Citation

Brandrud AS, Bretthauer M, Brattebø G, Pedersen MJ, Håpnes K, Bjorge T, Nyen B, Strauman L, Schreiner A, Møller K, Helljesen GS, Bergli M, Nelson E, Morgan TS, Hjortdahl P. BMJ Qual. Saf. 2017; 26(10): 806-816.

Affiliation

Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.

Copyright

(Copyright © 2017, BMJ Publishing Group)

DOI

10.1136/bmjqs-2017-006517

PMID

28676492

Abstract

INTRODUCTION: On 22 July 2011, Norway suffered a devastating terrorist attack targeting a political youth camp on a remote island. Within a few hours, 35 injured terrorist victims were admitted to the local Ringerike community hospital. All victims survived. The local emergency medical service (EMS), despite limited resources, was evaluated by three external bodies as successful in handling this crisis. This study investigates the determinants for the success of that EMS as a model for quality improvement in healthcare.

METHODS: We performed focus group interviews using the critical incident technique with 30 healthcare professionals involved in the care of the attack victims to establish determinants of the EMS' success. Two independent teams of professional experts classified and validated the identified determinants.

RESULTS: Our findings suggest a combination of four elements essential for the success of the EMS: (1) major emergency preparedness and competence based on continuous planning, training and learning; (2) crisis management based on knowledge, trust and data collection; (3) empowerment through multiprofessional networks; and (4) the ability to improvise based on acquired structure and competence. The informants reported the successful response was specifically based on multiprofessional trauma education, team training, and prehospital and in-hospital networking including mental healthcare. The powerful combination of preparedness, competence and crisis management built on empowerment enabled the healthcare workers to trust themselves and each other to make professional decisions and creative improvisations in an unpredictable situation.

CONCLUSION: The determinants for success derived from this qualitative study (preparedness, management, networking, ability to improvise) may be universally applicable to understanding the conditions for resilient and safe healthcare services, and of general interest for quality improvement in healthcare.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Language: en

Keywords

Communication; Crisis management; Medical emergency team; Quality improvement; Team-training