Non-medical aspects of civilian–military collaboration in management of major incidents

Abstract

PurposeDisasters and major incidents demand a multidisciplinary management. Recent experiences from terrorist attacks worldwide have resulted in a search for better assessment of the needs, resources, and knowledge in the medical and non-medical management of these incidents and also actualized the need for collaboration between civilian and military healthcare. The aim of this study was to evaluate the impact of the civilian–military collaboration in a Swedish context with the main focus on its non-medical management.MethodAn exercise, simulating a foreign military attack centrally on Swedish soil, was designed, initiated, and conducted by a team consisting of civilian and military staff. Data were collected prospectively and evaluated by an expert team.ResultsSpecific practical and technical issues were presented in collaboration between civilian and military staffs. In addition, shortcomings in decision-making, follow-up, communication, and collaboration due to prominent lack of training and exercising the tasks and positions in all managerial levels of the hospital were identified.ConclusionCurrent social and political unrests and terror attacks worldwide necessitate civilian–military collaboration. Such collaboration, however, needs to be synchronized and adjusted to avoid preventable medical and non-medical consequences. Simulation exercises might be one important source to improve such collaboration.

Facilitators and constrainers of civilian–military collaboration: the Swedish perspectives

“…It consists of necessary non-medical steps to initiate a leadership, collaboration, coordination, mutual communication, staff recruitment, and annual training. A good plan may also facilitate some medically important measures such as blood delivery, unified triage, psychological follow-up and quick distribution of patients to the operating theatres, intensive care units, or other wards [2,9,11]. A reliable, quick, standardized and professional prehospital healthcare, including aeromedical and marine care, is an important part of the disaster, and emergency care [30][31][32].…”

“…The existence or absence of valid disaster/emergency plan, trained and experienced command and control staff, reliable and unified communication system, ability to collaborate and coordinate, informationsharing, internal and external logistic, and training in a multidisciplinary setting are all important non-medical facilitators or constrainers. Meanwhile, evidence-based medical guidelines, simple and unified triage system, evidence-based prehospital, hospital, and on-route treatment strategies, are all important medical factors for successful medical management of an incident and consequently facilitators or constrainers [2,9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

“…As for Sweden, any incident with the same magnitude as in Paris will be a devastating and yet stronger indication for CMC. In an earlier report, the non-medical aspects of Swedish CMC were discussed [11], the aim of this review was to identify facilitators and constrainers of a civilian-military collaboration in a global and national perspective with a focus on its medical consequences.…”

Immediate response to major incidents: defining an immediate responder!

“…An increasing number of mass casualty incidents (MCIs) in recent years has revealed some major shortcomings in the medical and non-medical aspects of its management [1][2][3][4]. Besides natural disasters and armed conflicts, terrorism and mass shootings have emerged as main causes of mass injuries, deaths, and global threats [5][6][7].…”

Editorial: “Focus on disaster and military surgery”

“…The second one concerns follow-up and rehabilitation of these patients. In the second of the two articles, Khorram-Manesh et al describe a feasibility study in which a large-scale exercise was developed and deployed in Sweden to test military civilian cooperation following a mass casualty scenario (soldiers injured in combat transported to a civilian hospital by air) [4]. Several shortcomings were identified including different reporting The aim of the section for Disaster and Military Surgery is to promote both scientific knowledge and education of general and acute care surgeons in the treatment of injuries seen following disaster and wars.…”