In the past 5 years, 72 moribund patients have undergone resuscitative thoracotomy (RT) at the Medical University of South Carolina: 62 patients underwent the procedure before the adoption of a policy of mandatory rapid transport (scoop and run) for penetrating and unstable victims of trauma by our EMS system (Group I). Group II is comprised of ten patients who underwent RT following adoption of this policy. Resuscitation was successful in three patients in Group I (4.8%) and there were only two survivors (3.2%). In contrast, resuscitation was successful in two of ten patients in Group II (20%) and there was one survivor (10%). Nineteen patients in Group I (31%) were in traumatic full arrest on the scene, all of whom died. Twenty-five patients in Group I (40%) had a measurable pulse and/or blood pressure when EMS personnel arrived at the scene and subsequently “died” before their arrival at the trauma center. RT was also uniformly unsuccessful in this subgroup. Eighteen patients in Group I (29%) suffered cardiac arrest following their arrival at the hospital. Three of these patients (16.6%) were successfully resuscitated and two (11%) survived to leave the hospital. There were four traumatic full arrests in Group II (40%) and all four died. Only two patients in Group II (20%) lost their vital signs in transport and both died. Four patients in Group II (40%) suffered cardiac arrest after arrival at the hospital. Two of these patients (50%) were successfully resuscitated and one left the hospital (25%). The average time spent on the scene by EMS was 37 minutes, 15 seconds, in Group I and the average transport time was 13 minutes, 15 seconds. Thus the total mean field time was 50 minutes, 30 seconds, in this group. In the group of patients transported after the adoption of the scoop and run policy, 9 minutes, 30 seconds, were spent on the scene in the average case and the mean transport time was 13 minutes (22 minutes, 30 seconds, total field time). The authors conclude that RT is rarely successful in patients presenting to the emergency department with no vital signs. A significant number of potentially salvageable patients suffer loss of vital signs during prolonged transport. Thus, the overwhelming priority in prehospital management of the severely injured should be delivery of these patients to the emergency department with the least possible time in the field.