Background The emergence and spread of multidrug resistant microorganisms is a serious threat to transnational public health. Therefore, it is vital that cross-border outbreak response systems are constantly prepared for fast, rigorous, and efficient response. This research aims to improve transnational collaboration by identifying, visualizing, and exploring two cross-border response networks that are likely to unfold during outbreaks involving the Netherlands and Germany. Methods Quantitative methods were used to explore response networks during a cross-border outbreak of carbapenem resistant Enterobacteriaceae in healthcare settings. Eighty-six Dutch and German health professionals reflected on a fictive but realistic outbreak scenario (response rate ≈ 70%). Data were collected regarding collaborative relationships between stakeholders during outbreak response, prior working relationships, and trust in the networks. Network analysis techniques were used to analyze the networks on the network level (density, centralization, clique structures, and similarity of tie constellations between two networks) and node level (brokerage measures and degree centrality). Results Although stakeholders mainly collaborate with stakeholders belonging to the same country, transnational collaboration is present in a centralized manner. Integration of the network is reached, since several actors are beneficially positioned to coordinate transnational collaboration. However, levels of trust are moderately low and prior-existing cross-border working relationships are sparse. Conclusion Given the explored network characteristics, we conclude that the system has a promising basis to achieve effective coordination. However, future research has to determine what kind of network governance form might be most effective and efficient in coordinating the necessary cross-border response activity. Furthermore, networks identified in this study are not only crucial in times of outbreak containment, but should also be fostered in times of non-crisis.

Introduction: Post-disaster psychosocial support (PSS) is an indispensable element of disaster management. A variety of studies contributed to the development of guidelines, information about guideline implementation, and evidence-based practice, as well as the status of local PSS planning and delivery systems in different European regions. However, the multidisciplinary nature of the organization of post-disaster PSS requires interprofessional and inter-organizational collaboration, but is presently insufficient institutionalized on individual, organizational, and governmental levels, locally, within the region, and nationally. Aim: Objective of this research is to map the existing postdisaster PSS network in the Netherlands in the context of a terrorism scenario, and to identify probable collaboration problems rooted in weak ties and lack of alignment between actors at different levels. Methods: Focus groups were organized in Belgium, France, Norway, and the United Kingdom to learn from the interagency response to recent terrorist attacks. Next, social network analysis methods were used to analyze the structure of the collaborative network for post-disaster PSS in the Netherlands. A scenario-based questionnaire was distributed amongst relevant stakeholders through snowballing methods. Respondents were asked to identify organizations they collaborate with on different PSS activities during the preparedness, acute, and recovery phase. Results: The international focus groups resulted in valuable lessons for the Dutch PSS network. Data collection for social network analysis is currently in progress. Based on previous research we expect limited ties between disciplines during the preparedness phase and during the "registration of affected persons" in the acute phase. Most of the interactions between agencies will be linked to one-stop-shop service delivery, and less to commemorations and health monitoring.