Collaboration Exercises—The Lack of Collaborative Benefits

Extensive and complex scenarios dominated the exercises. In several cases, the exercise leaders wanted to add an advanced chain of events to a single exercise, challenging a path-dependent behavior. One example of this approach was the exercise “fire at nuclear power plant” (Exercise 15, Table 2). The exercise combined severe weather conditions with technical breakdowns, a traffic accident in the security area, a fire in a building, and finally, a reactor accident involving a radioactive release due to a malfunctioning backup cooling system. Parts of this chain of events were meant to confuse and distract from the events that were most essential. The events were also not related to each other.

Both the exercise leaders and the participants had difficulty practicing collaboration and using the opportunity to practice synchronous operation.

Exercises often go off the tracks and become too big.

(Paramedic)

In order to create structure, some exercise leaders went in and coached the key players in the exercise so that they would not lose track of the event’s development. Exercise leaders became a kind of “exercise prompter” and steered the course of the event so that it was consistent with their planning. Any shortcomings in the exercise were prompted with various ad hoc solutions.

… in such a major exercise in which there are so many participants, the exercise leaders go and give small hints and try to control it, so it doesn’t become completely crazy.

(Chief, Fireman)

The exercise’s complexity, the number of organizations, and the arrangements also made it harder to explain the idea and purpose of the exercise in an easy and comprehensible manner. Exercise leaders had no clear division of responsibilities among them, which affected the logistics, as well as who should do what in connection with the exercise. In the “fire in the prison” exercise (Exercise 5, Table 2), confusion arose because of the ambiguities between the exercise leaders and the prison staff. Police, rescue services, and ambulance had difficulty getting access to the prison area because the prison security staff followed normal procedures for entry and exit. The high safety measures at the prison made it difficult for those practicing to move smoothly inside the prison area. The participating personnel demobilized guns, batons, and pepper spray, and found it difficult to act as they would at an actual event inside the prison area. The ambulance personnel were not admitted inside and instead stood waiting outside the prison’s security gates.

Complex and difficult to manage scenarios and lengthy exercise sessions contributed to the exercise becoming passive. Participants tended to wait for each other in the hope that someone else would take the initiative. They chose not to mingle with the participants from the other organizations. If the aim was to achieve collaboration by increasing the complexity, it had the opposite effect. Participants avoided collaboration and isolated themselves by being with their own colleagues.

The complexity also meant that there could be unnecessary waiting times, for example, to wait for the call, to drive to the accident site, to take action at the accident site, to pack up, to get a snack, and to go home. The exercise got stuck and the development of the event did not go smoothly. The mock victims had to wait a long time before they were taken care of, in some cases getting exposed to the cold as a result. A large part of the personnel never got the opportunity to practice synchronous collaboration. In the “fire in the car tunnel” exercise (Exercise 6, Table 2), there was such a long waiting time that a dozen people never got to participate in the exercise. Both the police and the ambulance personnel stood a distance away from the accident site and listened to the radio traffic. A growing dissatisfaction arose at the assembly area; small groups of personnel stood idly in the biting wind at a parking lot and talked about how useless it felt to not participate actively in the exercise. In the “airplane crash” exercise (Exercise 7, Table 2), a rumor spread about whether there was a bomber on board a crashed plane (Fig. 1).

The plane was on fire and there were a large number of casualties and serious injuries on board. The rumor of a terrorist attack meant that the police cordoned off the area for 40 min to search for the perpetrator. Despite the severity of the injuries, the mock victims were lined up on the runway to be searched and interrogated. In the end, the police intervention was stopped because the mock victims were not dressed for the cold weather and began to show signs of exposure. The complexity of the event and the 10 organizations involved meant that the cross-boundary collaboration moments were difficult to attain. The delay affected the continuation of the exercise; efforts ended up being brief and were conducted dutifully without much enthusiasm.

One feature of the exercises was that those practicing had to repeat simple steps that they were already capable of doing and had practiced in their own organization. For example, the rescue services personnel carried out the injured throughout the exercise. In the “fire in the high school” and “fire in the elementary school” exercises (Exercises 4 and 10, Table 2), firemen wearing smoke helmets evacuated smoke-injured young people for most of the exercise, a task that they were well acquainted with from previous experience (Fig. 2). The same applied to ambulance personnel. In 15 of the exercises, the ambulance personnel devoted themselves mainly to tasks that were included in their regular practice, that is, to assess, immobilize, and stabilize patients and then load and transport them to the hospital. In several of the exercises, some 20 individuals from the ambulance personnel worked only on these tasks. Other personnel, especially police officers, were engaged in only a few of these tasks. The repetitive elements were prioritized over collaboration elements. Police officers often found themselves at the barrier tape and watched the event from a distance, recorded data, took witness statements, and maintained order. These elements were repeated over and over again until the conclusion of the exercise. It meant that the exercise time was filled with simple tasks, and the number of synchronous collaboration elements was minimized. Communication between those practicing was flawed. The tasks were performed side-by-side without mutual interaction or coordination.

