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Purpose: To investigate prehospital preparedness work for Mass Casualty Incidents (MCI) and Major Incidents (MI) in Norway. Method: A national cross-sectional descriptive study of Norway's prehospital MI preparedness through a web-based survey. A representative selection of Rescue and Emergency Services were included, excluding Non-Governmental Organisations and military. The survey consisted of 59 questions focused on organisation, planning, education/training, exercises and evaluation. Results: Totally, 151/157 (96%) respondents answered the survey. The results showed variance regarding contingency planning for MCI/MI, revisions of the plans, use of national triage guidelines, knowledge requirements, as well as haemostatic and tactical first aid skills training. Participation in interdisciplinary on-going life-threatening violence (PLIVO) exercises was high among Ambulance, Police and Fire/Rescue Emergency Services. Simulations of terrorist attacks or disasters with multiple injured the last five years were reported by 21/151 (14%) on a regional level and 74/151 (48%) on a local level. Evaluation routines after MCI/MI events were reported by half of the respondents (75/151) and 70/149 (47%) described a dedicated function to perform such evaluation. Conclusion: The study indicates considerable variance and gaps among Prehospital Rescue and Emergency Services in Norway regarding MCI/MI preparedness work, calling for national benchmarks, minimum requirements, follow-up routines of the organisations and future reassessments. Implementation of mandatory PLIVO exercises seems to have contributed to interdisciplinary exercises between Fire/Rescue, Police and Ambulance Emergency Service. Repeated standardised surveys can be a useful tool to assess and follow-up the MI preparedness work among Prehospital Rescue and Emergency Services at a national, regional and local level. [ABSTRACT FROM AUTHOR]

Increasingly confronted with the acute risk of large-scale disaster, local governments across the globe are searching for effective and efficient strategies for scaling their disaster response capacity. Emergency management research has examined such strategies in various urban settings, but still suffers from the lack of proper theoretical frameworks for studying how institutionalized modes of governance condition local scalability in different national contexts. Building on the research tradition of urban governance, this article develops a conceptual framework for conducting institutional analysis of overarching values, norms and practices that shape the local scaling of disaster response capacity. It demonstrates the analytical value of the framework by applying it in an illustrative case study of disaster response systems in the three Scandinavian countries of Sweden, Denmark, and Norway. The framework proves useful for systematizing and discussing nuances within and across institutional contexts. [ABSTRACT FROM AUTHOR]

This article addresses performance management of coordinating agencies in the field of societal security by examining what kind of administrative capacity their parent ministries focus on. It examines the performance contracts issued to the Norwegian Directorate for Civil Protection and Emergency Planning and the Swedish Civil Contingencies Agency. Based on a structural-instrumental and a cultural perspective, the importance of coordination, delivery, analytical and regulatory capacities is analyzed. A main finding is that the different governmental models of Sweden and Norway affect the number of performance objectives, while tasks and external shocks have some effect on the distribution of the different types of capacity. Despite being set up to act as boundary spanners in the policy field, both organizations are hybrid and compound agencies combining coordination capacity objectives with analytical, delivery and regulatory capacity objectives. [ABSTRACT FROM AUTHOR]

Background: In the wake of terrorist attacks, protecting the health and psychosocial wellbeing of those affected and the general population, are important tasks for the healthcare system. The responses to such emergencies are often complex, including different phases and many actors, and may unveil insufficiencies that incite reforms to existing systems. Recently, initiatives have been promoted to strengthen cooperation and coordination regarding the governance of health threats in Europe. Comparative research is requested on how states prepare for health emergencies such as terrorist attacks. This study investigated how governments in two European countries with universal health coverage prepared to address the civilian population's health needs after terrorist attacks, and the factors that contributed to shaping their chosen approach. Methods: Utilizing document analysis and Walt and Gilson's model for the analysis of health policy, national plans for post-terror health responses in Norway and France were studied with a focus on context, process, content, and actors. Results: Whereas target groups for psychosocial care and certain measures were similar in both cases, the contents of prescribed policies and the actors responsible for enacting them differed. One of the most distinct differences was to what extent specialized mental healthcare was relied upon to provide psychosocial follow-up in the emergency phase. In the French approach, specialized mental healthcare practitioners, such as psychiatrists, psychologists and psychiatric nurses, provided early psychosocial support. In contrast, the Norwegian approach relied on interdisciplinary primary care crisis teams in the local municipalities to provide early psychosocial support, with further involvement of specialized mental healthcare if this was considered necessary. Historical, political, and systemic differences contributed to the variation in the countries' responses. Conclusions: This comparative study highlights the complexity and diversity of health policy responses to terrorist attacks across countries. Moreover, challenges and opportunities for research and health management in response to such disasters, including possibilities and potential pitfalls for the coordination of this work across Europe. An important first step could be to map out existing services and practices across countries to better understand if and how common core elements for psychosocial follow-up might be implemented internationally. [ABSTRACT FROM AUTHOR]

