Enhancing Prehospital Interagency Collaboration During Terrorist Incidents: Perspectives from European Focus Group Interviews

Introduction: The escalation of conflicts in the Middle East has led to an increased risk of terrorism resurgence in Europe. During past terrorist incidents, inefficient interagency collaboration has repeatedly been identified as a key obstacle to an efficient response. This study aims to investigate the perspectives of European prehospital emergency medical providers and law enforcement officers on interagency collaboration during terrorist incidents. It seeks to identify barriers, best practices, and opportunities for enhancing collaboration. Methods: Interdisciplinary, international focus group interviews have been conducted online (at time of submission: nine interviews, 45 participants,13 European countries). Each interview has been analyzed using deductive coding for predefined topics, e.g., Command, Communication, and Hot Zone Care. Inductive coding has been used for additional content arising from the discussions. Results: The paucity of joint training opportunities and the need for political guidance were considered the most pressing issues. Interagency miscommunication, disparate situational awareness, and differing mindsets on the scene were identified to significantly impede provider safety on the scene. Within the national protocols of 73% (33/45) of participants, patient care inside the hot zone relied largely on police forces, including special forces. Concurrently, it has been emphasized that, due to a lack of resources, police forces are likely to focus not on patient care or evacuation but on threat elimination during the initial response phase. Additionally, evacuation resources have been identified as a bottleneck in transferring casualties from the hot zone to a safer zone. In summary, these factors create a therapeutic vacuum for casualties with potentially survivable injuries inside the hot zone. Conclusion: This study pronounces the need for joint training opportunities, which are anticipated to increase provider safety. Further, it highlights the urgent necessity of political commitment to set a framework that enables providers to diminish the therapeutic vacuum inside the hot zone.