the clinical effectiveness of pre-hospital and in-hospital collaborative treatment supported by smart emergency care system for severe trauma patients, and to provide references for optimizing trauma treatment processes. Methods A historical controlled study was conducted.A total of 97 severe trauma patients admitted to the emergency department from March to August 2024 were enrolled as a control group and received conventional trauma care; another 95 severe trauma patients admitted from September 2024 to February 2025 were enrolled as an intervention group and received pre-hospital and in-hospital collaborative treatment under smart emergency care system.The key time intervals, implementation rate of pre-hospital emergency interventions and pre-hospital rescue success rate were assessed and compared between the two groups. Results The intervention group presented significantly shorter emergency response time, rapid CT scanning time, rapid FAST time, emergency department length of stay, emergency blood transfusion preparation time and emergency surgery preparation time than the control group (all P＜0.05).The pre-hospital implementation rates of endotracheal intubation, hemostasis and bandaging, and urgent fluid resuscitation in the intervention group were 27.37%, 83.16% and 48.42%, respectively, which were markedly higher than those in the control group (all P＜0.05).Besides, the pre-hospital rescue success rate of the intervention group (95.79%) was superior to that of the control group (87.63%) (P＜0.05). Conclusion The implementation of pre-hospital and in-hospital collaborative treatment under smart emergency care system can effectively shorten the treatment time for severe trauma patients, promote the forward shift of core emergency interventions to pre-hospital phase, improve pre-hospital rescue success rates, and achieve seamless integration between pre-hospital and in-hospital trauma care.