In these turbulent times of increased frequency and magnitude of emergencies caused by climate change, pandemics, and other public safety hazards, there has been a growing interest in the question of how to enhance the robustness of emergency management systems. Recent research points to integrated networks of public and non‐profit actors as a superior strategy for developing robust governance responses to turbulent problems. This article suggests that institutionally conditioned trust between professionals and volunteers is key to robust emergency management. Based on institutional trust theory and the findings of an empirical case study of local emergency management in Denmark and Norway, it shows how six institutional sources of trust condition the scalable use of organized emergency management volunteers. The study contributes with a theoretical argument and empirical insights on how institutional trust strengthens the robust governance and management of emergencies. [ABSTRACT FROM AUTHOR]

Introduction: Little international comparative work exists describing pandemic-related spikes in overdose and related implications for drug and public health policy. We compared increases in overdose deaths during the pandemic in Norway and the United States, two countries in the top 10 for per-capita overdose mortality, yet with very different approaches to the pandemic, healthcare and drug policy. Methods: We examined monthly overdoses in 2020 versus baseline rates (the monthly average across 2017–2019). We compared excess overdose mortality to shifts in human mobility and social interaction, measured using cellphone-based mobility data, an indicator of the societal response to the pandemic. Results: Both the US and Norway saw large magnitude exacerbations in overdose mortality during the pandemic-related lockdowns, reaching 46.8% and 57.0% above baseline, respectively. Maximum increases occurred 2–3 months after peak reductions in mobility, suggesting lagged mechanisms. While overdose mortality returned to baseline relatively quickly in Norway, rates remained elevated in the US to the end of 2020. Conclusions: Spikes in overdose mortality in both contexts may relate to disruptions in healthcare access and the drug supply becoming more potent. Norway's quicker return to baseline may reflect more robust access to harm reduction and addiction-related healthcare services. Nevertheless, it is notable that even in Norway – with universal access to high-quality services, low COVID-19 rates, and a highly effective public health infrastructure – a greater than 50% spike in overdose deaths was still seen at the onset of lockdown measures. This may have important implications for future pandemic and disaster planning. [ABSTRACT FROM AUTHOR]

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Common operational understanding among engaged emergency responders is facilitated through shared operational pictures during crisis situations. Sharing is typically achieved through interactive tools, either desktop or web-based, in which map displays play an essential role. That role can be further strengthened if (1) agreed emergency symbols that are used in map-based interactive tools are sufficient to encode multifaceted operational information visually; and (2) the symbols are legible and meaningful for the diverse users of those tools. The authors revisited official emergency map symbols in use in Norway and reconsidered them against current requirements. To this end, they first conducted several meetings with stakeholders to elicit adequate revision requirements. Next, the reconsideration included the extension of the symbol set, symbol modification, and grouping. After the reconsideration, emergency management officers and specialists were interviewed. The interviews confirmed the agreement with the symbol categorization, extension of the symbols, and their modifications. The interviewees also made numerous suggestions to be considered in a follow-up study. Moreover, two concepts – symbol standardization and symbol harmonization – were proposed. [ABSTRACT FROM AUTHOR]

