European Perspectives on Pre-hospital Interagency Collaboration During Terrorist Incidents: A Focus Group Study

Background Recent international developments have led to increased terrorist activity and intentional violence across Europe. Interagency collaboration has repeatedly been identified as a key challenge in previous scenarios. This study explores the perspectives of European pre-hospital medical providers and law enforcement officers on collaboration during violent incidents, aiming to identify barriers, best practices, and opportunities for improvement. Methods Twelve modified focus group interviews (3-8 individuals per group) with embedded polls were conducted online. Deductive coding was performed for predefined topics, e.g., Command, Communication, Hot Zone Care, Provider Safety, and Interagency Understanding. Inductive coding was applied to additional content arising from the interview dynamics. Results 64 participants from 20 European countries were interviewed. 41% (26/64) were non-physician pre-hospital providers, 38% (24/64) worked as pre-hospital emergency physicians, and 22% (14/64) served in law enforcement, including special forces. 49% (30/61) of participants denied feeling adequately trained to collaborate with other responding services in a tactical scenario. Training methods were criticised for neglecting situational awareness and interpersonal competencies. Overall, joint training opportunities are reportedly rare, leading to misconceptions of the capabilities and priorities of interagency counterparts on scene. 64% (39/61) of participants reported police as the primary care provider for casualties in the hot zone, with many regional protocols extending this reliance into the warm zone and specifically onto special forces. However, the interviews indicated that police are unlikely to deliver such care without significant delay. Thus, casualty evacuation emerged as a key bottleneck and priority for further debate. Conclusions This study revealed a significant paucity of joint education and training opportunities. Training concepts should place greater emphasis on behavioural competencies instead of rigid protocol compliance. Although promising response frameworks exist across Europe, various deployed strategies risk prolonging the therapeutic vacuum of casualties inside high-risk zones and impairing provider safety. Joint strategies and interprofessional exchange will be essential to decrease such systemic vulnerabilities.