BOSTON -- Team 5 Investigates uncovered a breakdown in the state's emergency medical system that could be putting all of us at risk. NewsCenter 5's Sean Kelly reported on Thursday that life-saving tools for patients with life-threatening injuries are not always used, and the majority of EMS directors are unaware of it.

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At the scene of every traumatic accident, the decisions made are a matter of life or death. A person's survival depends on the kind of hospital they're taken to and the time it takes them to get there. "The longer that person is not in the care of an experienced trauma team, the greater their chance of dying," said Dr. Marc Restuccia, medical director of Life Flight at the University of Massachusetts Medical School.

Given all of the world famous medical assets the state has, getting to a trauma center should not be a problem. But our investigation found often times it is. And depending on where someone gets hurt, their chances of survival can vary greatly.

Liz Garthe and Nicholas Mango co-authored a 2007 statewide study that found 62 percent of crash victims who qualified for direct transport to a trauma center in 1996 didn't get there.

"If you qualify to go to a trauma center, you've got to get there to get your best chance of survival," said Mango.

They also found 83 percent of the patients who should have been transported by helicopters were not. "They weren't called. And what we found actually is when you deploy a helicopter it made a huge difference in the survivability of the injured people," said Garthe.

What the authors found equally troubling is that a crash victim's chances of surviving a crash drops significantly depending on where they get hurt. "I mean literally a person can take their car, drive across the state and they can pass through regions if they get into a very serious crash where they qualify for direct transport to a trauma center, they're highly unlikely to get it," said Mango.

Out of the state's five emergency medical service regions, crash victims in regions 4 and 5 fared among the worst when it came to getting access to the care they needed. Those in region 2 experienced the least amount of problems. "If every region worked as well fatalities in this state would drop by 22 percent," said Mango.

Dr. Erwin Hirsch is the head of the state's busiest trauma center. While he questions the report's complex methodology, he doesn't take issue with the results. "It pointed out that there's significant room for improvement and I think that's important," said Hirsch.

The directors of the state's air medical services agree. "Not transporting patients that should be transported is usually a political issue," said Dr. Susan Wedel, medical director of Boston Medflight. And Dr. Marc Restuccia believes more lives could be saved.

Despite warnings about medical helicopters being under utilized, neither service has seen much of an increase in calls. "The number of times we get called have actually been pretty stable," said Restuccia. "I think our increase was like 1 percent or 2 percent," said Wedel.

And Team 5 Investigates has learned the majority of the state's EMS Directors were never notified about these potential problems. Dr. Michael Murphy is trauma director for Region 4. "I'm not really familiar with the particulars. I have not read the study, no," said Murphy. We got the same story from Fred Fowler, executive director for Region 5.

Kelly: "Isn't that something that they should have told you about?"

Fowler: "I would have thought so, yes. It troubles me that we may have a problem and we don't know what the extent of the problem is."

It's also troubling to Sunni Fidler whose father was killed in a motorcycle accident last July. "Obviously we can't bring him back but questions should be answered," said Fidler.

Lawrence Fidler crashed in Marshfield, a town that crosses regions 4 and 5. Even though he suffered blunt injuries to his head and chest, an ambulance brought Fidler to South Shore Hospital instead of a trauma center. "He should have been taken somewhere that was equipped to handle his kind of accident," said Fidler.

Hospital officials would not discuss the case with Team 5 Investigates citing patient confidentiality.

Dr. Paul Dreyer oversees the state's trauma system for the Department of Public Health.

Kelly: "Why do you think that patients who qualify for trauma care aren't always getting it?"

Dreyer: "What I understand from experts in the field is that those conditions no longer exist today. Admittedly it's not something that uh, that we yet have data to support."

Kelly: "Why weren't all of the regional directors notified about it?"

Dreyer: "I haven't a clue. This is one study!"

But Dreyer should have a clue since he sent this letter to the study's authors last year telling them he'd set up a meeting with all five of the state's EMS directors.

Kelly: "At one point you thought it was significant, is that not the case anymore?"

Dreyer: "I think to me what's most important about this study is its illustration for the need for good data."

Massachusetts has been trying to collect that data for 16 years. In 1992, the National Highway Traffic Safety Administration issued a report recommending the state set up a trauma registry to track how every case is handled.

Kelly: "Why is it taking so long to get a trauma registry?" Dreyer: "I certainly think we all wish we had it now but we're not where we need to be."

Only last month did the state finally begin collecting that data. "Once you begin to look at the data, people are going to say geez, we can do better and you need an 800 pound gorilla, the Commonwealth of MA, paying attention to this," said Wedel.

State health officials believe they fixed some of these problems by putting in place guidelines for where trauma patients should go. But with limited oversight, nobody can say for sure whether those guidelines are being followed.