A fire developed in a facility being used as a discotheque that resulted in death for 63 young people. The rescue operations, ambulance responses, medical care provided at the scene, hospital operations, and psychosocial responses are described. Bodies blocked the exit and many survivors had to evacuate by leaping from windows. A total of 16 ambulances were used. Survivors and people not directly involved in the incident created disturbances and some even attacked responders. Many of those who escaped early suffered mild inhalation injuries and those who escaped later, sustained more severe inhalation injuries. High levels of both carbon-monoxide and cyanide were detected at autopsy. A total of 213 persons were transported to hospitals, 85 by ambulance. Most who died at the scene had severe burn injuries, were unconscious, or suffered from fire-gas injuries. A total of 150 victims were admitted to a hospital, of which 74 (49.3%) required intensive care. Only one of the four hospitals actuated a disaster alert. Psychosocial support was complicated due the multicultural characteristics of those involved. Support to the survivors and relatives of the victims was provided by representatives of various religious organization, non-profit organizations, and by the government of Gothenburg. Many recommendations are provided to better prepare for future events.

Disaster management plans of emergency departments (EDs) in four major public hospitals were reviewed. A comparison was made between these plans, and they were analyzed to gain an understanding of the differing objectives and doctrines behind the practices. These were summarized into five major management concepts, which are considered to be critical to the success of a disaster plan: 1) staff mobilization systems (cascading vs batch mobilization); 2) staff deployment systems; 3) team organization (surgeons vs residents); 4) area management (the role of the area manager); 5) casualty volume management (accommodation vs expansion vs extension concepts). The-concepts derived should serve as a useful guide to the development of an ED disaster plan and potentially influence how new ED facilities could be planned.