Medical estimates of potentially 'salvageable' lives with better emergency medical services (EMS) in fatal highway crashes have generally been around 20%. In rural counties in Texas, however, our statistical results show that at least 38% of fatal accidents could have been nonfatal. This higher figure may reflect the extreme contrasts in EMS accessibility that exist in certain rural areas. Accident related variables that would have affected our results were controlled by log linear analysis. Better 'quality' EMS in rural Texas would, apparently, save lives, but to insure cost-effectiveness more needs to be learned about the impact of various components of EMS: notification time, ambulance response and hospital care.