Road tunnel systems are becoming increasingly complex. Regardless of incident, the confined nature of the road tunnel impairs responding emergency services accessibility, with a risk for delay in treatment of time-sensitive injuries such as pneumothorax or internal hemorrhage. Consequently, the need for rapid decision-making by the emergency services commanders is increased. However, in Sweden ambulance commanders lack experience and training in managing road tunnel incidents. This may further delay the medical response.

The aim is to investigate if the ambulance commander decision-making in simulated road tunnel incidents may be improved by a specific road tunnel incident e-learning course.

A web-based intervention study was performed with 20 participants; 10 participants in the intervention and control group, respectively. The control group received a pre-recorded general lecture on incident management. The intervention group received a specific road tunnel incident e-learning course, consisting of five interactive modules with learning materials (e.g. road tunnel structures, collaboration and safety). All participants participated in web-based simulations of major road tunnel incidents at one and six months post-intervention. In these simulations, participants acted as ambulance commanders and decided on the best course of action in 15 dissimilar and multiple choice-based management decisions. For each decision, time and choice of decision were recorded as outcome measurements.

Preliminary analysis from the one-month follow up simulation indicates that none of the participants decided to enter the road tunnel system at the early stage of the incident. The motivation for the participants decision-making was not clear.

The cautiousness to enter the road tunnel system will impair the emergency medical services response, including delaying vital medical care. Further research into the reasoning behind this decision is needed and identified causes may be further addressed in updated educational materials and collaborative discussions.