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In 1998, in response to the escalating problem of violence and its impact on all sectors of the society, the Ministry of Health (MOH), Jamaica, established a pilot violence-related injury surveillance system (VRISS) in the country's leading public hospital, the Kingston Public Hospital (KPH) situated in the nation's capital. After six months' operation, VRISS was extended to include all injuries. Nine months later, the Jamaican Injury Surveillance System (JISS) was successfully introduced to four other hospitals and has been in operation since. Extension to an additional six institutions was implemented at the end of 2001. What were the challenges faced in introducing an injury surveillance system into the Accident & Emergency Department (A&E) of a general hospital, how they were overcome and what were the lessons learnt in the process?