Introduction Road traffic accident (RTA)-related death and disability are alarming health issues globally, which are rapidly increasing in developing countries. Timely presentation to a health center and prompt medical care are needed to prevent mortality and morbidity related to RTAs. This study was conducted to find out the hurdles in the golden hour arrival of RTA victims and to study its impact on RTA mortality at a tertiary health institute. Materials and methods This retrospective, cross-sectional analytical study was conducted in the Department of Emergency Medicine of Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital in Sangli, India, over a period of six months from January 1 to June 31, 2022, after obtaining institutional ethical committee approval. This tertiary care center is situated at the border of two states in Western India. All adult RTA victims who were treated during the study period were included. Data were collected using structured, pretested, and validated pro forma. Data was statistically analyzed. The factors associated with mortality were analyzed using a chi-squared test. Results We studied a total of 315 RTA victims. Around 49.2% (n=155) of patients were from the 29-48-year age group, and male (87%
n=276) predominance was observed. We observed 46% (n=144) of accidents on weekend days and found alcohol consumption in 45% (n=142). Around 61% (n=193) of accidents occurred within 50 km of our hospital. Only 20.6% (n=65) of patients arrived at a healthcare facility within the golden hour. We did not observe a significant association (p=0.166391) between golden hour arrival and mortality in our study but observed statistically significant associations for mortality with on-arrival Glasgow Coma Scale (GCS) values of less than 8, patients admitted to the intensive care unit (ICU), and the presence of traumatic brain injury. Transport vehicles accounted for 33% (n=104) of the obstacles in reaching the emergency department (ED), followed by finances (30%
n=96), lack of knowledge about the nearby health facility (14.6%
n=46), absence of an accompanying person (11%
n=35), and fear of legal formalities and hospital detention (5%
n=17). Twenty percent (n=63) of patients reported experiencing one or more of these obstacles. Conclusion Less than one-fourth of RTA patients arrived at a medical facility during the golden hour. In developing countries like India, the causes of delay are numerous. The severity of injuries determines RTA fatality.