On July 22, 2011, a single perpetrator killed 77 people in a car bomb attack in Oslo and a shooting spree incident on the island called Utøya in Norway. The following emergency medical response is now described and analysed. It is a good read on EMS response to major incidences and the challenges EMS can face in response to disasters.

Apart from the sad fact that it only takes one idiot to ruin the lives of many, there are now surfacing accounts of the lessons learned. This paper is covering the EMS response, and is summing up the difficulties getting an overview, finding a good place to set up your casualty clearing station and triage, and how to handle the amount of emergency response personnel, vehicles and aircrafts in a compact area that’s not designed to deal with this kind of traffic and activity. And as a bonus, having suboptimal weather conditions for flying.

It also talks about it all coming together anyway, due to the will among the emergency response crews to make this happen, and how logistics were sorted out along the way to make things work safely and quickly. An interesting look at a different side of the Utøya tragedy. Written by the people who were in charge and responded to the incident.

There’s also an excellent commentary on the report, by professor David J Lockey from London HEMS. Here are some of his points:

“Despite this challenge the response times described in this article are excellent. In Oslo the first ambulance was on scene three minutes after the first emergency call and a major incident was declared at eight minutes. At twenty six minutes there were 41 ambulances on scene and at 90 minutes all immediate needs had been met and the emergency resources were effectively ready for redeployment.”

“The fact that sixty flight movements were recorded during this incident does demonstrate the importance of air ambulances at this type of incident. It would be valuable to model the likely attendance times of advanced medical teams and evacuation times of casualties without the use of helicopters.”

“At Utøya island the challenges were more complex. In a more rural location the first ambulance was on scene in nine minutes and a major incident declared at 21 minutes. Victims could not be attended for more than an hour but the complex scene was cleared of victims two hours after first attendance.”

Although Oslo does not have the traffic congestion of large cities like London, the small population of Oslo, around 600.000, makes a show of 40 ambulances at scene quite impressive. Also, the gathering of 6 air ambulance helicopters and two military medical SAR helicopters is very impressive.

All the take-offs and landings and the presence of additional helicopters from the police and news agencies, gave the area air traffic like a medium sized airport – without the central control tower. And the poor visibility made it even more challenging. The rescue helicoptres resorted to communicating on the emergency channel.

The triage and treatment was solved by the experienced anaesthetist retrieval doctors and special paramedics on scene:

“Analysis of multiple scenes after the London bombings suggested improved triage and low mortality associated with physician-paramedic teams on scene [ref]. This was the model used at [the Oslo and Utoya] incidents and the mortality after attendance by physician-paramedic teams is reported as very low.”

A final note on communication problems and providing good emergency medical service (bold by us):

“[Sollid et al] describe some failure of communication … It is important to note that no well reported major incident has ever been free of communication issues. Providing good care without perfect communication should be the aim of all EMS systems. This appears to have happened in these incidents and may have been due to the presence of senior physicians and paramedics at the scene.”

Oslo government district bombing and Utøya island shooting July 22, 2011: The immediate prehospital emergency medical service response – Stephen JM Sollid et al

The commentary: The shootings in Oslo and Utøya island July 22, 2011: Lessons for the International EMS community – David J Lockey

Both articles from the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2012.

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