Objective For serious motor vehicle crashes (MVC) occurring in a rural area to quantify: how many occur more than 45 min by road to a major trauma centre (MTC); how many occur more than 45 min by helicopter to an MTC; and how many patients might have to be taken to a local trauma unit if their incident occurs more than 45 min by road from an MTC and when the helicopter cannot fly.

Methods MVC occurring in Shropshire, in which patients were killed or seriously injured during 2006–9 (inclusive) were analysed using the following parameters: distance from MTC by road; distance from MTC by air; weather and visibility-related factors that affect the operation of a helicopter emergency medical service.

Results 722 serious MVC occurred, of which 626 (87%) occurred more than 45 min by road from the MTC. Of these 626 incidents, 408 occurred in conditions in which the helicopter could fly. There were 218 incidents (30%), which were more than 45 min by road from the MTC and which occurred when the helicopter could not fly.

Conclusions The transportation of patients from remote and rural areas to MTC remains problematical. Further work is required to develop more efficient systems of retrieval and transfer, and in particular to consider how emergency medical helicopters might operate safely at night.