This report is a summary of a study conducted at the Royal Swedish Academy of War Sciences to evaluate collaboration during crisis management. The study includes relevant legal and regulatory dynamics, as well as conclusions and recommendations. Rules and regulations of international interest are presented in the Appendix. References are limited to those of international interest.

To develop a common structure for reports on health crises and critical health events guidelines have recently been published (Kulling et al 2010). They try to capture the experiences gained and for promoting a standardized methodology for sharing results and lessons. If future reporting follows common standards, then the documented findings would be comparable and could be used to learn and apply lessons within an individual field of activity and to apply those lessons learned also to other related preparedness activities. It could also facilitate the implementation of joint activities and joint reports involving different sectors. The development of this proposed method for common reporting on health crises and critical health events has been derived mainly from the following processes: (i) Health Disaster Management: Guidelines for Evaluation and Research in the Utstein Style; (ii) the Swedish Disaster Medicine Study Organization (KAMEDO); (iii) the Swedish Emergency Management Agency network of observers; (iv) the WHO Regional Office for Europe project (supported by the EU Health Programme) ‘Support Health Security, Preparedness Planning and Crisis Management in the EU, EU accession and neighboring (ENP) countries’ including expert consultations. The guidelines include the following headlines: Title, Preface, Authors, Executive Summary, Introduction/Material/Methodology, Pre-Event Status (Background, Preparedness, Hazard(s)involved, Risks, Vulnerability, Resilience), Health Crises and Critical Health Events (Damage, Consequences of Damage (Changes in Functions/Disturbances), Responses (Relief Responses, Recovery Responses), Development, Discussion, Lessons Identified and Actions Recommended, Conclusions, References, Appendices, Keywords, Index, Abbreviations. Pilot testing is suggested followed by an extensive review process. The guidelines should be supplemented further with determinants and indicators when the guidelines are used for in depth reporting to evaluate crisis response operations. Reference Kulling P, Birnbaum M, Murray V, Rockenschaub G. Guidelines for Reports on Health Crises and Critical Health Events.

The proposed guidelines for a common structure for reports on health crises and critical health events are an attempt of capturing the experiences gained and a further step for promoting a standardized methodology for sharing results and experiences. Such a common and standardized approach will facilitate the analysis and comparison of findings in order to improve preparedness planning and response and advance international collaboration and learning. If future reporting follows common standards, then the documented findings would be comparable and could be used to learn and apply lessons within an individual field of activity and to apply those lessons learned also to other related preparedness activities. It could also facilitate the implementation of joint activities and joint reports involving different sectors.

Introduction: The use of a common template for observer studies is a way of structuring the experiences gained (lessons observed and learned) from such studies. This facilitates the comparison of reports within one's own field as well as between different sectors. It also facilitates the implementation of joint observer activities and joint observer reports, promoting more comprehensive and holistic learning from the events. Methods: Using the Utstein method for studying disasters and the Swedish Disaster Medicine study organization (KAMEDO) as an inspiration, a number of Swedish governmental authorities and organizations compiled a template for presenting standardized observer reports. The following tides have been identified to be included: (1) Tide; (2) Preface; (3) Observers and Authors; (4) Summary and Experiences; (5) Introduction/Material and Methods; (6) Hazard; (7) Background (including pre-event status and preparedness); (8) Event; (9) Damage; (10) Disturbances; (11) Responses; (12) Recovery and Development; (13) Discussion; (14) References; (15) Appendices; (16) Keywords; (17) Index; and (18) Abbreviations. Results: This template has been used successfully for observer studies within the health sector (evacuation of Swedes from the war in Lebanon, 2006, a power supply failure at a major university hospital in Stockholm, 2007), within the food sector (Cryptosporidium contamination of water supply in Ireland, 2007, consequences for water supply from floods in the UK, 2007, sewage contamination of water supply in Finland, 2007) and within crisis management and rescue services sectors (floods in the UK, 2007, sewage contamination of water supply in Finland, 2007, wild fires in California, 2007) Conclusions: The use of a common, standardized template for the documentation of lessons observed and learned from major disasters/crises has proven useful. In addition to enhancing the completeness and learning value of the reports, it also has proven to be a useful tool for stimulating intra-sectoral cooperation and learning.

A sudden and extensive power failure occurred at Karolinska University Hospital in Huddinge on Easter Saturday, 07 April 2007. The power failure lasted one hour and 22 minutes, but it took a longer time for activities to return to normal. It put many patients at great risk, particularly in the intensive care unit and other departments with critically ill patients. This report details the conditions and response at Karolinska University Hospital during the power failure and provides lessons learned for future events.

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A large-scale armed conflict between Hezbollah and Israel in July 2006 caused the evacuation of a large number of Swedish residents from Lebanon. This report describes the evacuation throughout its various stages. Swedish authorities were prepared for an event of this type from the experience of the 2004 Asian tsunami disaster. Lessons learned from the management and medical care during the evacuations are presented in this report.

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