The objective of this study was to determine the proportion of EMS (Emergency Medical Services) Motor Vehicle Collision cases within a large state meeting Trauma Triage Criteria (TTC) who are ultimately cared for in trauma centers (TC). This cross-sectional observational study utilized EMS records linked with hospital discharge records for the year 1997. Using ICDMAP-90® AIS and ISS scores were computed. ICD-9-CM and E-codes were used to define acute trauma cases resulting from motor vehicle collisions. This population-based system evaluation demonstrated effective TTC implementation in urban areas. However, in rural areas, many severely injured patients were transported to non-trauma centers.