Emergency Medical Response in Mass Casualty Tunnel Incidents - with Emphasis on Prehospital Care

Responding to mass casualty incidents in a tunnel environment is problematic not least from aprehospital emergency medical services (EMS) perspective. The aim of this review was to 1) categorizepreconditions for emergency response in tunnel environments based on Haddon’s matrix and 2) identify specificEMS knowledge of providing prehospital care. Twenty eight articles, reports and book chapters were selected forfurther analysis. Firstly, sorting the data from each included article was done according to Haddon’s matrix. Theresult covers human factors, technical factors, physical environmental factors and socioeconomic environmentalfactors all related to preconditions for emergency response. To describe the EMS’s knowledge the data wasalso sorted according to command and safety, communication, assessment, and triage treatment and transport,also known as CSCATT. Few studies, especially of high quality, actually provide detailed information regardingemergency response to tunnel incidents and those that do, often have a main focus on management by therescue service. While many incidents studied were caused by fires in tunnels, thus requiring rescue servicein action, the subsequent EMS response issues that have taken place appear to have been given limitedattention. To optimize the survival rates and health of the injured, as well as to provide a safe and effective workenvironment for the emergency services, there is a need to explore the event phase