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Trauma-related injuries are a common cause of mortality globally. There has been little examination of prehospital fatalities (deaths occurring either at the scene of the injury event or en route to hospital) and the identification of primary and secondary prevention opportunities in the prehospital setting to prevent trauma-related fatalities in New Zealand.To determine the patterns of prehospital injury deaths in New Zealand for the period 2008–2012. Methods: All deaths registered in 2008–2012 with an underlying cause of death International Classification of Injury (ICD-10) external cause code within V01-Y36 were selected from the Mortality Collection and linked to both hospital discharge data and Coronial case files extracted from National Coronial Information System (NCIS). Hospital discharge data and Coronial case files were used to identify if cases died either in the hospital or prehospital setting. Deaths that occurred in residential care facilities were identified and excluded from this study. Information regarding the demographic characteristics of the decedents, and the injury circumstances was extracted.7004 injury deaths were identified from the Mortality Collection and had Coronial case files available on NCIS. The majority of deaths occurred in the pre-hospital setting (n=5791, 82%). The rate of pre-hospital fatal injury was 26.7 per 1 00 000 population. The highest rates of pre-hospital fatal injury occurred in adolescents (16–24 years), males, Indigenous Maori and caused by suffocation or transport-related injury mechanisms.The major burden of fatal injury in New Zealand occur in the prehospital setting. Understanding the distribution of pre-hospital injury-related mortality key step in identifying opportunities for primary prevention and possible secondary previous including improved care in advanced trauma system and bystander interventions.