Express railway disaster in Amagasaki: a review of urban disaster response capacity in Japan.

On the morning of 25 April 2005, a Japan Railway express train derailed in an urban area of Amagasaki, Japan. The crash was Japan's worst rail disaster in 40 years. This study chronicles the rescue efforts and highlights the capacity of Japan's urban disaster response.Public reports were gathered from the media, Internet, government, fire department, and railway company. Four key informants, who were close to the disaster response, were interviewed to corroborate public data and highlight challenges facing the response.The crash left 107 passengers dead and 549 injured. First responders, most of whom were volunteers, were helpful in the rescue effort, and no lives were lost due to transport delays or faulty triage. Responders criticized an early decision to withdraw rescue efforts, a delay in heliport set-up, the inefficiency of the information and instruction center, and emphasized the need for training in confined space medicine. Communication and chain-of-command problems created confusion at the scene.The urban disaster response to the train crash in Amagasaki was rapid and effective. The Kobe Earthquake and other incidents sparked changes that improved disaster preparedness in Amagasaki. However, communication and cooperation among responders were hampered, as in previous disasters, by the lack of a structured command system. Application of an incident command system may improve disaster coordination in Japan.