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Mass casualty incidents are characterised by an immediate, unforeseen and unquantifiable surge in demand for ambulance services which soon becomes apparent and will exceed any “local” resources available. Casualties require the correct treatment, promptly, at an appropriate resource without incurring any further harm. In the absence of firm operational guidelines, this paper provides templates for ambulance commanders both at call centre and on-site to approach the management of mass casualty incidents.

Desk research indicated that there were both guidelines on how various elements of the emergency services should work together plus academic papers on techniques to adopt in mass casualty situations. Standing orders or written protocols for ambulance commanders, however, provide little or no specific guidance or an outline plan upon how they should command in a mass casualty situation. Following analysis of relevant public enquiry reports and discussions with ambulance commanders and using the materials from desk research, a four-stage approach was devised for testing using retrospective analysis from field and desktop exercises.

To have confidence, each commander needs simple digital real-time templates from which they understand their role and how the overall plan defines priorities with the greatest need. A plan should cover call-centre and on-site operations including a basic operational checklist from start to finish; resource structure and inter-relationships; sources and availability of resources plus information and control procedures to impose limited quality control procedures.

The design and implementation of digital templates to provide minute-by-minute visibility to all commanders which have not been recorded before. Such templates give commanders confidence to determine, locate and call forward relevant resources to attend casualties in order of priority of need. Time-lapsed records are useful not just in the minute-by-minute decision processes but also for critical organisational learning and in any post-event review by either a coroner or lawyers at a public enquiry.

The purpose of this paper is to examine emergency medical service (EMS) personnel’s perceptions and experiences of managing underground mining injury incidents.

In total, 13 EMS personnel were interviewed according to a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using qualitative content analysis.

An underground mining environment was described as unfamiliar and unsafe and, with no guidelines for operational actions in an extreme environment, such as underground mines, the EMS personnel were uncertain of their role. They therefore became passive and relied on the rescue service and mining company during a major incident. However, the medical care was not considered to be different from any other prehospital care, although a mining environment would make the situation more difficult and it would take longer for the mine workers to be placed under definitive care.

This study complements earlier studies by examining the EMS personnel’s perceptions and experiences of major incidents.

The purpose of this paper is to further the theoretical understanding of leadership in emergency type organisations by modelling contextual aspects which are assumed to influence it.

A theoretical analysis followed by an operationalisation of key concepts and two small‐scale empirical cross‐sectional tests.

Contextual conditions at the group, organisation, and environmental levels that are assumed to influence leadership in emergency type organisations were modelled in lower‐ to higher‐extent bipolar dimensions. An empirical test involving Scandinavian military officers (n=57) and Swedish health care (ambulance) professionals (n=39) yielded profiles for leaders at three different hierarchical levels during severely demanding operations: field‐level group/team leaders; field‐level commanders/managers; and high‐level strategic commanders/managers. Considerable differences were found between the three profiles on scales designed to measure environmental and more structure‐related organisational conditions. Almost no differences were noted on “softer” aspects such as organisational culture and small group characteristics.

The study focuses only on traditional hierarchical organisations that are designed to function in extreme conditions (the armed forces and acute health care).

If empirically further tested and proved valid, the suggested model could be of value in leadership and organisational development efforts.

The theoretical approach is new. The presented operationalisations open up for full‐model tests of leadership models based on an interactional person‐by‐situation paradigm.

Major incidents in road tunnels remain a collaborative challenge for the emergency services (fire and rescue service, police and ambulance), emergency dispatch centres (EDCs) and infrastructure owners. The aim of this paper is to investigate how collaborative partners to the ambulance services perceive the rescue effort and to identify factors that may influence its efficiency.

Focus group and individual interviews were conducted with 19 participants who were infrastructure owners or had operational or tactical responsibilities with the emergency services or EDCs in two regions in Sweden with multiple road tunnels. The collected data were analysed using qualitative content analysis.

Three main categories described efficiency factors during and after an incident: (1) coordinating the initial information (using a shared terminology), (2) achieving situational awareness (identifying those persons in need) and (3) lessons (not) learnt (lack of joint tactical plans and exercises). The emerging theme was access, assess and evaluate.