Background: Infection with the novel coronavirus SARS‐CoV‐2 induces antibodies that can be used as a proxy for COVID‐19. We present a repeated nationwide cross‐sectional study assessing the seroprevalence of SARS‐CoV‐2, the infection fatality rate (IFR), and infection hospitalization rate (IHR) during the first year of the pandemic in Norway. Methods: Residual serum samples were solicited in April/May 2020 (Round 1), in July/August 2020 (Round 2) and in January 2021 (Round 3). Antibodies against SARS‐CoV‐2 were measured using a flow cytometer‐based assay. Aggregate data on confirmed cases, COVID‐19‐associated deaths and hospitalizations were obtained from the Emergency preparedness registry for COVID‐19 (Beredt C19), and the seroprevalence estimates were used to estimate IFR and IHR. Results: Antibodies against SARS‐CoV‐2 were measured in 4840 samples. The estimated seroprevalence increased from 0.8% (95% credible interval [CrI] 0.4%–1.3%) after the first wave of the pandemic (Rounds 1 and 2 combined) to 3.2% (95% CrI 2.3%–4.2%) (Round 3). The IFR and IHR were higher in the first wave than in the second wave and increased with age. The IFR was 0.2% (95% CrI 0.1%–0.3%), and IHR was 0.9% (95% CrI 0.6%–1.5%) for the second wave. Conclusions: The seroprevalence estimates show a cumulative increase of SARS‐CoV‐2 infections over time in the Norwegian population and suggest some under‐recording of confirmed cases. The IFR and IHR were low, corresponding to the relatively low number of COVID‐19‐associated deaths and hospitalizations in Norway. Most of the Norwegian population was still susceptible to SARS‐CoV‐2 infection after the first year of the pandemic. [ABSTRACT FROM AUTHOR]

The strategic contingency plans on all levels in Norway include references to possible needs for translating and adapting information flow into other languages. However, the situation at the grassroot level shows that these measures have not been considered an essential service. Valuable time passed during the first wave of COVID-19 until different public actors figured out their responsibilities and before the information was translated, adapted, and given, via appropriate media, to the beneficiaries. This article analyses actors and actions in eight online articles published by the Norwegian Broadcasting Corporation, NRK, focusing on crisis communication, and linguistic diversity in Norway during the initial period of the COVID-19 pandemic (March-June 2020). The analysis shows that the pandemic becomes a magnifying glass on the society uncovering social challenges like lack of trust in the authorities, stigmatization, and social inequality. [ABSTRACT FROM AUTHOR]

The degree to which exercises improve the collaboration among different organizations during an emergency is under debate. This study aims to contribute to the scarce research on this topic by giving insight into the perceived effects of exercises on collaboration, learning, usefulness and interorganizational trust. In particular, this quantitative study looked into the differences between the effects of tabletop and full‐scale exercises. A questionnaire assessing collaboration, learning, usefulness and trust—the CLUT instrument—was developed. Data were collected from 173 full‐time emergency management personnel in Norway and Canada. Usefulness, learning and collaboration outcomes were perceived to be high for both types of exercises, but full‐scale exercises were perceived to have greater learning and usefulness outcomes than tabletop exercises. Stronger relationships were identified between the perceived effects on learning and usefulness, collaboration and trust in tabletop compared to full‐scale exercise, whereas the relationship between the perceived effects upon collaboration and trust was stronger in full‐scale exercises. Multiple regression analysis showed that the variables used to measure exercise usefulness can better predict tabletop exercise outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Learning at the local level is an important contributor to safe and resilient communities. The purpose of this article is therefore to explore what motivates municipalities in Norway to learn from disasters and how they learn from them. This purpose has been fulfilled by (1) addressing the process of learning from disasters occurring within municipalities, and (2) learning from disasters in other municipalities, in particular from the terrorist incidents that occurred in Oslo on 22 July 2011. Design/methodology/approach: An interview study was conducted of individuals responsible for municipal emergency preparedness. Findings: Unwanted events that occur outside municipal borders only trigger learning processes if they are geographically proximate. Events occurring within the geographical borders of the municipality represent greater potential for learning than those occurring outside its borders. Availability of resources for municipal civil protection activities is another factor that has an impact on learning. Originality/value: The local level plays a key role in generating and maintaining adequate civil protection and emergency preparedness in society. Although the literature on learning from disasters is extensive, learning processes at the local level have been given little attention. This article thus contributes to the existing body of knowledge by studying learning processes following disasters at the local level. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to investigate how the initial phase of the COVID‐19 pandemic affected the hospital stroke management and research in Norway. Materials and methods: All neurological departments with a Stroke Unit in Norway (n = 17) were invited to participate in a questionnaire survey. The study focused on the first lockdown period, and all questions were thus answered in regard to the period between 12 March and 15 April 2020. Results: The responder rate was 94% (16/17). Eighty‐one % (13/16) reported that the pandemic affected their department, and 63% (10/16) changed their stroke care pathways. The number of new acute admissions in terms of both strokes and stroke mimics decreased at all 16 departments. Fewer patients received thrombolysis and endovascular treatment, and multidisciplinary stroke rehabilitation services were less available. The mandatory 3 months of follow‐up of stroke patients was postponed at 73% of the hospitals. All departments conducting stroke research reported a stop in ongoing projects. Conclusion: In Norway, hospital‐based stroke care and research were impacted during the initial phase of the COVID‐19 pandemic, with likely repercussions for patient care and outcomes. In the future, stroke departments will require contingency plans in order to protect the entire stroke treatment chain. [ABSTRACT FROM AUTHOR]

