In 2005, a seven-car commuter express train collided with an apartment building in Japan. The crash left 107 passengers dead and 549 injured. This paper highlights confined space medicine mat was provided for three survivors and introduces the current approach for training Japan Disaster Medical Teams (JDMATs) and/or rescue professionals.

A retrospective analysis of confined space medicine provided after the train crash and a study of training of JDMATs and/or rescue teams.

Three medical teams and search-and-rescue teams rescued three survivors whose bodies were trapped in the tangled wreckage of the first car. The medical teams secured intravenous lines and provided oxygen and approximately 4L of fluid before extrication. A 46-year-old woman was extricated in 14 hours, a 19-year-old man in 16.5 hours, and an 18-year-old man 22 hours after the crash. All three worsened at the final moment of extrication. Their crush syndrome required resuscitation at the scene, and intensive care such as hemodialysis and limb amputation in hospitals. Two patients survived and one patient died on me fifth day due to multiple organ dysfunctions.

Now, the curriculum of the JDMAT training course includes lectures and introductory exercises with rescue teams to learn the importance and difficulties of confined space medicine at the scene.

Confined space medicine was provided successfully after the train crash. Knowledge of confined-space medicine is essential to medical and rescue teams. Further education and training curriculum must be created.