The national death rates from rural trauma are disproportionately higher compared to urban areas. Traumatic brain injury is a major cause of hospital admissions in Hawai'i. This is the first in a two part series to explore this significant public health concern. Data on traumatic brain injuries from 2000-2004 was obtained from 2 sources. Male gender, alcohol use, and lack of protective devices resulted in higher rates of injury. Rates of severe injury were higher in young adults, the elderly, and in rural locations, but rural mortality rates here did not differ compared to urban settings. The greatest potential to reduce morbidity and mortality resides in the formulation and implementation of preventive strategies.