Aims: To compare the early impact of COVID-19 infections and mortality from February to July 2020 across the Nordic nations of Sweden, Norway, Denmark, and Finland through available public data sources and conduct a descriptive analysis of the potential factors that drove different epidemiological outcomes, with a focus on Sweden's response. Methods: COVID-19 cases, deaths, tests, case age distribution, and the difference between 2020 all-cause mortality and the average mortality of the previous 5 years were compared across nations. Patterns in cell phone mobility data, testing strategies, and seniors' care home deaths were also compared. Data for each nation were based on publicly available sources as of July 31, 2020. Results: Compared with its Nordic peers, Sweden had a higher incidence rate across all ages, a higher COVID-19-related death rate only partially explained by population demographics, a higher death rate in seniors' care, and higher all-cause mortality. Sweden had approximately half as much mobility change as its Nordic neighbours until April and followed similar rates as its neighbours from April to July. Denmark led its Nordic peers in testing rates, while Sweden had the highest cumulative test-positivity rate continuously from mid-March. Conclusions: COVID-19 pushed Sweden's health system to its capacity, exposed systemic weaknesses in the seniors' care system, and revealed challenges with implementing effective contact tracing and testing strategies while experiencing a high case burden. Looser government restrictions at the beginning of the outbreak are likely to have played a role in the impact of COVID-19 in Sweden. In an effort to improve epidemic control, Sweden has increased testing rates, implemented more restrictive prevention measures, and increased their intensive care unit bed capacity. [ABSTRACT FROM AUTHOR]

Background: Helicopter emergency medical services (HEMS) and search and rescue helicopters (SAR) aim to bring specialized personnel to major incidents and transport patients to definite care, but their operational pattern remains poorly described. We aim to describe the use of HEMS and SAR in major incidents in Norway and investigate the feasibility of retrospectively collecting uniform data from incident reports.Methods: We searched HEMS medical databases from three HEMS and one SAR base in south-east Norway for the written reports of incidents from 2000 to 2016. After incidents were included through consensus in the author group, we collected data as described in majorincidentreporting.org and a previous cross-sectional study and rated availability of the variables.Results: From a total of 31 803 missions, we identified 50 (0.16%) major incidents with HEMS/SAR involvement where road traffic accidents were the most common type of incident (n = 28, 56%), and rural area was the most prevalent location (n = 35, 70%). Inter-agency cooperation was common and HEMS contributed most often with treatment and transport. The majority of information was found in the free-text area in the medical records hereby increasing the risk for rater variability.Conclusion: Major incidents are rare in Norway. HEMS and SAR play an important role in incident logistics, cooperation with other agencies, treatment and transport of patients and should be included in major incident plans. Retrospective data collection is challenging as data variables are not systematically integrated into the database. Future research should focus on systematic data gathering and a system for sharing lessons learned. [ABSTRACT FROM AUTHOR]

