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10 years ago today, Trauma Surgery & Acute Care Open (TSACO) published its first manuscript. The founding editor-in-chief, Dr Timothy Fabian, described the birth of a new journal at a time when open access publishing was rapidly reshaping the landscape.1 The American Association for the Surgery of Trauma (AAST) owned one traditional, subscription journal. But, the organization realized that to stay relevant, it had to join the open access revolution. They partnered with BMJ, launching TSACO on 24 May 2016. Dr Fabian wrote about the future of medical publishing1 and took on this new challenge. For 7 years, he led our fledgling journal through its formative years. He loves the birth analogy and slowly growing from infancy to toddlerhood. That first year, the journal published 33 manuscripts. We have grown that number exponentially ever since.