i can see that happening. from a pre-hospital perspective the rates are higher because 1) rolling your car on some lonely country road makes it less likely that you will be found iin an expedious manner 2) it takes longer for EMS to get to you and then get you to definitive care 3) in parts of rural texas you can easily be 1.5 hours from a level 1 or 2 trauma center (by helicopter) 4) in many parts of rural texas first responders and law enforcement are not "allowed" to call for aeromedical transport thus getting them to the scene faster. jim paramedic