Injury is a leading cause of death and health loss. Many fatal injuries may be prevented, or at least their severity reduced, through an optimally structured emergency medical service (EMS) system that can provide timely and appropriate care. Our current research, which includes an exploration of the potential survivability of prehospital injury deaths in NZ, suggests up to half of injury deaths occur in the prehospital setting, and that 40% of these have survivable or potentially survivable injuries. Suggesting barriers to timely receipt of appropriate care exist that likely impact on outcomes following major trauma. St John’s recent introduction of an electronic patient report form, and the establishment of a national major trauma registry, mean we can now use these data to investigate the impact of EMS care on major trauma survival using a cohort study design. The findings will inform future planning and delivery of EMS care.