title: Non-medical aspects of civilian-military collaboration in management of major incidents.
abstract: OBJECTIVE
  Disasters and major incidents demand a multidisciplinary management. Recent experiences from terrorist attacks worldwide have resulted in a search for better assessment of the needs, resources, and knowledge in the medical and non-medical management of these incidents and also actualized the need for collaboration between civilian and military healthcare. The aim of this study was to evaluate the impact of the civilian-military collaboration in a Swedish context with the main focus on its non-medical management.
  
  
  METHODS
  An exercise, simulating a foreign military attack centrally on Swedish soil, was designed, initiated, and conducted by a team consisting of civilian and military staff. Data were collected prospectively and evaluated by an expert team.
  
  
  RESULTS
  Specific practical and technical issues were presented in collaboration between civilian and military staffs. In addition, shortcomings in decision-making, follow-up, communication, and collaboration due to prominent lack of training and exercising the tasks and positions in all managerial levels of the hospital were identified.
  
  
  CONCLUSIONS
  Current social and political unrests and terror attacks worldwide necessitate civilian-military collaboration. Such collaboration, however, needs to be synchronized and adjusted to avoid preventable medical and non-medical consequences. Simulation exercises might be one important source to improve such collaboration.
authors.affiliation: Prehospital and Disaster Medicine Center, Regionens Hus, 405 44, Gothenburg, Sweden. Amir.khorram-manesh@surgery.gu.se.|Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. Amir.khorram-manesh@surgery.gu.se.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-2734-5733
authors.initials: A
authors.lastname: Khorram-Manesh
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Lönroth
authors.affiliation: Prehospital and Disaster Medicine Center, Regionens Hus, 405 44, Gothenburg, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Rotter
authors.affiliation: Prehospital and Disaster Medicine Center, Regionens Hus, 405 44, Gothenburg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Wilhelmsson
authors.affiliation: Prehospital and Disaster Medicine Center, Regionens Hus, 405 44, Gothenburg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Aremyr
authors.affiliation: Prehospital and Disaster Medicine Center, Regionens Hus, 405 44, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Berner
authors.affiliation: Prehospital and Disaster Medicine Center, Regionens Hus, 405 44, Gothenburg, Sweden.
authors.forename: A Nero
authors.initials: AN
authors.lastname: Andersson
authors.affiliation: Prehospital and Disaster Medicine Center, Regionens Hus, 405 44, Gothenburg, Sweden.|Department of Health and Crisis Management and Policy, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Carlström
mesh_terms: D004189:Disaster Planning; D006801:Humans; D000070516:Intersectoral Collaboration; D054527:Mass Casualty Incidents / Q000517:prevention & control*; D008889:Military Personnel; D016544:Patient Simulation; D013548:Sweden
keywords: Civilian–military; Collaboration; Exercise; Simulation; Terrorism; Trauma