In the “fire on a car ferry” exercise (Exercise 3, Table 2), resources were needed to transport the injured. Because of an inadequate radio communication, most of the police units and some of the ambulance services had difficulties locating the ferry.

The communication that occurred was mostly within each organization. Several police units had placed themselves at checkpoints in remote areas on the beach, far from the car ferry. Some police officers boarded the ferry using a police boat but did not pay any attention to the injured. They passively looked on as understaffed ambulance personnel worked to attend to, carry, and transport the injured. Subsequent interviews revealed that the police personnel felt unsure of working with the injured individuals. In an interview, a police officer explained the reason for the hesitation to get involved:

We are not used to working with injured individuals. It feels like carrying or handling the injured improperly could worsen the situation.

(Police)

In the “fire in the elementary school” exercise (Exercise 10, Table 2), police were instructed to register injured students. A large number of police officers were allocated throughout the exercise to record the names and addresses of the mock victims on preprinted forms. When the exercise was over, the forms were collected and discarded. A feeling of discontent spread among the police personnel who felt that the exercise was rather pointless. Their collaboration with the other organizations had been limited during the exercise. The task they kept busy with—filling out personal information on claim forms—had nothing to do with collaboration.

The collaboration that occurred in all observed exercises was mainly limited to sequential and parallel collaboration, which essentially meant that each organization performed its tasks, one at a time, or worked in parallel side-by-side with the other organizations. Synchronous or overlapping seamless collaboration between organizations could occur for short periods. It seemed spontaneous when working on the extrication of victims from wrecked cars, evacuation of victims from a bus, or evacuation of the wounded from a burning building. This meant that the advanced collaboration elements were practiced relatively sparsely during the exercises.

We try to work as it is stated in our plans. The rescue leader does his thing, the police do theirs, and ambulance personnel do their tasks. Then we try to resolve issues individually.

(Ambulance Nurse)

It proved difficult to break down organizational barriers and collaborate with people the exercise participants did not know and were not used to working with. In the “fire at the defense headquarters” exercise (Exercise 12, Table 2), one police officer had difficulty getting help to carry a person who had been injured due to the smoke from the building. Personnel from the ambulance and rescue services did not see it as their duty to help the police officer even though they were just a few meters away. The police officer, instead, got some unexpected help from a civilian observer who came and helped to carry the smoke-injured victim to the medical care area.

In the “fire on a car ferry” exercise (Exercise 3, Table 2), the engine room on a car ferry had caught fire while out in the middle of the lake. The rescue services, police, and ambulance were supposed to rescue the injured, exhausted, and shocked victims using boats and transporting them to the medical assembly areas located on land. The police boat kept its distance during the rescue work and did not rescue the smoke-injured people from the car ferry. Rescue service and ambulance boats did not coordinate the work among themselves. They did not know what the others were doing or which part of the car ferry was supposed to be taken care of. Organizations worked sequentially and in parallel but without common coordination.

In the “fire at the military naval base” exercise (Exercise 18, Table 2), an arson fire occurred in connection with a school visit at a military naval base. Efforts to rescue the injured were delayed significantly because the ambulance personnel did not go down into the underground rock caverns until the police had surrounded, blocked off, and secured the area. The area in the rock caverns was quite large, which made it impossible for the police to secure the area within a short time. The fact that the organizations misunderstood each other meant that the exercise leaders finally had to order the ambulance personnel to begin the crucial life-saving medical work down in the rock cavern, even though the area was not cordoned off and secured. The police conducted the subsequent evaluation internally. The other participants did not get any insight into how the other organizations had arrived at different decisions during the exercise.

In the “fire on car ferry” exercise (Exercise 8, Table 2), some 20 injured persons were evacuated (Fig. 3). Already at the beginning of the exercise, the organizations split up and began repetitively to perform their own tasks, without evaluating the overall needs. This meant that the exercise was out of step and the quality of the efforts varied because some periods were understaffed. The reason was that those practicing did not keep track of the overall picture at critical moments.

In the studied exercises, the exercise leaders generally considered collaboration as something that was “given” and “well-proven,” while in reality it was not “given” how organizations should act together during the exercise. To handle the situation, the participants, for the most part, worked sequentially and in parallel. The synchronous, cross-boundary operations the exercises were intended to rehearse, encourage, and reinforce were rarely in evidence.

During subsequent interviews, the participants found it difficult to articulate clearly what they learned during the exercise. Some focused on a variety of practical features, others highlighted personal reflections, while a large group did not perceive that they had learned anything at all. One interviewee described it this way:

What did you learn about collaboration?

Well, actually nothing, you can say. I sound very negative, but I did nothing. I stood there and sent people to an assembly area, I mean, that’s nothing. It taught me nothing.

(Ambulance Nurse)

Some chose to view the fact that the exercises did not focus on collaboration as an experience. They perceived that they could still learn something from the exercise that could be applied and used in a real event. Therefore, many of the participants thought it was important to make mistakes, try things on their own during the exercise, and test alternative strategies.

