It requires efficient usage of medical resources to treat multiple patient situations or major accidents succesfully. When observing multiple patient and major accidents occurred in Finland and around the world, problems especially in the management area of medical rescue have been discovered. Varied instructions for management of situations have been used in Jokilaakso area, so I noticed that the matter needed a change.

The aim of this project work was to produce operating guidelines and cards for the medical rescue leaders. Management of situations can be improved with careful planning and preparation. When leading is facilitated it also optimizes the limited usage of medi-cal rescue resources. The patients are also provided with better care.

Instructions were made as a project work in collaboration with those involved in emer-gency care outside Jokilaakso hospital. Participants were gathered from different emer-gency care service providers and hospitals as well as from Northern Ostrobothnia Hospital District. The form of working was meetings between which I worked on the in-struction according to the feedback and assessment. Materials used in the project were emergency care materials used in Finland and and research results of major accidents occurred in Finland and abroad.

As a result of this thesis, instructions for management of medical rescue and operating cards for medical instructors in emergency care outside hospital were produced. Com-pleted instructions and operating cards give good ground for successful management of situations to the manager of a medical rescue operation. They have been brought into use in Jokilaakso area outside hospital emergency care which I regard as an excellent evaluation of my own work. In future those involved in emergency care have to remem-ber to update the instructions regularly. It is advisable to start joint practices in order to improve the function.