The aim of the study on which the article is based was to identify groups of communities with similar resilience profiles, using Norwegian municipalities as a case. The authors used a set of socioeconomic and environmental indicators as measures of municipalities' resilience and performed a cluster analysis to divide the municipalities into groups with similar multivariate resilience signatures. The results revealed six groups of municipalities that, apart from their unique combinations of indicator scores, featured certain spatial patterns, such as an "urban cluster" with urbanized municipalities and a "suburban cluster" with municipalities concentrated around major cities. The authors conclude that municipalities in each of the groups shared aspects that made them either more or less resilient to natural hazards, which could make them potential targets for shared interventions. Additionally, the authors conclude that clustering can be used to identify municipalities with similar resilience features and that could benefit from networking and sharing operational planning as a way to improve their respective communities' resilience to natural hazards. [ABSTRACT FROM AUTHOR]

• Weather and climate services (WCS) for farmers in India and Norway reveal similar governance challenges related to format, relevance, and tailoring of knowledge communicated. • A 'most different case study' comparison underscores that WCS remain supply-driven. • More deliberate approaches to institutional design is suggested to foster co-creation and improved engagement of farmers and extension agents in developing the services. • Active use of social media, such as crop-based WhatsApp groups, can facilitate integration between external science-based knowledge/models and local practice and learning. High-quality weather and climate services (WCS) can be critical for communicating knowledge about current and future weather and climate risks for adaptation and disaster risk management in the agricultural sector. This paper investigates the structure and performance of weather and climate services for farmers from a governance perspective. Empirically the paper compares the institutional design and operations of agro-meteorological services in Maharashtra/India and Norway through a 'most different case study' approach. The two cases were selected to represent great diversity in location, scale and institutional design. A governance approach based on semi-direct interviews and policy and institutional analysis was combined with local survey data of farmers' perceptions and use of the services. Despite the fact that the context for the two agromet advisory services was very different from a climate-weather, eco-agriculture and socio-institutional angle, the analysis reveals great similarities in the services structures and critical governance challenges. In both countries the agromet services communicated knowledge that was largely perceived not to be well tailored to farmers' needs for decisions in specific crops- and farm operations, spatially too coarse to address local issues, and, often unreliable or inaccurate in terms of the quality of data. Farmers did, however, respond positively to specific and locally relevant information on e.g., warnings about high rainfall and spread of pests. Observing such similarities across very diverse contexts enhances the generalization potential, precisely because they evolved under very different circumstances. Similar observations find support in the wider WCS literature. Based on the empirical findings, we propose a more deliberate approach to institutional design of WCS in order to enhance governance performance and co-creation of the services at local, district and national scales. It is suggested that greater participation of farmers and agricultural extension agents in the co-creation of these services is a necessary means of improving the services, supported by the WCS literature. However, we insist that greater participation is only likely to materialize if the deficiencies in institutional design and knowledge quality and relevance are addressed to greater extent than done today. The comparison between the two services shows that Norway can learn from India that a more ambitious scope and multiple forms of communication, including the use of social media/WhatsApp groups, can facilitate greater awareness and interest among farmers in multi-purpose agromet services for multi-way communication. India can learn from Norway that a more integrated and decentralized institutional design can strengthen the network attributes of the services, foster co-creation, and improve participation of both poor and large-scale farmers and extension agents. [ABSTRACT FROM AUTHOR]

People with disabilities are often at increased risk during infectious disease pandemics, due to complex biological and social factors. Synergistic biological interactions can lead to severe complications or reduced vaccine efficacy, while people with disabilities also tend to have lower access to health care, higher rates of poverty, might be institutionalized, and are frequently excluded from preparedness planning and crisis responses. Further, there are limited data from historical epidemics to inform public health efforts that address disability concerns. We provide novel evidence for disability-related disparities in influenza outcomes using data from Norwegian psychiatric hospitals and schools for children with disabilities during the 1918 influenza pandemic. Both students and patients suffered higher mortality compared to staff members. Recognition of differential risk factors for people with disabilities is essential for the development of equitable and effective pandemic preparedness policies. [ABSTRACT FROM AUTHOR]

