The study revealed that cross-border collaboration between regional actors was hardly or not at all addressed at the national level during political decision- or policymaking. Within the EMR previous direct communication at the personal level was replaced by national procedures, which made regular cross-border collaboration significantly more difficult and in parts impossible. The cross-border transfer regulations of patients with COVID-19 proved to be complex and led, among other complications, to patients being transported to hospitals far outside the border region. Our findings indicate that existing though informal regional (pre-pandemic) structures were helpful to deal with and to compensate for the disruptions during the crisis and need to be formalized, as well as better promoted and recognized also at the national and EU level to increase resilience.

Conclusion

As emergency situations or public health threats do not stop at borders, the cross-border collaboration of regional public safety services is highly important and in many European cross-border regions embedded in the European identity of the regional population. Falling back on stringent national reorganization and policy decision-making when trying to manage major crises like the pandemic should not disenable or hamper cross-border collaboration. The resilience of public safety in cross-border regions depends on sound and reliable regulations and legal tools that allow for the necessary cross-border support. To be effective, it is imperative that healthcare professionals at all levels (from operational up to political) are well-informed about cross-border resources and competencies to strengthen the cooperation among the EU Member States. Governance structures and decision-making for cross-border collaboration need to be based on robust legal instruments and the principles of transparency and participation. This pandemic clearly calls for the improvement of such instruments as well as the political will and understanding to further strengthen cross-border collaboration including a fresh look at the Cross-Border Mechanism (CBM) that were first suggested under the Luxembourg EU presidency to make the best use of scarce resources based on solidarity and mutual understanding.