The findings suggest that establishing national policies and collaborative forums might yield more efficiently managed rescue efforts in road tunnel incidents in Sweden and other countries with similar organisational structures.

This study offers new insights on interoperability during responses to complex underground incidents.

Spree killing impacts significantly on emergency services and is becoming more prevalent across the world. The purpose of this paper is to explore the Cumbrian spree killing, which resulted in the fatal shooting of 12 people with a further 11 wounded. This study highlights why these events are so difficult to manage in an attempt to assist policy makers and practitioners deal with them more effectively.

A qualitative methodology was used, examining open source information and internal police documentation. This was supported by semi-structured interviews with command staff (three), and questionnaires involving a representative group of police staff (11), who were all deployed on the incident.

This case study mirrored the characteristics of many other spree killings. The sophistication of the killer, together with the speed of mobility, significantly increases the challenges posed to the police, specifically in terms of: deployment, decision making, interoperability and managing the media. Further, it questions the effectiveness of normal command and control management approaches that are typically used in these situations.

Spree killing (active shooter) events are increasing across the globe. This study highlights the critical challenges to be dealt with. It argues a more innovative inter-agency paradigm is needed to deal with crimes in action.

There are few academic papers in relation to spree killing. This paper analyses the factors that impact upon the effectiveness of the police response.

ABERDEEN‐based Bond Helicopters is set to provide high speed support to the roadbound ambulance service in the West Midlands.

The purpose of this paper is to explore the nature of humour within two different organisations, policing and ambulance work, which are linked by their focus on emergency work.

Semi structured interviews with 45 police officers and ambulance staff sought to understand more about the relationships between these two distinctly different professions who work together closely and regularly in often very difficult situations.

Interviews with police officers and ambulance staff revealed that humour is a key component in the working relationship of police officers and ambulance staff. The humour of superiority and the humour of exclusion are used to both cope with the demands of their work, reinforce group values and to strengthen the shared bonds between the two occupations.

Humour has been studied within organisations but this paper reveals that humour also functions across occupational divides. Police officers and ambulance staff draw from a mutually acceptable but culturally defined joke‐book in the course of their work. The informal forces of humour appear, ironically, to provide a means of enhanced interoperability between the two organisations but at the expense of other agencies involved within the emergency service field.

The purpose of this paper is to explore the organisational cultures of two different parts of the emergency service, the police and the ambulance service.

Semi-structured interviews with 45 police officers and ambulance staff sought to understand more about the relationships between these two distinctly different professions who work together closely and regularly in often very difficult situations.

Interviews with police officers and ambulance staff revealed the strong and harmonious working relationship between the two professions and an existence of both shared organisational characteristics and shared cultural characteristics. These cultural characteristics, identified as both explicit and tacit in nature provide the “glue” which not only binds each organisation together but which appears to cement a longer term, tangible link between the police and ambulance services.

This paper reveals a new dimension within cultural analyses of occupational groups by considering the shared cultural characteristics of two groups within the emergency services, police officers and ambulance staff. This potential for cultural boundary crossing is explored in detail.

The purpose of the paper is to explore the universality of a qualitatively (grounded theory) developed model of leadership in complex and/or stressful rescue operations.

The model was operationalised and tested on leaders (n=385) from the ambulance service, the police force, and the rescue services in Sweden. A questionnaire was operationalised from the codes and categories of the previously developed model.

The study showed that the most important factors in explaining the outcome of complex rescue operations were organisational climate before the incident, positive stress reactions, and personal knowledge of the co‐actors during the episode. Cases where the leader appraised that the situation could not be resolved with the available resources were characterised by less favourable ratings, irrespective of whether humans were perceived as being threatened or not. The strength of this controllability aspect was interpreted in terms of a professional action‐oriented identity.

The results were affected by a high dropout rate and the fact that there were comparatively few large‐scale rescue operations.

The results may be valuable in both training and exercises with rescue operation commanders.

The paper presents a validation of a new, integrative, theoretical process model of leadership in complex, stressful rescue operations.