Background: Worldwide growth in tourism leads to increased risk of mass casualty incidents. Hospitals operate more or less at full capacity on a day to day basis and such, disasters and mass casualty incidents can be a challenge.  Hospitals play an important role in the reception of injured and it is important that emergency response plans are based on evidence-based practice. In Landspítali University hospital, specialised trauma teams and regular exercises have led to an improved response to mass casualty incidents.

Objective: To describe and analyze the response of Landspitali University following two mass casualty incidents involving tourists in a bus; condition of patients on arrival and the effort required from the hospital to provide treatment.

Methods: : Data was collected from medical records of patients received in the hospital following a bus accident inon Mosfellsheiði in the vicinity of Reykjavik 25th of October 2016 and in Eldhraun, in the southern region of Iceland on the 27th of december 2017, with regards to several variables, including condition on arrival and outcomes after theemergency department admission.

Results: Of 42 passengers in the incident on Mosfellsheiði in 2016, 15 were transported immediately via ambulance to Landspítali for treatment, 27 were cared for in a Red Cross emergency shelter, two of whom were transported to the hospital later in the day. There were no fatalities but two were admitted to the critical care unit. Following the accident in Eldhraun (n=45) 33 passengers were transported to the HSU regional emergency department and 12 were transported via helicopter to Landspítali (eight red (immediate) and four yellow(urgent)), thereof two requiring surgery and four requiring intensive care. Two were discharged from the hospital same day. One passenger died on scene and one 18 days later.

Conclusions: Thisstudy provides insight into patient related factors in mass casualty events, triage protochols, modes of transportation and patients‘ outcomes that can be used to review and improve response of such incidents, both on scene and in hospitals.