… it’s really through mistakes that one learns (…)… if you end up in an exercise scenario where things do not work well, you can use that at an actual event, where you can change the things that did not work.

(Ambulance Nurse)

… regardless of how it goes, you always learn something in the exercises. (…) It is also an experience of collaboration exercises that it does not really matter how it goes, you always learn something. That’s worth something in itself.

(Chief, Fireman)

I think it is important that the exercises are designed in such a way that you can really try different things that could fail and then compare different strategies.

(Ambulance Nurse)

One difficulty was that very little time was allocated following the exercises to discuss experiences and reflections in connection with the exercises. When the exercises were concluded, the material had to be packed up and a meal had to be served. In most cases, there was not much time left for collective reflections.

There wasn’t much time for collaboration in this exercise. A longer discussion might have been preferable. Then we would also have learned more about how the others work and how to collaborate better.

(Fireman)

Long, time-consuming exercises made it difficult to have enough time for monitoring and evaluating.

I think that what happens afterward is almost more important than the exercise itself, to tie things up, and it was short, I think, and stressful. It’s always the same when you have exercises, there isn’t enough time. But it must be planned so that you have plenty of time to assess and learn from it.

(Police)

There was a need to plan the exercises so that those practicing did not run out of time at the end. Respondents felt that more emphasis needed to be placed on a concluding evaluation with discussion, feedback, and reflection.

There were different views on the extent to which those practicing had gained some benefit from the collaboration exercise, which could be used in actual situations. The responses can be grouped into two categories. There was a small group who felt that they did not gain any benefits from the exercise and a larger group who believed that they had gained limited benefits from the exercise, which could be useful in actual accident work. Those who found it difficult to relate the exercise to their daily work felt that the situations that were practiced were too broadly constructed and cumbersome to be recognized as being related to the regular work.

Do you use what you learn in the exercises in actual situations?

No, I cannot think of anything that I’ve used actually.

(Police)

It’s so seldom, or almost never, that one or that I’ve been through this kind of complex event with so many injured. Then, the incident seemed imaginary. It makes it hard to bring this to your daily work.

(Fireman)

Unfortunately, it’s a little bad with the lessons learned, I would say. It seems that you forget what you’ve learned when it happens for real. (…) In principle, we almost never do this with markings and logbooks in reality. We never have this claims experience. I have worked since 1994, and have never been part of that.

(Exercise Leader, Police)

I felt like I have learned nothing new about this here. So there’s not much I can take with me.

(Ambulance Nurse)

The reason that the exercises did not have a stronger impact on the actual accident work was due to the extent of the exercises, lack of realism, and the participants’ difficulty to empathize with and relate to the exercise scenario. A large proportion of respondents felt that they could relate some parts of the exercises to real situations. In particular, when new strategies were tried, they turned out to work in actual situations. One interviewee expressed it like this:

Finally… at an exercise, then I did this and this and it actually worked well. I am testing it and also using it now in a critical situation.

(Ambulance Paramedic)

Through the exercises, those practicing could test their stress tolerance. Even if the scenarios were so confusing that things were difficult to evaluate, the participants could test their ability to stay calm and think clearly. Many of them saw this as beneficial for actual events.

At the same time, I want to state that these exercises, they help in that in real-life situations, they keep you a little bit, a little calmer, and you start thinking in a different way already on the way.

(Ambulance Paramedic)

Although it was difficult to specify exactly what from an exercise could be beneficial in an actual event, several respondents felt that the exercise contributed to an unconscious experience, which was activated during actual events. The experience of the exercise remained with them and affected the practical work in the field. This was a good reason for having these exercises regularly and for the participants who met at actual events to participate in the collaboration exercises.

Yes, absolutely. Everything we practice, you put in a backpack. You put it somewhere in the back of your head. If you end up in a similar situation again, you remember what you did in the exercise. All exercises give you experience.

(Fireman)

A limitation in terms of the benefits was that it was difficult to transfer the experiences of those practicing to other colleagues in the same organization who did not participate in the exercise. The respondents expressed that there was a transmission problem within the organization that was difficult to come to terms with.

It’s very difficult to take the experiences from one exercise and try to share them with those who were not there.

(Chief, Fireman)

Often, the exercise evaluations came long after the exercises had been conducted and the colleagues did not read them. A few people talked about the lessons learned from these exercises. When those practicing had returned home, it was as if the exercises had never occurred. This meant that the exercises could be beneficial to those practicing, but not for those colleagues who did not participate.

Another manifestation of the difficulty with the exercises was to get the experienced officers of each organization to sign up for the collaboration exercises. In many cases, they did not want to participate. They switched their shift or took sick leave to avoid the exercise.

The regular officers do not want to go. They are afraid to appear weak. (…) In the past, I checked them off on a list. Then they switched their shift at the last minute with someone else.

(Exercise Leader, Police)

This tended to result in a certain contagious effect when even younger employees were reluctant to participate in the exercises.