**3. Results**

In the result section, the exercise organizers' learning process is illustrated by the seven phases of the cycle of expansive learning, as illustrated in Figure 3.

**Figure 3.** Cycle of expansive learning of exercise organizers as they developed the rescue operation practice as inspired by Engeström [29].

As can be discerned from the results, the learning process of the exercise organizers did not follow the cycle of expansive learning from start to finish, and the cycle was looped in various ways. The primary explanation is that the process was iterative, consisting of different types of activities (e.g., meetings and exercises), and continued over a fairly long time. As time went on, more and more data were produced from the various exercise organizers. During the first six full-scale exercises, the rescue service and mining companies together produced a total of 18 documents, while exercises 7–10 included 41 documents produced by various exercise organizers. The documentation peaked during the last reported exercise of this study; namely, during the 11th exercise, all of the exercise organizers contributed with a total of 47 documents. During the process, there was not only an increase in the number of documents, but their quality and the complexity of information also increased. The first exercise documents mainly consisted of technical reports, but as the learning process continued, the organizations also started to consider organizational and collaboration aspects.

#### *3.1. Questioning the Present Practice of the Rescue Operation*

Questioning the present practice of the rescue operation began during and after the aforementioned major fire incident in one of the Swedish underground mines. The evaluation performed by the rescue service indicated that the rescue service lacked knowledge about suitable tactics and methods for rescuing someone in a mining environment. To develop knowledge and tactics to work under these circumstances, a collaboration between the rescue service and mining companies was initiated by, for example, performing full-scale exercises together. However, the EMS was still a missing actor in this

collaborative initiative, which led to EMS personnel being uncertain of how to manage these kinds of incidents. Therefore, the university partners questioned the lack of a comprehensive strategy for managing underground major fires in collaboration including all central actors.

#### *3.2. Analyzing the Present Practice of the Rescue Operation*

In order to analyze the present practice of the rescue operation, the exercise organizers created a flow chart together based on their experiences from full-scale exercises and real events. This flow chart visualized each organization's practices and activities from the incident occurring through to the last injured mineworker being transported to the hospital. This flow chart was further used as a tool to analyze collaborative challenges and to find solutions. Identified collaborative challenges included that the rescue service was perceived as having the main responsibility of the rescue operation and that each organization mainly considered their own organizational tasks. How the environment or the task at hand would necessitate modifications of the rescue operation was less discussed, and the mining organizations, for example, considered that their task was to accommodate the needs of the rescue service. Further, the EMS worked according to a pre-hospital managemen<sup>t</sup> concept that assumes direct access to the injured and therefore were not prepared for rescue operations in which they might not have the possibility to access the injured for several hours.

#### *3.3. Modeling New Tools for the Exercise*

During the iterative process of meetings and exercises, the exercise organizers continually tried to find solutions to the identified problems with the rescue operation practice. They gradually created several tools—including a modified first-aid course for the mineworkers, an emergency managemen<sup>t</sup> template, and an educational video—in order to facilitate the participants' ability to collaborate during the full-scale exercises.

The tool of a modified first-aid course, with a checklist for the systematic examination of an injured peer and guidelines for care and communicating injury information, was developed. The exercise organizers developed the modified first-aid course because they recognized the necessity of the mineworkers to be qualified specifically in how to care for severely injured peers underground until being rescued. The mineworkers had taken a commercial first-aid course, but the environment and their prolonged responsibility for their peers called for the development of the course. The modified first-aid course was also developed due to the exercise organizers realizing that, in order to make the exercise rescue operation of the injured mineworkers more realistic, a medical dimension needed to be added to the rescue service focus. The rescue service focus during the exercises was noticed in the unrealistic acting of the mineworkers. They waited passively until being rescued and were walking even though they were supposed to act as though they had fractures in their lower extremities. Thus, when the mineworkers were educated in the modified first-aid course they became active participants in the exercises. The injured mineworkers were instructed to not only call in the alarm of the incident but also start to act as they would in a real fire emergency. They self-escaped to a rescue chamber and there they would be helped by a peer. This meant that the mineworkers had to give first aid and care for the injured mineworker until being rescued as they would in a real event.

