To better understand the effects of delayed medical care and long transportation times when emergency medical services (EMS) failed after the 1999 Chi-Chi, Taiwan earthquake, we analyzed the patterns and outcomes of patients with chest injuries who were transferred to an unaffected back-up hospital. The medical records of 164 trauma patients who were transferred to Taichung Veterans General Hospital from September 21 to September 24, 1999 were reviewed. Of the 164 patients, 26 (15.9%) had chest injuries. Chest injuries were caused by blunt trauma in all cases. Minor chest injury was noted in 16 patients (61.5%). Mortality developed in two patients, who were transferred after first aid in the field hospital and were in shock status on arrival to emergency department of the back-up hospital. Inadequate resuscitation attributable to insufficient manpower in field hospitals and long transportation times to back-up hospitals are the major problems to be solved in developing disaster plans. For evacuation of overwhelming casualties and for support of medical resources, transportation by helicopter is suggested in aftermath of a large earthquake.