Road traffic accidents cause several thousand deaths each year in England and Wales. One approach to reducing this toll is to ensure that services are planned to achieve early response of ambulances to accident victims and their rapid conveyance to a hospital with good accident and emergency facilities. In order to undertake medical care of the highest quality, there has been a policy of concentrating such facilities in large units. Unfortunately, this has the disadvantage that distances and travel times from some accident sites to these centres can be considerable, particularly in rural areas. The county of Norfolk is a generally rural area which has a high death rate from road traffic accidents, and it has been suggested that access to accident and emergency facilities may be a factor. Data on serious and fatal road accidents from police accident records were analysed for the period 1987 to 1991. The time taken for an ambulance to reach each accident and to convey the victim to the nearest hospital accident and emergency department was estimated using a geographical information system. Regression analysis was used to analyse the factors affecting the odds of death versus serious injury for each individual. An elevated probability of death was found among the old, pedestrians, casualties involved in multiple accidents, and casualties on roads with higher speed limits. However, no relationship was found between outcome and the estimated time taken to reach victims and to convey them to hospital, either before or after adjustment for other factors.(ABSTRACT TRUNCATED AT 250 WORDS)