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- Albertsson, Pontus, et al.
(author)
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The Haddon matrix, a tool for investigating severe bus and coach crashes
- 2003
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In: International Journal of Disaster Medicine. - : Informa UK Limited. - 1503-1438 .- 1755-4713 .- 1651-3037. ; 1:2, s. 109-119
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Journal article (peer-reviewed)abstract
- Objective: The aim of the study was to use the Haddon matrix to analyse crash and injury mechanisms in a severe coach crash, to investigate if a safety belt would have reduced injuries, and highlight the triage problem in a mass casualty situation during severe circumstances. Methods: A specific coach crash was chosen as the subject for the case study. All 34 occupants on board were interviewed about the crash, their injuries, and how they sustained their injuries. Medical records concerning ambulance and hospital treatment have been examined. Police reports and other documents concerning the vehicle, weather conditions and the road have been examined. The materials were structured in different cells according to Haddon's matrix. Results: The coach went off a road via a guard-rail and landed on the right side, in a 90° position right across a small river. The main reason for the coach to deviate from the road was strong and gusty side winds imposing lateral forces on the coach, making steering impossible. The impact from the crash was greatest in the front part of the coach, as this part fell 3 metres from the bridge guard-rail down to the river bank. The most frequent injury mechanism was that occupants were hit by other falling occupants. Most occupants would have benefited from having worn seat belts. Ten ambulances and one helicopter from different locations were called upon and the first ambulance arrived 30 minutes after the alarm (a 67-km drive). The helicopter, with an anaesthetist on board, arrived after 1 hour and 20 minutes (a 120-km flight). Nine occupants with moderate injuries and 10 seriously or severely injured occupants were transported by ambulance or helicopter to the hospital. Fifteen occupants, triaged as priority 3, were transported by a chartered coach to hospital where they arrived after about 3 hours. Conclusion: If 100% of the occupants had used a two-point belt, about two-thirds of the injured occupants with MAIS 2+ injuries would have sustained an injury reduction. A further injury reduction by roughly 20% could have been achieved by shifting from two-point belts to three-point belts. Triage of injured occupants could be different from normal practice because of the limited space inside a coach, and the use of ordinary equipment is not always possible inside a crashed vehicle. The fact that most of the side windows remained in position after the crash probably prevented many occupants from serious and fatal injuries caused by ejection or partial ejection.
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| 2. |
- Backman, Kaj, et al.
(author)
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Protocol from the coach crash in Ängelsberg, Sweden, January 2003
- 2004
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In: International Journal of Disaster Medicine. - : Informa UK Limited. - 1503-1438 .- 1755-4713 .- 1651-3037. ; 2:3, s. 93-104
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Journal article (peer-reviewed)abstract
- The crash took place on Friday, 24 January 2003. Due to technical problems, a train was cancelled in Ludvika, a village in central Sweden. A replacement coach was to transport the passengers 115 km to Vsters, via the same route. In darkness, at 4.23 pm, i.e. during working hours, the coach went off the road on a left-hand curve. The driver reduced the speed to 49 km/h before the curve, but lost control of the coach, which skidded off the road, down a high road bank and landed on its right side. The coach's structural damage was mainly located on the right side. Of the 49 occupants, 11 were partially or totally ejected, and 6 were fatally injured. Forty occupants had injuries classified as ISS 1-15, three as ISS 16-30 and six as ISS 41-75. All those in the last group sustained fatal injuries.
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| 3. |
- Bergh Johannesson, Kerstin, et al.
(author)
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Impact of bereavement among relatives in Italy and Sweden after the Linate airplane disaster
- 2006
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In: International Journal of Disaster Medicine. - : Informa UK Limited. - 1503-1438 .- 1755-4713 .- 1651-3037. ; 4:3, s. 110-117
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Journal article (peer-reviewed)abstract
- Objectives Victims of major disasters are at risk for development of posttraumatic stress disorder (PTSD). The aim of this study was to compare two groups of bereaved relatives from Italy and Sweden, and to examine the role of psychosocial support and psychological reactions 18 months after traumatic bereavement. Method 153 bereaved relatives of deceased victims in the Milano/Linate air plane crash were assessed through a questionnaire. Reactions of psychological distress were measured by the Impact of Event Scale-Revised (IES-R). Results In the total group 53, 2 % showed symptoms indicating that they might meet the DSM-IV criteria for PTSD. The frequency was higher among the Italian relatives (58.7%) compared to the Swedish (42, 6 %). Females compared to males showed more signs of posttraumatic reactions in the total population as did spouses and parents within the Italian group. The general health status, measured by subjective evaluation, was significantly affected in both groups as a result of the disaster. A significant recovery after 18 months was reported, although not to the pre-accident level. The Swedish relatives had a pattern of using more psychotherapy compared to the Italians among whom it was more common to use medication both for anxiety and sleeping problems. The need for psychotherapy and medication was related to higher scores on IES-R. Conclusions: (1) Traumatic losses deeply affect bereaved relatives. Health is affected and a large group of these relatives develop strong symptoms of post-traumatic stress. (2) Swedish bereaved relatives seem to be more apt to ask for professional help, e.g. psychotherapy, while in Italy it is more common to rely on family, friends and medication. (3) Acute organized psychosocial support in the aftermath can possibly facilitate for victims to handle a traumatic loss but it does not prevent the development of strong post-traumatic reactions. Future investigations may show how it is possible to optimize the help with more specific interventions of support and treatment.
