Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway – an interview study

Abstract

Background High demands are placed on the emergency medical services to handle rescue operations in challenging environments such as tunnels. In Oslo, Norway a specialised management function within the emergency medical services, the medical on-scene commander, in line with the command structure within the police and fire brigade, might support or take over command and control from the ambulance incident officer arriving as the first ambulance personnel on scene. The aim was to shed light on the emergency medical service experiences from real tunnel incidents described by the Oslo medical on-scene commanders. Methods Interviews were conducted with six of the seven medical on-scene commander in Oslo, Norway. Data were analysed using a qualitative content analysis. Results The overall theme was “A need for mutual understanding of a tunnel incident”. The medical on-scene commander provided tactical support, using their special knowledge of risk objects and resources in the local area. They established operation plans with other emergency services (the police and fire brigade) in a structured and trustful way, thus creating a fluent and coordinated mission. Also, less time was spent arguing at the incident site. By socialising also outside ordinary working hours, a strong foundation of reliance was built between the different parties. A challenge in recent years has been the increasing ordinary workload, giving less opportunity for training and exchange of experiences between the three emergency services. Conclusions The enthusiastic pioneers within the three emergency services have created a sense of familiarity and trust. A specially trained medical on-scene commander at a tunnel incident is regarded to improve the medical management. To improve efficiency, this might be worth studying for other emergency medical services with similar conditions, i.e. tunnels in densely populated areas.

Prehospital major incident management: how do training and real-life situations relate? A qualitative study

“…One question that caused a burden to the commanders pertained to the responsibility for the safety and security of colleagues. The same issue has been described among prehospital incident commanders during tunnel incidents 24 and terrorist attacks. 18 During the interviews, reflections about the acceptable levels of risks, formal and moral obligations, legal and professional responsibilities of ambulance personnel in general were raised, as well as dilemmas in the specific context of a major incident.…”

Templates for handling multi-agency collaboration activities and priorities in mining injury incidents: a Delphi study

“…In such a case the incident might escalate, resulting in negative consequences such as a time delay. Hylander et al (2019) conclude in a study concerning on-scene commanders that a mutual understanding among the emergency services could improve efficiency and decrease time arguing at the scene. Also at the strategic level, there is a need to create collaboration among the stakeholders from the involved organizations to improve the multi-agency response in emergencies in extreme environments to avoid unnecessary time loss (Stierna Doohan et al ., 2019).…”

Senior ambulance officers in Swedish emergency medical services: a qualitative study of perceptions and experiences of a new management role in challenging incidents

“…8 29 30 According to the senior function for prehospital medical management developed in Oslo, the EMS shows a more active attitude and uses the policy of 'safe enough' instead of 'entirely safe'. 6 The 'safe enough' policy might be a new approach for some, and more research, and perhaps even new legislation, is needed before there can be a change in attitude within the Swedish EMS.…”

“…This is in line with experiences from Oslo showing that mutual trust improves on-site collaboration. 6 Others have also shown that it is beneficial to have a pre-existing bond between the emergency services officers before managing an emergency together. 31 In this study, other collaborative organisations, such as the RTCC, were asked to be included in the collaboration forum because this was perceived to improve on-site collaboration.…”

“…In Oslo, knowledge about, for example, road tunnels, is seen as an important factor for a quick and competent response. 6 If an MI occurs in a road tunnel, this puts extra demands on both the victims and the emergency services. This was what happened in the Oslofjord tunnel in Norway in 2011, where 32 road users were injured.…”