In December of 1995 a system of trauma care based on Advanced Trauma Life Support (ATLS) principles was instituted to assess the impact of such principles on trauma care in a rural general hospital setting. This audit reviews the results over a 2 yr period to December 1997. All patients admitted with major trauma (i.e. with life threatening or potentially life threatening injuries) to Cavan General Hospital (CGH) were eligible for inclusion. This numbered 70 patients admitted (for at least 3 days), or who were transferred after resuscitation and stabilization as well as inpatient deaths. Twenty-seven patients who died prior to admission are also reviewed. The endpoints assessed were death, disability and survival 3 months post-accident. Based on injury severity scores 7 per cent of cases suffered fatal non-survivable injury, 20-30 per cent had very serious injury with an overall mortality rate of 17 per cent. The predicted mortality rate was 30 per cent. One-third had their full treatment at CGH with a 76 per cent survival rate. The other two-thirds were transferred for specialist intervention with an overall survival of 80 per cent, a disability rate of 16 per cent and a mortality rate of 4 per cent. No patient died during transportation.