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| 4. |
- Lundgren, Peter, et al.
(author)
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Insulated spine boards for prehospital trauma care in a cold environment
- 2004
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In: International Journal of Disaster Medicine. - : Informa UK Limited. - 1503-1438 .- 1755-4713 .- 1651-3037. ; 2:1-2, s. 33-37
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Journal article (peer-reviewed)abstract
- Objectives: The aim of this study was to examine, during field conditions, what impact additional insulation on a spine board would have on thermoregulation. Method: The study was conducted outdoors, under field conditions in February in the north of Sweden. The subjects, all wearing standardised clothing, were immobilised on uninsulated (n=10) or insulated spine boards (n=9). Tympanic temperature as well as the subjects’ estimated sensation of cold and their estimated level of shivering were measured at five minute intervals during the trial. Statistical analysis of the data gathered for the first 55 minutes was performed. Results: There were no differences between the two groups regarding reduction in body core temperature or cold discomfort. There was, however, a statistically significant increase in estimated shivering for the subjects placed on uninsulated spine boards. Conclusion: Additional insulation on a spine board by the means of an insulation mat rendered a significantly reduced need for shivering in a cold environment. This is an effect that could be of great importance during protracted evacuations of injured, ill or otherwise compromised patients. In the light of these results we conclude that spine boards, as well as other materials used for prehospital transportation of patients in cold environments, should be well insulated. This is a measure that could be accomplished by such simple means as using an additional insulation mat.
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| 5. |
- Örtenwall, Per, et al.
(author)
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The Bomb Explosion in Myyrmanni, Finland 2002
- 2003
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In: International Journal of Disaster Medicine. - : Informa Healthcare. - 1503-1438 .- 1755-4713 .- 1651-3037. ; 1:2, s. 120-126
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Journal article (peer-reviewed)
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| 10. |
- Rüter, Anders, et al.
(author)
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A new system for transmission of on-line information from scene of accident and ambulances to hospitals
- 2003
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In: International Journal of Disaster Medicine. - : Informa UK Limited. - 1503-1438 .- 1651-3037. ; 1:2, s. 127-131
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Journal article (peer-reviewed)abstract
- Objective. The 'Swede information system' was introduced in a county with approximately 450,000 inhabitants in April 2000. The implementation of this information system, intended to be operative in major incidents and disasters, has included the introduction of new technologies as well as new standard operating procedures for both ambulance crews and hospital staff. The objective of this study was to see how this information system with digitally mediated transmission was used as a daily routine during a 2-month period, 1 year after its introduction. Methods. The Swede information system sends on-line information from ambulances to emergency wards in the county. The technique used is a LAN (local area net) for communication within the site of the accident, Mobitex® from the ambulances to a data server and from this by Internet to the hospitals. During March and April 2001 all events when an ambulance was dispatched were recorded. All cases when the system was used to notify the receiving hospital were recorded as well as all cases when the ambulance crew alerted the hospital through the alert function. All technical problems and any period of time when the system was 'out of use' were noted. Results. During the period of the study, the system was successfully used to transfer data from the scene to hospital in a total of 3353 missions, including transport of a patient from the scene to an emergency department. Of these, in 150 transports the transferred data served as a base for immediate support on arrival at the hospital that was of critical importance for primary management in the hospital. In all, 2883 different kinds of medical data were transmitted. The local help-desk was notified of problems with the system on 11 occasions; six of these were technical problems and the rest were user-related. The IS Swede system was not operational during parts of 3 days (<5%) of the time. Conclusions. Despite the introduction of new equipment and new standard operating procedures, IS Swede was accepted within the organization to a degree which could be considered operational in major incidents. Technical problems with IS Swede caused only minor disturbances during the study period.
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