• Karin Hugelius, Samuel Edelbring, and Karin Blomberg.
• Faculty of Medicine and Health, Örebro University, Örebro, Sweden Karin.hugelius@oru.se.
• BMJ Open. 2021 Sep 23; 11 (9): e048792.

ObjectiveTo explore the relationship between preparations and real-life experiences among prehospital major incident commanders.DesignAn explorative, qualitative design was used.SettingPrehospital major incidents in Sweden. Data were collected between December 2019 and August 2020.ParticipantsPrehospital major incident commanders (n=15) with real-life experiences from major events, such as fires, bus accidents, a bridge collapse and terrorist attacks, were included. All but one had participated in 2-day training focusing on the prehospital management of major incidents. In addition, about half of the participants had participated in simulation exercises, academic courses and other training in the management of major incidents.MethodsData from two-session individual interviews were analysed using inductive thematic analysis.ResultsThe conformity between real-life major incidents and preparations was good regarding prehospital major incident commanders' knowledge of the operational procedures applied in major incidents. However, the preparations did not allow for the complexities and endurance strategies required in real-life incidents. Personal preparations, such as mental preparedness or stress management, were not sufficiently covered in the preparations. To some extent, professional experience (such as training) could compensate for the lack of formal preparations.ConclusionsThis study identified perceived gaps between preparations and real-life experiences of being a prehospital major incident commander. To minimise the gaps between demands and expectations on perceived control and to better prepare individuals for being prehospital major incident commanders, the training and other preparations should reflect complexities of real-life incidents. Preparations should develop both technical skills required, such as principles and methodology used, and personal preparedness. Personal preparations should include improving one's mental preparedness, self-knowledge and professional self-confidence required to successfully act as a prehospital incident commander. Since little is known about what pedagogical methods that should be used to enhance this, further research is needed.© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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