Planning and decision making in emergency response systems face new challenges due to climate changes and the increased risk of multiple or compound natural hazards. This is especially the case in areas with inexperience of such events. The aim of this paper is to identify important activities concerning planning and decision-making during responses to natural hazards, and their potential need for decision support. The knowledge base of the study consists of interviews with 12 representatives from the Swedish emergency response system, supplemented by documents covering policies, operations, and responsibility. Thematic coding was applied to the interview data for identification of important planning and decision activities. Needs of decision support were identified by applying activity theory to the identified activities. We found needs of decision support connected to eight identified key activities concerning consequence analysis, national reinforcements, and resource management. The results illuminate a lack of technology to support response activities during both single and multiple natural hazards. The findings can inform policy makers of emergency response of where to concentrate the development of tools for collaborative preparedness and response work to cope with future challenges from natural hazards.