The bomb attack in Oslo and the shootings at Utøya, 2011 KAMEDO report 97 Kamedo – the Swedish Disaster Medicine Study Organisation – has existed since 1964 and was previously known as the Swedish Disaster Medicine Organisation Committee. The committee started its activities under the auspices of the Swedish Research Delegation for Defence Medicine. In 1974 Kamedo was transferred to FOA (the Swedish Defence Research Establishment), now called FOI (the Swedish Defence Research Agency). Kamedo has been affiliated with the National Board of Health and Welfare since 1988. The main task of Kamedo is to send expert observers to places in the world affected by large-scale accidents or disasters. The observers are sent to disaster areas at short notice and collect relevant information by contacting key individuals, principally on a colleague-to-colleague basis. The information they obtain may only be used for documentation purposes. There are four main areas which are studied first and foremost: the medical, psychological, organisational and social aspects of disasters. Results from the studies are published in Kamedo reports that are listed on the National Board of Health and Welfare’s website. As of report number 74 the full reports may be downloaded, but for the earlier reports only the summary is available on the website. From report number 34 and onward they have a summary in English and as of report number 55 these are downloadable from the website. From number 89 and onward the whole reports have been translated into English. The authors are responsible for the contents and conclusions, the National Board of Health and Welfare draws no conclusions in the document. The experts’ compilation may, however, be used as a basis for the Board’s standpoint. You may quote text from the National Board of Health and Welfare in, for example, educational material provided at cost price, providing you state the source. You may not however use the text in any commercial context. The National Board of Health and Welfare has the sole right to decide how this work shall be used, in accordance with the Act (1960:729) on copyright in literary and artistic works (the Copyright Act). Pictures, photographs and illustrations are also protected by the Copyright Act and their use requires the permission of the author. Article no. 2012-12-23 Published www.socialstyrelsen.se, December 2012 2 Preface Acts of terror often entail major challenges for healthcare as there may be many serious casualties. Incidents of an antagonistic nature can involve further complications since they may place particular demands for collaboration between the parties responsible for the management of such incidents. In the aftermath of a traumatic event, the high number of survivors and bereaved relatives constitute a serious challenge to society's ability to provide psychosocial support. This report studies both of the incidents that affected Norway on 22 July 2011 and focuses on investigating how the Norwegian healthcare services and psychosocial support services managed the situation. The report also contains a discussion of Norway's management of the incident and how Sweden would have managed a similar incident. Johanna Sandwall Unit Manager, Unit for Emergency Preparedness 3 4 Contents Preface ........................................................................................................... 3 Authors .......................................................................................................... 8 Main authors ....................................................................................................... 8 Co-author and editor .......................................................................................... 8 Reference group .................................................................................................. 8 People who have contributed through their participation in interviews or by submitting written information ............................................................... 8 Abbreviations and definitions ..................................................................... 12 Summary and experiences .......................................................................... 15 Summary ........................................................................................................... 15 Healthcare ................................................................................................................... 15 Psychosocial support .................................................................................................. 17 Communication and media relations .......................................................................... 19 Experiences ....................................................................................................... 20 Healthcare ................................................................................................................... 20 Psychosocial support .................................................................................................. 22 Communication and media relations .......................................................................... 23 Introduction/material and method ............................................................. 24 Risks (threats and vulnerability) ................................................................. 26 Background ................................................................................................. 27 The Norwegian crisis management system ..................................................... 27 The Norwegian healthcare and medical system ............................................. 28 Emergency medical care and ambulance resources .................................................... 28 The organisation of psychosocial support in Norway.................................... 30 Local level .................................................................................................................. 30 Distriktspsykiatriske sentre (DPS) – District Psychiatric Centre ................................ 30 Fylkesmannen – County Governor ............................................................................. 30 Regional Resource on Violence, Traumatic Stress and Suicide Prevention (RVTS) . 31 Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS ................... 31 Identification of the deceased .......................................................................... 31 Hospitals that were directly involved in the care of casualties on 22 July... 32 Oslo University Hospital Trust ................................................................................... 33 Vestre Viken Hospital Trust ....................................................................................... 36 Preparedness for medical, healthcare and psychosocial support in Norway ............................................................................................................... 38 National level .............................................................................................................. 38 Emergency planning within the Helse Sør-Øst RHF .................................................. 40 Local emergency planning in Hole Municipality ....................................................... 43 Communication plans and media prepardeness .......................................................... 43 5 The situation prior to the incident .................................................................. 45 Oslo............................................................................................................................. 45 Utøya .......................................................................................................................... 45 Course of events .......................................................................................... 46 Injuries and disruptions .............................................................................. 48 Injuries ............................................................................................................... 48 Summary of physical injuries ..................................................................................... 48 The need for psychosocial support ............................................................................. 49 Damage to buildings ................................................................................................... 49 Disturbances ...................................................................................................... 50 Security assessments ................................................................................................... 50 The Offices of the Norwegian Government................................................................ 50 The Fire Service .......................................................................................................... 51 Traffic situation .......................................................................................................... 51 Actions ......................................................................................................... 52 Activation of disaster readiness and management, and work at the incident scene .................................................................................................... 52 Oslo University Hospital Trust ................................................................................... 52 Vestre Viken