Introduction: On 26 December 2004, a large earthquake in the Indian Ocean and the resulting tsunami created a disaster on a scale unprecedented in recorded history. Thousands of foreign tourists, predominantly Europeans, were affected. Their governments were required to organize rapid rescue responses for a catastrophe thousands of miles away, something for which they had little or no experience. The rescue operations at three international airports in Sweden, the UK, and Finland are analyzed with emphasis on “lessons learned” and recommendations for future similar rescue efforts.

Methods: This report is based on interviews with and unpublished reports from medical personnel involved in the rescue operations at the three airports, as well as selected references from an electronic literature search.

Results: In the period immediately following the tsunami, tens of thousands of Swedes, Britons, and Finns returned home from the affected areas in Southeast Asia. More than 7,800, 104, and approximately 3,700 casualties from Sweden, the UK, and Finland, respectively, received medical and/or psychological care at the temporary medical clinics organized at the home airports. Psychiatric presentations and soft tissue and orthopedic injuries predominated.

Conclusions: All three airport medical operations suffered from the lack of a national catastrophe plan that addressed the contingency of a natural or disaster due to a natural or man-made project occurring outside the country's borders involving a large number of its citizens. While the rescue operations at the three airports functioned variably well, much of the success could be attributed to individual initiative and impromptu problem-solving. Anticipation of the psychological and aftercare needs of all those involved contributed to the relative effectiveness of the Finnish and Swedish operations.