• accreditation
• ambulatory care
• anaesthesia

On 22 July 2011, a terrible attack by a lone shooter on the Norwegian island of Utøya cost 77 young lives, injured 78 and changed the lives of hundreds forever within 73 min. In the current international context of increased threat, sharing experience about disaster response is crucial. With some exceptions,1–3 many of these studies adopt a deficit-based analysis approach and focus on dysfunctions rather than positive lessons.

In contrast, Brandrud et al 4 adopted an original approach. The group used the conclusions of two official and independent commissions as starting point, namely that the medical response to the incident was particularly well managed. This enabled a ‘positive deviance’ 5 6 analysis to draw important lessons from this incident.

The authors attempted to gather crucial insights with the help of detailed group interviews and expert review: How did a rural district hospital, Ringerike, that is not a level-1 trauma centre manage a major disaster effectively, despite the fact that its resources were exhausted 40 min after admission of the first patients? What can this outstanding performance teach health professionals in preparation for disaster in any setting, and especially in a non-specialist hospital?

The answers provided by the study are …