In this thesis Silje Aurora Andresen explores the political in discourses of disasters and disaster management as a window to "the inner workings of society" (p. 1). Andresen addresses the following research questions (p. 3): Which concepts can help analyze and explain current discourses and practices of disasters and disaster management? The thesis examines how disasters, such as the fire in Lærdal in 2014, become a site and occasion for struggles over governmentality, which Andresen claims are characterized by a "disastermentality." Besides the substantial foundation and good conclusion, the four papers form the analytical core of the thesis and take forward the thesis topic in different ways and thus provide different aspects of doing disaster research: Paper I. Andresen, S.A. 2019. [Extracted from the article]

Background: Participation in the rescue effort after the terror attacks of 22 July 2011 was challenging, unprecedented and unpredictable. Work related to major events can be stressful, but can also lead to a sense of personal growth. However, there are few studies that elucidate the experience of gaining confidence in carrying out your own role. Objective: To investigate the extent to which rescue workers are better equipped to master similar situations in the future. We also wanted to identify what factors are associated with a heightened perception of mastery. Method: Ten months after the terror attacks on 22 July 2011, healthcare personnel, the police and the fire and rescue service, as well as voluntary groups, participated in a cross-sectional study on professional challenges, perceived support and personal reactions after the events. Qualitative data from healthcare personnel enabled a more in-depth analysis of the findings. Results: The response rate was 62 per cent (1734/2801). All groups reported that they were now better equipped to master similar situations in the future (average value 3.5-3.7; scale 1-5). Early response (OR 1.5, CI 1.2-1.9), several witnessing experiences (OR 1.5, CI 1.2-1.9) and a greater degree of role clarity (OR 1.5, CI 1.2-1.9) were associated with a heightened perception of mastery. Compared with the under 30s, the perception of mastery was lower in the 30-49 age group (OR 0.7, CI 0.5-0.9 (p = 0.05) and the group aged 50 years and over (OR 0.5, CI 0.3-0.7, p < 0.001). Conclusion: Real events provide a learning opportunity that cannot be gained from studying theory or through simulation exercises. High stress levels were associated with a heightened perception of mastery. Supportive management, the perception of cooperation and pride in their efforts may also have contributed to the healthcare personnel's heightened perception of mastery. [ABSTRACT FROM AUTHOR]

The article focuses on how rural households cope with blackouts caused by winter storms. We approach household preparedness using a practice theory perspective, and argue that preparedness is mundanely preformed as part of everyday practices. The data material consists of at home visits to 14 households from Norway and Sweden. The results demonstrate that households cope with blackouts by activating and mobilising competences, meanings and materials belonging to different practices, and that this is an ongoing process to ensure the continuation of everyday life during disruption. The article concludes by arguing for the need to bring forward studies on informal preparedness activities, in a research field where household preparedness tends to be framed using a top-down perspective on crisis management. [ABSTRACT FROM AUTHOR]

Framing has previously been studied in the field of pandemic preparedness and global health governance and influenza pandemics have usually been framed in terms of security and evidence-based medicine on a global scale. This paper is based on the pandemic preparedness plans, published after 2009, from eight European countries. We study how pandemic preparedness is framed and how pandemic influenza in general is narrated in the plans. All plans contain references to ‘uncertainty’, ‘pandemic phases’, ‘risk management’, ‘vulnerability’ and ‘surveillance’. These themes were all framed differently in the studied plans. The preparedness plans in the member states diverge in ways that will challenge the ambition of the European Union to make the pandemic preparedness plans interoperable and to co-ordinate the member states during future pandemics. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

