Injuries associated with the use of ejection seats: a systematic review, meta-analysis and the experience of the Israeli Air Force, 1990-2019

•Emergency services may be called upon to treat aircrew that has ejected and should be familiar with the injuries associated with such accidents.•Among 1710 aircrew who ejected, pooled mortality and major injury rates were 10.5% and 29.8%, respectively. Survival rates have improved dramatically over the years.•The major injuries included spinal fractures (61.6%), extremity trauma (27.3%), and head trauma (8.9%).•The majority of spinal fractures were anterior wedge compression fractures, which in many cases were initially associated with minor symptoms.•Although penetrating injuries were extremely rare, they may be seen in combat ejections.