Background: On July 22, 2011, a single perpetrator killed 77 people in a car bomb attack and a shooting spree\r\nincident in Norway. This article describes the emergency medical service (EMS) response elicited by the two\r\nincidents.\r\nMethods: A retrospective and observational study was conducted based on data from the EMS systems involved\r\nand the public domain. The study was approved by the Data Protection Official and was defined as a quality\r\nimprovement project.\r\nResults: We describe the timeline and logistics of the EMS response, focusing on alarm, dispatch, initial response,\r\ntriage and evacuation. The scenes in the Oslo government district and at Ut�¸ya island are described separately.\r\nConclusions: Many EMS units were activated and effectively used despite the occurrence of two geographically\r\nseparate incidents within a short time frame. Important lessons were learned regarding triage and evacuation,\r\npatient flow and communication, the use of and need for emergency equipment and the coordination of\r\nhelicopter EMS.
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