SJTREM has published an account by Sollid and colleagues of the pre-hospital medical response to the major incidents, which occurred in Oslo and Utøya island on July 22, 2011. Although very similar incidents have occurred in Europe and elsewhere, this terrible day saw the greatest loss of life recorded in this type of incident in recent times. Internationally EMS providers looked on with the certain knowledge that this type of incident is sadly one that we all have to prepare for. It is unrelated to national foreign policy, religious extremism or the existence of known terrorist activity. In short this type of incident is unpredictable and has the potential to happen in any community at any time.