The exercise organizers also developed a tool of a joint emergency managemen<sup>t</sup> template due to the realization that when the complexity of the scenarios increased, the rescue operation managers had di fficulties in creating a shared situational awareness. They observed that this also became obvious to the managers themselves, who drew up a simple table to ge<sup>t</sup> an overview of the injured and injuries. Therefore, the exercise organizers gathered and, in several iterations, developed an emergency managemen<sup>t</sup> template in order to increase transparency and to create common situational awareness among the managers of the rescue operation. The emergency managemen<sup>t</sup> template tool was also complemented with a course for the managers of the mining organization.

The tool of an e-learning educational video, in order to create a common understanding of each other's structures, terminologies, and tasks during a major fire incident, was also developed by the

exercise organizers. They had observed that the managers of the rescue operation did not collaborate in an optimal way and even made mistakes during the full-scale exercises. For example, during one of the exercises, the EMS managers were directed by the mining managers to the casualty collecting point and therefore were delayed in reaching the emergency operations center where the other organizations' managers were located. The mining managers had limited knowledge about the EMS organization and managemen<sup>t</sup> structure and did not know that the first arriving EMS unit primarily has a managerial responsibility. The exercise organizers thus realized that the organizations' lack of knowledge about each other's tasks limited their collaboration.

#### *3.4. Examining and Testing the New Practice for Exercise*

The exercise organizers constantly evaluated and developed the tools during the progress of the project. For example, they developed the emergency managemen<sup>t</sup> template when they observed that the rescue operation managers made different interpretations about what they were supposed to write on the template. The introduction of smaller rehearsal exercises focusing on the responsibilities of the managers of the rescue operation also made it possible for the exercise organizers to solve some of the identified challenges prior the full-scale exercise, for example, that there were too many people in the rescue operations center, which led to a noisy environment. The exercise organizers, therefore, instructed the rescue operations managers to start using headsets with their communication devices and also started to consider which managers needed to be in the rescue operations center and who could work in adjacent rooms.

The exercise organizers examined the new solutions for the rescue operation comprehensively and critically. They worked toward reducing the time of the rescue operation in order to make sure the injured mineworkers reached definite care as soon as possible. The exercise organizers also discussed whether the EMS personnel could enter the mine during a fire. This discussion related to the conflict between the safety of the EMS personnel and the medical needs of the injured mineworkers. The exercise organizers solved this by arguing that the managers would have to consider the circumstances of each specific incident. They further argued that if it is impossible for the EMS personnel to enter the mine, they are nevertheless responsible for the injured mineworkers and should be actively involved in the planning of the rescue operation.

#### *3.5. Implementing the New Practice in the Exercise*

The full-scale exercises were planned and performed in-between the collaboration meetings, which made it possible for the exercise organizers to test and modify the new tools, practices, and equipment for the rescue operation. The implementation of new tools and practices was an iterative process, where the implementation of one tool or practice led to certain improvements and highlighted new challenges that called for the development of ye<sup>t</sup> another solution. For example, the development and implementation of the modified first-aid course led to more complex injury scenarios, which led to the development of the emergency managemen<sup>t</sup> template. During the course of the project, the exercise organizers continued their learning process, and the scenarios of the exercises rapidly increased in complexity. The participants of the exercises, being educated in the new tools and practices between exercises, managed the increased difficulty of the scenarios. Initially, the smoke-divers aimed at rescuing confined uninjured mineworkers from one rescue chamber. Later exercises included scenarios with a long-distance smoke-diving operation involving prioritization of two rescue chambers with severely injured mineworkers within them while the Medical Incident Commander communicated with the mineworkers who were helping their injured peers.

#### *3.6. Reflecting on the Process of Developing a New Practice*

During the course of the project, the exercise organizers also started to change focus—from primarily prioritizing their own organizational objectives, they started to see how their organizational objectives contributed to the collaborative process necessary during the full-scale mining exercises.

