The findings suggest firefighters and police officers have overall positive experiences and opinions on working with ambulance personnel in USAR. This aligns very well with INSARAG Guidelines [2] and two other extensive publications on building USAR capacity [4, 5] that support the need for medical professionals in USAR teams.

Working as police officers and firefighters is inherently risky. Both training and actual work exposes such personnel to physical and psychological threats that they seek to minimize both individually and through organizational measures.

Both police officers and firefighters seem to realize that injuries sustained in a USAR-setting can be more complicated than their own training prepares them for. They also express relief when ambulance personnel take responsibility for assessing and treating patients, even those that have not experienced it themselves report that patients are best handled by health professionals. This opinion can be based on the principles from Norwegian authorities on managing large incidents [1] or their own experiences or fears of having to manage a field of expertise they feel they do not master.

Feeling safe as part of a team working in a dangerous environment necessitate trust [15]. Informants emphasized the need for mutual trust, suggesting that even tough emergency workers feel the need for safety, especially in dangerous situations. They also express the need and appreciation for being trusted back. This fundamental human need to trust and feel trusted seems to be paramount within emergency services and should not be underestimated [15]. Sharing knowledge contributes to developing trust, but trust is also a prerequisite for sharing knowledge [16, 17].

In recent years, establishing a shared mental model between emergency personnel has had an increasing focus [1, 18,19,20,21]. A shared mental model is easy to achieve within one service of people with the same education and the same view on how to interpret and reach their goals. However, among personnel from different agencies, it is less straightforward. In all five interviews, the need for more cross-agency training was expressed without anyone expressing the opposite. Thus, the general assumption among USAR-specialists is that effectively establishing shared mental model on high-risk assignments depends on practicing together, and that this is a prerequisite for effective rescue operations. A typical example for this need is the quote about search dogs also being weapons. The police officer felt that USAR personnel from BE did not take the necessary precaution around a search dog at work. It is reasonable to presume that this is because BE and Victor have not trained enough together for them to trust BE operators understand fully that police patrol dogs at work need to be handled with great care, and that others should keep their distance as a general rule unless invited.

The development of USAR Oslo is not based on an assignment or project established by any governmental entity or top management in any of the three agencies. Ground level special rescue professionals in OBRE with knowledge about and interest in USAR reached out to Victor in 2015. This type of development could be described as bottom-up [14]. In all five interviews concern is expressed about the lack of focus from superior entities on a national or regional level.

Indeed, the lack of governmental ownership of USAR preparedness is often mentioned. The prevailing opinion seems to be that the future of USAR in Norway depends on the governmental support. Specifically, governmental bodies need to give all three emergency services the assignment and funding necessary to build a robust USAR organization comprised of education, training, and governance. Firefighters in particular reported that the responsibility for such a task delegated to each local fire and rescue service would be impossible, as most services in Norway are too small to be able to maintain such a specialized capacity. The police and ambulance service would meet the same challenge in rural areas. Several participants in the interviews express that specialized rescue capacities such as USAR would best be established on a regional or national basis.

There is a feeling of pride within USAR Oslo among the interviewees that emerges across diverse comments and answers. A special source of pride is the fact that the governmental commission’s evaluation after the Gjerdrum landslide concluded the success of the acute effort in the first hours was crucial for preventing loss of lives [12]. Many reported that USAR Oslo has proven their ability to deliver, especially at Gjerdrum, in close cooperation with USAR-trained personnel from Nedre Romerike Brann & Redning. Despite such experienced and documented success, there is a lack of directorial or political initiative to give the field focus and development opportunity. As such, respondents reported disappointment, pessimism, and even hopelessness.

To our knowledge, no one has ever asked firefighters and police officers what they have experienced and think about working closely with ambulance personnel in precarious situations. As USAR incidents are rare and always unique, an explorative study seems to be most appropriate. We thus undertook a qualitative study to gather data from a variety of personnel, where factors like experience, exposure, and preconceptions among the informants could add colour and depth to the canvas. To ensure efficiency in data gathering, focus groups interviews was selected instead of individual interviews. The group dynamic effect among colleagues who know each other very well could also lead to more openness, honesty and sharing of creative opinions [7], which was desired.

The selection of contributors in the focus groups has been entirely up to the services discretion. The criteria were that they were certified USAR-operators within their service, willing, and accepting that the interviews were taped and used in an article. Internal validity [22, 23] is addressed by review of the interview guide after each interview and by thoroughly following the six phase model of the method [10, 24].

The size of focus groups is a possible limitation to our study. Malterud describes a project should comprise three to five interviews, each with six to ten participants [6]. Two of the interviews in this study has only three participants, the other three has four. Reading the results should take this into account. There is a possibility that those not interviewed have other opinions on the topics covered in the interviews, but no hints of rumours or organizational opinions to the contrary of findings in the collected data emerged during the interviews. On this basis we regard the results as representative for the two USAR-trained colleges at OBRE and Victor.

The findings in this study are directly valid to other services and regions in Norway, and to other countries with similar organizational boundaries between emergency services. External validity wise this can be understood as that the opinions and psychosocial mechanisms uncovered, like trust, familiar faces, the value of social encounters, small training sessions with informal debriefs, are probably valid in a broader area of creating teams across organizational lines. We have not investigated how USAR collaboration is organized in other countries, but it is known that there are many variations, where both privately funded non-for-profit organizations and governmental emergency services may have the capacity for both domestic and international USAR efforts. For instance, USAR health capacity in Great Britain is funded over the national budget through National Ambulance Resilience Unit (NARU), in Canada national and regional capacities are funded and organized by Public Safety Canada via Disaster Financial Assistance Arrangements (DFAA). The European Union has funded partially or in full the establishment of USAR capacities in several European countries, and representatives from several Norwegian fire and rescue departments have recently attended conferences and courses in their process.

Reflexivity is the question of how our own assumptions and biases influenced this research project. EW works as a paramedic in the air ambulance department at Oslo University Hospital, with ten years’ experience as USAR-specialist. He is also a CBRNe (Chemical, Biological, Radiation, Nuclear and explosions) specialist in the ambulance department and is a familiar face among USAR-specialists in all three agencies. It is fair to be aware of possible bias in favour of USAR Oslo. To counter this possibility, MH conducted the interviews. He had no insight into USAR, nor is he a familiar face to USAR specialists in OBRE and Victor. Furthermore, themes have been identified and highlighted based on the number of times statements have been coded and the sincerity with which they have been voiced. Finally, EWs preconceptions about the need for USAR preparedness in Norway and the model for building a capacity similar to USAR Oslo is supported by United Nations [2], the evaluation report after the quick clay landslide at Gjerdrum [12], and two extensive master thesis [4, 5]. These preconceptions are not controversial; indeed they are aligned with the demand that emergency services collaborate in complex rescue missions, something Norwegian authorities have regarded as a prerequisite [1, 25].