After a serious car crash when your survival depends on urgent helicopter transport to a specialized trauma center -- will you receive it? Most likely not, according to the findings of a first-in-the-nation study by Health and Safety Research, Inc., a Massachusetts non-profit. As a result, your chance of survival can be reduced by 2-to-10 times.

The findings are striking because for the study year, Massachusetts had the lowest crash death rate in the U.S., and one of the 10 lowest in the world. The states and countries with higher crash death rates may under- utilize life-saving resources to a greater extent.

The HSRI comprehensive one-year statewide study of the response of Massachusetts' EMS and hospital system to people involved in fatal level car crashes, appears in this month's Journal of Trauma, a leading peer-reviewed medical journal. The study was conducted under the auspices of the Massachusetts Department of Public Health and the Massachusetts Governor's Highway Safety Bureau.

A sophisticated methodology tracked the path and outcome of every involved person starting at the crash scene -- whether transported or not -- including helicopter and ground ambulance use, community or specialized trauma center hospital treatment, and inter-hospital transfers. Qualification for helicopter transport and/or trauma center care was calculated using state/national guidelines.

Among other major findings, the HSRI study shows that 83% of people who qualified for direct helicopter transport to a trauma center and 62% of people who qualified for direct transport (via ground or air ambulance) to a trauma center did not receive those resources. Helicopters did not arrive at 88% of the crashes, primarily because they were not requested. Survival varied by a factor of 3 between the state's five EMS regions, and up to a factor of 10 times, depending where and how people were taken for treatment. Overall, people who qualified and received transport directly to a trauma center had about twice the survival of those who qualified but did not receive those resources.

"Advanced transport and hospital resources can't be effective when victims are not directed to them," says lead author Nicholas Mango. "The majority of severely injured persons qualified for advanced medical resources they did not receive. Had they received those services, we believe crash fatalities could be substantially reduced."