Cross-border collaboration in a major incident: emergency medical services response to a train crash

On 15 August 2025, a fatal train crash happened in Southern Denmark following a collision with a truck at an unsecured railway crossing, resulting in derailment and one overturned carriage. One person was killed, and 29 people were injured. This case report aims to give a detailed description of the response of emergency medical services to evaluate cross-border and inter-authority cooperation as well as adherence to major incident guidelines and established communication pathways.

Initial calls indicated several critical patients and numerous school children on the train. Nineteen Danish and German units, including four helicopters, were dispatched to the scene. Access to the site was restricted to a single narrow countryside road, requiring careful organization of staging areas, access/egress routes, and casualty clearing stations. A Joint Incident Command was formed, and patients were triaged, treated, and registered using an electronic prehospital system allowing for continuous coordination with the dispatch center for hospital allocation. Two critically injured patients were transported by helicopter to two trauma centers in Denmark and Germany, and the remaining patients were distributed across three regional hospitals. The response to this incident largely aligned with national guidelines and cross-border cooperation agreements. However, delays in incident management were identified, and responders criticized infrequent training opportunities for major incidents. The rate of unauthorized radio shifts was lower than previously described.

This report describes the response to a major incident, characterized by effective inter-authority cooperation and successful cross-border collaboration between Danish and German emergency services. Routine collaboration during everyday responses proved crucial to ensure efficient collaboration during crises. While adherence to major incident protocols was generally high, challenges remained regarding the site organization and timely establishment of command structures. The observed delays may reflect limited experience with major incident management among regular responders, prompting the need for comprehensive incident command training of prehospital physicians. Compared to previous incidents, communication consistency was notably improved, likely due to dedicated training efforts after prior communication failure. The incident underscored the importance of joint inter-authority response concepts and the central coordinating role of the dispatch center. Enhanced training accessibility and continued evaluation of real-life incidents are recommended to further improve preparedness for future incidents.