A significant proportion of fatalities from motor vehicle collisions (MVC) could be prevented through better emergency medical service (EMS) care. Despite a lack of conclusive research, there is a consensus that prehospital time (the time between the MVC and the patient’s arrival at the hospital) must be reduced as much as possible. Many studies use response time (the time between EMS dispatch and arrival at the scene) as an indicator of overall prehospital time and a metric of EMS performance. However, there are other components of prehospital time that may be equally important, including the discovery time between the collision and EMS notification, the on-scene time, and the transport time from the scene to the hospital. In rural MVCs, the discovery time can be substantial if there are no witnesses or survivors capable of calling emergency services. Technologies that automatically detect MVCs can shorten discovery times in such circumstances. Transport times depend on the distance between the crash scene and the hospital; this time could be reduced by increasing access to trauma centers, especially in rural areas. On scene time is a component of the total time, however there is a trade-off between minimizing scene time to reduce total time and providing optimal on-scene care. Increasing capacity of EMS personnel and/or utilizing technology such as telemedicine should be considered as part of this trade-off. Future research is needed to determine the relative benefits and costs of reducing any of these segments of prehospital time.