*5.4. System*

The responsibility for and managemen<sup>t</sup> of the proposed FSC-concept must be carefully considered before implementation into a crisis managemen<sup>t</sup> system. To rapidly deploy and operate ACFs, the logistics and transportation of material, equipment, and patients must be swift and well-coordinated. The efficiency of communication structures and the distribution of resources are of paramountimportance. The command and control of the FSC is one of the most critical factors in achieving a successful response. In any context, leadership and decision-making are two critical factors that determine an event's outcome. Besides having a central coordinator, such as a public health agency, the ACF should be operating locally, close to the incident scene, with regional operational guidance and possible material reinforcement distributed from the regional and/or national levels and related agencies [12,19].

The importance of correct and e fficient triage during a MID cannot be stressed enough, and selection of the patients for treatment at an ACF is crucial. Over-triage could lead to an unnecessary overflow of patients to hospitals, which could result in the depletion of precious resources, and under-triage may endanger the lives of the victims [30]. Readiness and competence to conduct simple and vital maneuvers, including ventilating a patient until transport to the definitive care, should be presented, and necessary materials must be available. Triage should also give particular concern to vulnerable populations.

Exercises are crucial to create a coherent system that allows for practicing in a FSC and e fficient deployment and operation of ACFs. Broad collaborative exercises involving all actors in the crisis managemen<sup>t</sup> system should be held regularly to streamline e fforts from all parties. Appropriate educational initiatives can increase the motivation to help. Educational initiatives should be adapted to the level of care in the assigned task and existing competencies at the facilities of interest [38]. Further studies should determine the content of educational initiatives suitable for professionals and civilians involved in MID management. Findings from a recent study in Sweden indicate a need for new public education initiatives to enable nonprofessionals to become immediate responders [32,36]. There is also the potential to incorporate volunteer resources in some of the ACF operations. All MIDs are likely to a ffect the mental health of victims, which must be considered and treated alongside their physical injuries and trauma. Mental health preparedness has been deemed insu fficient in most countries and must improve [39].

Preserving a network of concurrent material provision and maintenance with education, training, and exercise initiatives continuously running requires significant financial resource allocation, which must be prioritized. Without necessary resources a FSC-response system is toothless. Insu fficient program duration has been identified as an essential factor that explains the considerable ine ffectiveness of many community-based health and safety programs. Having a long-term program view, active planning against conflicting missions, and mobilizing su fficient resources are necessary to establish, deliver, and sustain the system over time [7].

#### **6. Implications and Recommendations**

Integrated participatory and sustainable planning can increase resilience and is closely related to some of the World Health Organization's (WHO) sustainable development goals [40]. If optimally implemented, the FSC-concept can lead to a safer and more resilient society by encouraging increased civil engagemen<sup>t</sup> and educational initiatives [12,32]. However, a successful implementation of FSC depends on some essential factors:

1. Mapping capabilities, resources, and networks in the community as part of contingency planning. While decentralizing forces and resources can benefit the independence of communities, they still need support from higher levels. Smaller cities had a higher response rate in this study, which might reflect a higher willingness to engage in their community.


#### **7. Limitations and Strengths**

The small number of investigated facilities, especially sports facilities, did not allow any statistical analysis of the results. However, the descriptive results confirm that the FSC-concept can be applied in more contexts than the Swedish one and has transferability to other settings in Europe and possibly to other regions as well [41].

The lack of previous studies in this field did not allow any comparison of results with other publications.
