In a 12-year period (1970-1981), there were 112 patients operated on with major open intra-abdominal vascular trauma (MOIVT). These were any penetrating injuries to the aorta, inferior vena cava, portal vein, or their primary branches. Sixty-four patients were treated without benefit of paramedics. Only four of 43 patients who had emergency department blood pressures of 60 mm Hg or greater upon entry died (9.3%), whereas 18 of 21 (85.7%) patients with blood pressures of less than 60 mm Hg died (p less than 0.0001). Forty-eight of the 112 patients have been treated by paramedics during the past 4 years. Entry level blood pressures are those first recorded by the paramedics in the field. The mortality in those with blood pressures of 60 mm Hg or greater remained essentially unchanged. However, 11 of 22 patients with blood pressures of less than 60 mm Hg survived compared to three of 21 (p less than 0.025). Over the past 12 years, the community's homicide rate has been stable (71/yr), but the case incidence of MOIVT has risen from an average of 8/yr to 12/yr during the paramedic years. The average annual aggravated assault rate increased from 796 to 1,119. It is believed the improvement in the salvage rate is due to early intervention by trained paramedics functioning within a trauma care system.