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SJTREM has published an account by Sollid and colleagues of the pre-hospital medical response to the major incidents, which occurred in Oslo and Utoya island on July 22, 2011 [1]. Although very similar incidents have occurred in Europe and elsewhere, this terrible day saw the greatest loss of life recorded in this type of incident in recent times. Internationally EMS providers looked on with the certain knowledge that this type of incident is sadly one that we all have to prepare for. It is unrelated to national foreign policy, religious extremism or the existence of known terrorist activity. In short this type of incident is unpredictable and has the potential to happen in any community at any time.  The aftermath of this type of incident is complex. Initially public and private grief dominates. There is then an attempt to comprehend the motives and background to apparently senseless acts that led to the tragic loss of innocent lives. Usually there is intense scrutiny of the perpetrator in an attempt to identify something in his or her background which might have predicted the incident. Inevitably the emergency response to the incidents is examined sometimes objectively and sometimes less so. The families of the victims and the public want to be reassured that everything possible was done to prevent the loss of life. Government legislation may result from incidents - the Dunblane school killings in Scotland in 1996 which resulted in the death of fifteen small children and their teacher led to rigorous controls on gun ownership in the UK. Later the emergency services can be subject to further scrutiny at inquests or public inquiries. These can be months or years after the event (the inquests into the London bombings in 2005 were only completed five years later). The motivations behind requests for information about the emergency response are varied. However, placing objective information about the emergency service response in the public domain is a responsible act. It allows other EMS services nationally and internationally to analyse and exercise their emergency responses to similar incidents with credible background information. This may allow improved emergency responses to future incidents which may occur before the conclusions of lengthy public or legal investigations. The authors of this paper are to be commended for bringing objective information into the medical literature in a timely manner after managing a difficult incident with great skill.  Although all major incidents are unique they all have common elements. The incidents in July in Norway can be usefully categorised to analyse the challenges faced by the regional EMS system.

The shootings in Oslo and Utøya island July 22, 2011: Lessons for the International EMS community