title: Role of air-medical evacuation in mass-casualty incidents--a train collision experience.
abstract: BACKGROUND
  On 21 June 2005, a passenger train collided with a truck near Revadim, Israel. The collision resulted in a multiple-scene mass-casualty incident in an area characterized by difficult access and a relatively long distance from trauma centers. A major disaster response was initiated by civilian and military medical forces including the Israeli Air Force (IAF) Search and Rescue teams. The air-medical evacuation from the accident site to the trauma centers, the activities of the airborne medical teams, and the lessons learned from this event are described in this report.
  
  
  METHODS
  A retrospective analysis of data gathered from relevant elements that participated in management, treatment, and evacuation from the accident site was conducted.
  
  
  RESULTS
  The accident resulted in 289 injured passengers and seven of the injured were killed. Six helicopters (performing nine sorties) participated. Helicopters evacuated trauma victims and aided in transporting air-medical teams to the site of the collision. Overall, 35 trauma victims (10 urgent) were evacuated by air to trauma centers. The length of time between the first helicopter landing and completion of the air evacuation was 83 minutes. The air-medical evacuation operation was controlled by the commander of the IAF Search and Rescue. Different crew compositions were set in real time.
  
  
  CONCLUSIONS
  Air-medical evacuation during this unique event enabled prompt transportation of casualties from the scene to trauma centers and provided reasonable distribution of patients between various centers in the region. This operation highlighted the necessity for flexibility in medical decision-making and the need for nonconventional solutions regarding crew compositions during management of an airborne evacuation in similar settings. Air-medical evacuation should be considered as a part of responses to mass-casualty incidents, especially when the site is remote or characterized by accessibility difficulties.
authors.affiliation: Tel-Hashomer, Ramat-Gan, Israel. amitassa@zahav.net.il
authors.forename: Amit
authors.initials: A
authors.lastname: Assa
authors.forename: Dan-Avi
authors.initials: DA
authors.lastname: Landau
authors.forename: Erez
authors.initials: E
authors.lastname: Barenboim
authors.forename: Liav
authors.initials: L
authors.lastname: Goldstein
mesh_terms: D017732:Air Ambulances / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D054527:Mass Casualty Incidents / Q000401:mortality / Q000706:statistics & numerical data*; D018986:Motor Vehicles / Q000706:statistics & numerical data*; D010360:Patient Transfer; D011890:Railroads / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology*