{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T15:33:55Z","timestamp":1789832035051,"version":"4.0.1"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"French Ministry of Health"},{"name":"ANRS for Emerging Infectious Diseases"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The first COVID-19 epidemic wave hit the East and Ile-de-France regions in France, resulting in overwhelmed intensive care units (ICUs). Alongside helicopters and planes, high-speed trains were used for the first time to mass-evacuate critically ill patients. This study aimed to compare outcomes of patients evacuated by trains and by aircrafts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a multicentre retrospective cohort study. Between 13 March and 10 April 2020, 38 ICUs in France transferred patients with severe COVID-19 to 60 ICUs in unaffected regions and countries. Patients were divided into the train group (n\u2009=\u2009130) and the air group (n\u2009=\u2009163). The study outcomes included 28-day case-fatality, destination ICU length of stay and post-transfer Sequential Organ Failure Assessment (SOFA) score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Age and comorbidity did not differ between groups. Although patients spent more time (+2 hours) and travelled further (+250 km) in the train group than in the air group, the median post-transfer SOFA score was lower in the train group (6 vs 7;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). The 28-day mortality rates were not different (train\/air unadjusted incidence risk ratio: 0.96;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.94). The ICU stay duration was shorter (\u22126 days) in the train group, but this difference was reduced after adjusting for clinical events, such as nosocomial infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High-speed train was a safe vehicle for remote transfer of critically ill patients. The selection of healthier patients and the better physiological and care conditions during the evacuation may explain the shorter ICU stays of patients transferred by trains.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0348090","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:23:26Z","timestamp":1777397006000},"page":"e0348090","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["High-speed trains versus air transport vectors for mass transfers of critically ill patients: The TRANSCOV cohort study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9552-2284","authenticated-orcid":true,"given":"Chatpimuk","family":"Thipayamaskomon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1087-9197","authenticated-orcid":true,"given":"Olivier","family":"Grimaud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3617-5411","authenticated-orcid":true,"given":"Pierre","family":"Tattevin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lionel","family":"Lamhaut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuelle","family":"Leray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemie","family":"Letellier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Bayat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Fermanian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marc","family":"Philippe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Maury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Noizet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Braun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Dolz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc-Antoine","family":"Sanchez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9l\u00e8ne","family":"Coignard-Biehler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Prieto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugues","family":"Delamare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Cayr\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Carli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Vuagnat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Pottecher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agn\u00e8s","family":"Ricard-Hibon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the TRANSCOV Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"issue":"2","key":"pone.0348090.ref001","first-page":"31","article-title":"La coordination d\u2019acteurs multiples en situation extr\u00eame. Le cas des transferts extrar\u00e9gionaux de patients Covid-19","volume":"47","author":"P Cucharero Atienza","year":"2022","journal-title":"RIMHE: Revue Interdiscip Manag Homme Entreprise"},{"issue":"1","key":"pone.0348090.ref002","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.pxur.2022.01.008","article-title":"Organisation des TGV sanitaires \u00ab Chardon \u00bb pendant la crise COVID-19","volume":"6","author":"C Dagron","year":"2022","journal-title":"M\u00e9decine de Catastrophe - Urgences Collectives"},{"key":"pone.0348090.ref003","doi-asserted-by":"crossref","first-page":"288","DOI":"10.3166\/afmu-2020-0275","article-title":"Retour d\u2019exp\u00e9rience des \u00e9vacuations par train \u00e0 grande vitesse de patients en syndrome de d\u00e9tresse respiratoire aigu\u00eb sur infection \u00e0 Covid-19: les missions Chardon","volume":"10","author":"L Lamhaut","year":"2020","journal-title":"Ann Fr Med Urgence"},{"issue":"1","key":"pone.0348090.ref004","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s13613-021-00933-2","article-title":"Impact of ICU transfers on the mortality rate of patients with COVID-19: insights from comprehensive national database in France","volume":"11","author":"M-A Sanchez","year":"2021","journal-title":"Ann Intensive Care"},{"issue":"1","key":"pone.0348090.ref005","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s13613-021-00841-5","article-title":"Inter-hospital transport of critically ill patients to manage the intensive care unit surge during the COVID-19 pandemic in France","volume":"11","author":"B Painvin","year":"2021","journal-title":"Ann Intensive Care"},{"issue":"7","key":"pone.0348090.ref006","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1007\/s00134-021-06412-3","article-title":"Inter-regional transfers for pandemic surges were associated with reduced mortality rates","volume":"47","author":"A Guillon","year":"2021","journal-title":"Intensive Care Med"},{"key":"pone.0348090.ref007","article-title":"Mass medical evacuations to decrease the intensive care burden: results from the TRANSCOV cohort study","author":"O Grimaud","year":"2025","journal-title":"Chest"},{"issue":"10","key":"pone.0348090.ref008","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-054774","article-title":"TRANSCOV cohort protocol: an epidemiological study assessing the impact of critically ill COVID-19 patients long distance transfers between intensive care units","volume":"11","author":"O Grimaud","year":"2021","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0348090.ref009","doi-asserted-by":"crossref","first-page":"363","DOI":"10.5090\/kjtcs.2017.50.5.363","article-title":"Inter-facility transport on extracorporeal life support: clinical outcomes and comparative analysis with in-house patients","volume":"50","author":"TH Hong","year":"2017","journal-title":"Korean J Thorac Cardiovasc Surg"},{"key":"pone.0348090.ref010","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1146\/annurev-publhealth-032315-021402","article-title":"Mediation analysis: a practitioner\u2019s guide","volume":"37","author":"TJ VanderWeele","year":"2016","journal-title":"Annu Rev Public Health"},{"issue":"3","key":"pone.0348090.ref011","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.amj.2022.12.007","article-title":"An updated review of literature for air medical evacuation high-level containment transport during the coronavirus disease 2019 pandemic","volume":"42","author":"JJ Herstein","year":"2023","journal-title":"Air Med J"},{"issue":"1","key":"pone.0348090.ref012","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s13049-020-00789-8","article-title":"Pre-hospital care and interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective","volume":"28","author":"P Hilbert-Carius","year":"2020","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"4","key":"pone.0348090.ref013","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.amj.2021.04.003","article-title":"Analysis of european air medical evacuation flights of coronavirus disease 2019 patients","volume":"40","author":"S Sammito","year":"2021","journal-title":"Air Medical J"},{"key":"pone.0348090.ref014","doi-asserted-by":"crossref","DOI":"10.1093\/milmed\/usaa512","article-title":"Oxygen management during collective aeromedical evacuation of 36 COVID-19 patients with ARDS","volume":"186","author":"M Beaussac","year":"2021","journal-title":"Military Med"},{"issue":"4","key":"pone.0348090.ref015","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1111\/anae.15680","article-title":"Patient outcomes following transfer between intensive care units during the COVID-19 pandemic","volume":"77","author":"F Huq","year":"2022","journal-title":"Anaesthesia"},{"key":"pone.0348090.ref016","doi-asserted-by":"crossref","first-page":"102794","DOI":"10.1016\/j.tmaid.2024.102794","article-title":"The leading \u201cblended\u201d civil medical evacuation operation (MEDEVAC) in unforeseen health emergency. From military use to civil development","volume":"63","author":"N Fagoni","year":"2025","journal-title":"Travel Med Infect Dis"},{"issue":"1","key":"pone.0348090.ref017","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s12245-016-0115-6","article-title":"A retrospective comparison of helicopter transport versus ground transport in patients with severe sepsis and septic shock","volume":"9","author":"R Kashyap","year":"2016","journal-title":"Int J Emerg Med"},{"key":"pone.0348090.ref018","unstructured":"Araiza A, Duran M, Surani S, Varon J. Aeromedical transport of critically ill patients: a literature review. 2021."},{"issue":"6","key":"pone.0348090.ref019","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.19726","article-title":"Characteristics of Medical Evacuation by Train in Ukraine, 2022","volume":"6","author":"S Walravens","year":"2023","journal-title":"JAMA Netw Open"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348090","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:23:32Z","timestamp":1777397012000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348090"}},"subtitle":[],"editor":[{"given":"Amir","family":"Nutman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0348090","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}