This was evident in the evaluation reports of the exercises. In the beginning, there were few and very technical rescue service evaluation reports of the exercises. In the last of the included exercises in this study, a broad range of evaluation reports from all of the organizations, evaluating both technical, operational, and organizational aspects, were included. One of the most important realizations was that the exercises, while becoming more complex, also directed more of the attention toward the injured/non-injured mineworkers. The exercise organizers started to think, for example, about what to do if there were several injured mineworkers located at different places in the smoke-filled mine. Who should be prioritized and why? The exercise organizers realized the importance that all three organizations shared the discussion on priorities and that the prioritization was done in collaboration. The mining managemen<sup>t</sup> has to contribute with their knowledge about the mine layout, the rescue service has to combine this knowledge with their practical knowledge about the feasibility of the rescue operation, and the EMS should give their medical prioritization of the injured and be able to explain the medical consequences of the different rescue operation choices.

The prioritization discussion highlights the possibly extensive time it will take until the injured mineworkers are rescued during major fire exercises. The tool of a modified first-aid course was also developed because the exercise organizers realized that the uninjured peers in the same rescue chamber have to be able to take care of the injured mineworkers until being rescued. The uninjured peers are thus a resource for the EMS managers if the mining communication system is operational. The Medical Incident Commander gathers information from and helps the uninjured peer in a structured way but is also able to prioritize between the injured mineworkers. This was an issue during some of the exercises, and the exercise organizers stated that the uninjured mineworkers had to give all the information and the Medical Incident Commander did not ask enough or the right questions. Therefore, the EMS exercise organizers had to modify their protocol of questions to match the modified first-aid education given to the mineworkers. However, the exercise organizers also highlighted the need of the uninjured mineworkers to receive psychological support and information about the progress of the rescue operation from the EMS.

The benefit of performing full-scale exercises was also that the exercise organizers learned the practicalities and logistics of performing a rescue operation in an extreme environment. They had to continually evaluate the necessary equipment and resources. An example of equipment that was developed and refined throughout all of the 11 exercises is a rescue carriage, which could transport both the rescue services' equipment and immobilized injured mineworkers in the smoke-filled tunnels. Another challenging aspect of the rescue operation concerned communication. Because the common emergency organization communication system was not operable in underground mines, they adopted the mining communication system. However, the exercise organizers then observed that this led to operative and collaborative issues during the exercises, e.g., the number of necessary radio frequencies.

#### *3.7. Consolidating and Generalizing the New Practice*

During the progress of the project, the exercise organizers adjusted the rescue operation practice for major fires in underground mines. They developed new knowledge and tools regarding what worked during the full-scale exercises and implemented those during the next exercise, or adjusted aspects that they evaluated needed improvement. Therefore, the rescue operation practice for major fires in underground mines was constantly changing and improving, becoming more and more comprehensive. The process also led to organizational development. The exercise organizers from the mining companies had to develop their own emergency command structure, with the preparedness to answer all of the requests from the emergency organizations and at the same time having the overall responsibility for their personnel and the mine. The exercise organizers from the rescue service also had to develop their own practices and to develop plans to conduct the rescue operation as effectively as possible by, for example, utilizing reconnaissance teams from the part-time rescue service arriving first to the mine. The complex rescue operation tended to make the planning process too excessive, which slowed the progress. The exercise organizers from the EMS also had to create new practices, develop mining rescue operation plans and adapt their managemen<sup>t</sup> structure to conform to the complexity of the environment, for example, the location of the Medical Incident Commander was evaluated by the exercise organizers. The Medical Incident Commander should be as close to the injured mineworkers as possible but loses touch with the progress of the rescue operation when located in the mine. Therefore, the Medical Incident Commander was located in an adjacent room to the emergency operation center in order to be able to stay in touch with the progress of the rescue operation as well as with the mineworkers helping the injured.
