Of fatally injured patients with non-CNS injuries reaching the ER alive in an entire state from 1975–1979, 22% were judged to have potentially survivable injuries. A previous study from 1969–1974 in the same state of fatally injured abdominal injury patients showed 26% potential survivors. Errors in initial volume replacement, airway-respiratory control, and in the recognition of surgical urgency stand out in the present series.Review of these cases suggests that stabilization and resuscitation are necessary before transfer and that bypass to a regional trauma center would not have been likely to be effective in such a rural state.