• Johan Hylander, Britt-Inger Saveman, Ulf Björnstig, and Lina Gyllencreutz.
• Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, 901 87, Umeå, Sweden. johan.hylander@umu.se.
• Scand J Trauma Resus. 2019 Aug 20; 27 (1): 7878.

BackgroundHigh demands are placed on the emergency medical services to handle rescue operations in challenging environments such as tunnels. In Oslo, Norway a specialised management function within the emergency medical services, the medical on-scene commander, in line with the command structure within the police and fire brigade, might support or take over command and control from the ambulance incident officer arriving as the first ambulance personnel on scene. The aim was to shed light on the emergency medical service experiences from real tunnel incidents described by the Oslo medical on-scene commanders.MethodsInterviews were conducted with six of the seven medical on-scene commander in Oslo, Norway. Data were analysed using a qualitative content analysis.ResultsThe overall theme was "A need for mutual understanding of a tunnel incident". The medical on-scene commander provided tactical support, using their special knowledge of risk objects and resources in the local area. They established operation plans with other emergency services (the police and fire brigade) in a structured and trustful way, thus creating a fluent and coordinated mission. Also, less time was spent arguing at the incident site. By socialising also outside ordinary working hours, a strong foundation of reliance was built between the different parties. A challenge in recent years has been the increasing ordinary workload, giving less opportunity for training and exchange of experiences between the three emergency services.ConclusionsThe enthusiastic pioneers within the three emergency services have created a sense of familiarity and trust. A specially trained medical on-scene commander at a tunnel incident is regarded to improve the medical management. To improve efficiency, this might be worth studying for other emergency medical services with similar conditions, i.e. tunnels in densely populated areas.

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