Trauma Center titles share the same universe and timeline. The original game and its remake are set in the year 2018. Under the Knife 2 is set three years after the first game's events. Trauma Team takes place at some point after the events of Second Opinion, though it is not directly connected to the rest of the series. The action takes place around the locality of Resurgam First Care, a fictional hospital in the United States where many of the protagonists work. New Blood is set ten years after the events of Second Opinion. Two recurring characters are Naomi Kimishima, a player character in Second Opinion and Trauma Team; and Derek Stiles, who makes appearances in each title in the series. A recurring narrative theme in the Trauma Center series was saving life through surgery, and the passion of doctors to save lives. In Second Opinion, a secondary theme was the damaging impact of surgery being used for the wrong reasons. The narrative themes of New Blood are the battle to save lives and the preciousness of life. The story of Under the Knife 2 incorporated issues of treating the poor, doctor shortages, and anti-aging medicine. In Trauma Team, the story focused on how people lived full lives in a world that could see terrible life-threatening events, drawing direct inspiration from the 2009 swine flu pandemic. Development The original Trauma Center was created by Atlus staff member Katsura Hashino, who acted as producer. Beginning production in 2004, the team wanted to recreate the surgical simulation gameplay of PC titles for the DS, since its controls and hardware were more capable compared to others of the time. Many of the staff were veterans of Atlus's role-playing Megami Tensei, making production challenging due to the team's inexperience. Following the success of Under the Knife, Hashino formed some of the team into a dedicated team to work on the series; they were internally known as "CaduceTeam", made up of what director Daisuke Kanada described as Atlus's most enthusiastic gamers. Kanada has worked on multiple Megami Tensei titles and collaborated with Hashino on several games since Maken X in 1999; Second Opinion was his debut as a director. Production of Second Opinion began in January 2006. Recurring staff included Kanada as director; artist Masayuki Doi, who replaced original artist Maguro Ikehata from Second Opinion onwards; programmer Takaaki Ikeda; and scenario writer Shogo Isogai,