Objectives: To describe the use of radiology in the emergency department (ED) in a trauma centre during a mass casualty incident, using a minimum acceptable care (MAC) strategy in which CT was restricted to potentially severe head injuries.Methods: We retrospectively studied the initial use of imaging on patients triaged to the trauma centre following the twin terrorist attacks in Norway on 22 July 2011.Results: Nine patients from the explosion and 15 from the shooting were included. Fourteen patients had an Injury Severity Score >15. During the first 15 h, 22/24 patients underwent imaging in the ED. All 15 gunshot patients had plain films taken in the ED, compared to three from the explosion. A CT was performed in 18/24 patients; ten of these were completed in the ED and included five non-head CTs, the latter representing deviations from the MAC strategy. No CT referrals were delayed or declined. Mobilisation of radiology personnel resulted in a tripling of the staff.Conclusions: Plain film and CT capacity was never exceeded despite deviations from the MAC strategy. An updated disaster management plan will require the radiologist to cancel non-head CTs performed in the ED until no additional MCI patients are expected.Key Points: • Minimum acceptable care (MAC) should replace normal routines in mass casualty incidents. • MAC implied reduced use of imaging in the emergency department (ED). • CT in ED was restricted to suspected severe head injuries during MAC. • The radiologist should cancel all non-head CTs in the ED during MAC. [ABSTRACT FROM AUTHOR]

An emergency management tool developed for training police, fire and ambulance teams in Norway and Sweden provided the data for this paper. The teams communicated with representatives of the local power companies and county and municipality officials in responding to various emergency scenarios in a web-based training tool. The project generated rich textual data of the content of the communications as well as a range of quantitative data on who communicated with whom, how often and with what type of information. The author analyzed the qualitative data using the NVivo software package and the quantitative analysis used the R statistics package and the social network analysis (SNA) module. The textual analysis shows distinct patterns of concepts and terms used by the various emergency response agencies. The quantitative analysis illustrates the flow of communication among the participants of the emergency management training (EMT). Visual representation of both the qualitative and quantitative data from the project provides a thorough insight into processes of communication among emergency response personnel in role-playing training sessions. The data visualization enhances the debriefing session following emergency response training. The research group at Mid Sweden University and NORD University recently received funding for a three-year continuation of the project. The new project will emphasize the demand side (community stakeholders) in addition to the supply side (the emergency personnel). [ABSTRACT FROM AUTHOR]

A series of 131I tracer experiments have been conducted at two research stations in Norway, one coastal and one inland to study radioiodine transfer and dynamics in boreal, agricultural ecosystems. The hypothesis tested was that site specific and climatological factors, along with growth stage, would influence foliar uptake of 131I by grass and its subsequent loss. Results showed that the interception fraction varied widely, ranging from 0.007 to 0.83 over all experiments, and showing a strong positive correlation with biomass and stage of growth. The experimental results were compared to various models currently used to predict interception fractions and weathering loss. Results provided by interception models varied in the range of 0.5–2 times of the observed values. Regarding weathering loss, it was demonstrated that double exponential models provided a better fit with the experimental results than single exponential models. Normalising the data activity per unit area to remove bio-dilution effects, and assuming a constant single loss rate gave weathering half-times of 22.8 ± 38.3 and 10.2 ± 8.2 days for the inland and coastal site, respectively. Whilst stable iodine concentrations in grass and soil were significantly higher (by approximately a factor of 5 and 7 times for grass and soil respectively) at the coastal compared to the inland site, it was not possible to deconvolute the influence of this factor on the temporal behaviour of 131I. Nonetheless, stable iodine data allowed us to establish an upper bound on the soil to plant transfer of radioiodine via root uptake and to establish that the pathway was of minor importance in defining 131I activity concentrations in grass compared to direct contamination via interception. Climatological factors (precipitation, wind-speed and temperature) appeared to affect the dynamics of 131I in the system, however the decomposition of these collective influences into specific contributions from each factor remains unresolved and requires further study. The newly acquired data on the interception and weathering of radioiodine in boreal, agricultural ecosystems and the reparametrized models developed from this, substantially improve the toolbox available for Norwegian emergency preparedness in the event of a nuclear accident. • A series of 131I tracer experiments on grass have been conducted at two research stations in Norway. • Influence of environmental factors on foliar uptake and loss have been studied. • Interception fractions exhibited strong positive correlation with biomass and stage of growth. • For weathering loss, double exponential models provided a good fit with the experimental results. • Results have been used to reparametrize and refine generic models used in emergency preparedness. [ABSTRACT FROM AUTHOR]

