Mass casualty incidents (MCI) in tunnels can result in devastating consequences. Despite this, there is a knowledge gap in the perspectives and experiences of strategic stakeholders in relation to the emergency medical response to MCI in tunnels. This study aims to explore and describe this issue. The study includes 11 interview participants from the emergency services organisations and governmental and municipal organisations in Sweden. The results indicate that the medical perspective is inadequately represented at a strategic level due, among other, to limited input from emergency medical representatives during planning stages and a lack of social networks. The results implicate a need to create and improve networks among the stakeholders from the involved organisations. Emergency medical personnel should not only be acknowledged for their expertise but should also be included to a greater extent in the planning stages and exercises. Medical and rescue personnel need time to jointly discuss how they, in the best way, can save lives in tunnel MCIs.