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Major incidents in tunnel environment will pose several challenges for the emergency service organisations in terms of heat, visibility and lack of experiences from working in confined environments. These aspects, in turn, could pose challenges to establish collaboration. This study aims to contribute to the field of collaborative tunnel responses by exploring how “common knowledge” (Edwards, 2011) is built by the emergency services organisations, that is, what the organisations consider important while working on a potentially common problem, and their motives for the interpretations and actions if a major tunnel incident occurs.

Participants from the road traffic control centre, emergency dispatch centre, emergency medical service, rescue service and police were included in the study. Data from four focus group sessions was analysed using thematic analysis.

The study revealed that the tunnel environment presents specific aspects of how common knowledge was produced related to lifesaving and safety. The themes structuring mechanisms to reduce uncertainty, managing information for initial priorities, aligning responsibilities without hampering each other's work and adjusting actions to manage distance, illustrated how common knowledge was produced as crucial aspects to a collaborative response. Organising management sites, grasping and communicating risks, accessing the injury victims, was challenged by the confined environment, physical distances and imbalance in access to information and preparedness activities in tunnel environments.

This study offers new insights of common knowledge, by illustrating a motive perspective on collaborative responses in tunnel incidents. Creating interoperability calls not just for readiness for action and tunnel safety, but also training activities acknowledging different interpretations and motives to further develop tunnel responses.

Involvement of parents/carers may increase effectiveness of primary school-based alcohol-misuse prevention projects through strengthening family-based protective factors, but rates of parental engagement are typically low. This paper reports findings from an exploratory trial of a school-based prevention intervention – Kids, Adults Together (KAT), based on the Social Development Model, which aimed to promote pro-social family communication in order to prevent alcohol misuse, and incorporated strategies to engage parents/carers. The purpose of this paper is to assess the feasibility and value of conducting an effectiveness trial of KAT.

The study was a parallel-group cluster randomised exploratory trial with an embedded process evaluation. The study took place in south Wales, UK, and involved nine primary schools, 367 pupils in Years 5/6 (aged 9-11 years) and their parents/carers and teachers. Questionnaires were completed by pupils at baseline and four month follow-up, and by parents at six month follow-up.

Overall KAT was delivered with good fidelity, but two of five intervention schools withdrew from the study without completing implementation. In total, 50 per cent of eligible parents participated in the intervention, and KAT had good acceptability among pupils, parents and teachers. However, a number of “progression to effectiveness trial” criteria were not met. Intermediate outcomes on family communication (hypothesised to prevent alcohol misuse) showed insufficient evidence of an intervention effect. Difficulties were encountered in identifying age appropriate outcome measures for primary school-age children, particularly in relation to family communication processes. The study was unable to find comprehensive methodological guidance on exploratory trials.

It would not be appropriate to conduct an effectiveness trial as key progression criteria relating to intervention and trial feasibility were not met. There is a need for new measures of family communication which are suitable for primary school-age children, and more guidance on the design and conduct of exploratory/feasibility trials.

KAT achieved high rates of parental involvement, and its theoretical framework and processes could be adapted by other interventions which experience difficulties with recruitment of parents/carers.

Emergency care delivery is a process requiring input from various healthcare professionals within the hospital. To deliver efficient and effective emergency care, professionals must integrate rapidly at multiple interfaces, working across functional, spatial and professional boundaries. Yet, the interdisciplinary nature of emergency care presents a challenge to the optimization of patient flow, as specialization and functional differentiation restrict integration efforts. This study aims to question what boundaries exist at the level of professionals and explores how these boundaries may come to influence integration and operational performance.

To provide a more holistic understanding of the inherent challenges to integration at the level of professionals and in contexts where professionals play a key role in determining operational performance, the authors carried out an in-depth case study at a busy, Level 1 trauma center in The Netherlands. In total, 28 interviews were conducted over an 18-month period.

The authors reveal the existence of structural, relational and cultural barriers between (medical) professionals from different disciplines. The study findings demonstrate how relational and cultural boundaries between professionals interrupt flows and delay service processes.

This study highlights the importance of interpersonal and cultural dynamics for internal integration and operational performance in emergency care processes. The authors unveil how the presence of professional boundaries creates opportunity for conflict and delays at important interfaces within the emergency care process, and can ultimately accumulate, disrupting patient flow and increasing lead times.