Landslides in sensitive clays pose a major threat to life, property and the environment. The lack of warning signs and the extreme mobility of quick clays increase the risk. When occurring along fjords, lakes or large rivers, the landslides can generate destructive tsunamis. Historical records show that 45% of the shoreline landslides in marine sediments in Norway triggered tsunamis with run-up height of 1 to 15 m. To improve the management of the hazard and risk due to landslides in sensitive materials, the profession needs to develop tools for modelling the mobility of landslides and their tsunamigenic potential. The paper back-calculates the 1978 Rissa landslide, one of the largest quick clay landslides in Norway. Because of the quantity of data available, the Rissa landslide provides a unique benchmark to study the mobility of the quick clay, and the tsunami following the landslide. The paper describes a new approach to model landslide mobility and tsunami run-up, and presents the results of the analyses and a comparison of the results with the observations. The back-calculated mobility (runout distance, flow velocity and debris thickness) and wave run-up on the lakeshore agreed well with the measurements. [ABSTRACT FROM AUTHOR]

• Systems thinking applied to road tunnels. • Insight into the development of tunnel standards and tunnel safety in Norway, "the tunnel country". • Overview of challenges associated with the emergency preparedness processes in seven major Norwegian tunnel fires. • A discussion that improve the understanding of the concept "safety constraints". Efficient emergency response is key to preventing major losses in tunnel fires. Our general concern in this paper is the degree to which tunnel systems are prepared and the means by which we can be prepared for a major fire in a single-tube road tunnel. Conformance to prescriptive regulations dominates existing practice in the area of emergency preparedness. Risk-based approaches exist but have little influence on emergency preparedness designs for tunnel systems. A successful emergency response to tunnel fires is dependent on many actors collaborating under serious time constraints. Safety becomes a matter of controlling critical processes necessary to keep the system in a safe state. Efficient decision-making in situations of major uncertainty is vital, to achieve safety goals. This essentially means that efficient emergency preparedness for road tunnels is a matter that needs attention in the early design phases and continuous improvements during the operational phase. To achieve high-performance emergency preparedness against tunnel fires, there is a need for radical changes to the design and operation of tunnels. In this paper, it is claimed that a system-theoretic approach is appropriate to deal with the tunnel system's complexity and to drive the design of appropriate control structures for critical processes, from the design phase to the actual emergency. It is shown how system theoretic approaches will change the safety management practices for tunnels and how this will increase consistency between potential fire scenarios and associated control actions. [ABSTRACT FROM AUTHOR]

Severe wooden home conflagrations have previously been linked to the combination of very dry indoor climate in inhabited buildings during winter time, resulting in rapid fire development and strong winds spreading the fire to neighboring structures. Knowledge about how ambient conditions increase the fire risk associated with dry indoor conditions is, however, lacking. In the present work, the moisture content of indoor wooden home wall panels was modeled based on ambient temperature and relative humidity recorded at meteorological stations as the climatic boundary conditions. The model comprises an air change rate based on ambient and indoor (22 °C) temperatures, indoor moisture sources and wood panel moisture sorption processes; it was tested on four selected homes in Norway during the winter of 2015/2016. The results were compared to values recorded by indoor relative humidity sensors in the homes, which ranged from naturally ventilated early 1900s homes to a modern home with balanced ventilation. The modeled indoor relative humidity levels during cold weather agreed well with recorded values to within 3% relative humidity (RH) root mean square deviation, and thus provided reliable information about expected wood panel moisture content. This information was used to assess historic single home fire risk represented by an estimated time to flashover during the studied period. Based on the modelling, it can be concluded that three days in Haugesund, Norway, in January 2016 were associated with very high conflagration risk due to dry indoor wooden materials and strong winds. In the future, the presented methodology may possibly be based on weather forecasts to predict increased conflagration risk a few days ahead. This could then enable proactive emergency responses for improved fire disaster risk management. [ABSTRACT FROM AUTHOR]