| 1. |
- Aléx, Jonas, 1975-
(författare)
-
Cold exposure and thermal comfort among patients in prehospital emergency care : innovation research in nursing
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundPatients’ cold exposure is a neglected problem in prehospital emergency care. Cold stress increases pain and anxiety and contributes to fear and an overall sense of dissatisfaction. When left untreated, cold stress disturbs vital body functions until ultimately reaches hypothermia.AimThe overall aim was to investigate patients’ experiences of thermal comfort and reactions to cold exposure in prehospital emergency care and to evaluate the effects of an intervention using active warming from underneath.MethodStudy I:Persons (n=20) injured in a cold environment in the north of Sweden were interviewed. Active heat was given to 13 of them.Study II:In wintertime, 62 patients were observed during prehospital emergency care. The field study was based on observations, questions about thermal discomfort, vital signs, and temperature measurements.Study III:Healthy young persons (n=23) participated in two trials each. Data were collected inside and outside a cold chamber. In one trial, the participants were lying on a regular ambulance stretcher and in a second trial on a stretcher supplied with a heated mattress. Outcomes were the Cold Discomfort Scale (CDS), back, finger, and core body temperature, four statements from the State-TraitAnxiety-Inventory (STAI), vital signs, and short notes about their experiences of the two stretchers.Study IV:A quantitative intervention study was conducted in prehospital emergency care in the north of Sweden. The patients (n=30) in the intervention group were transported in an ambulance supplemented with a heated mattress on the stretcher, whereas only a regular stretcher was used in the ambulance for the patients (n=30) in the control group. Outcomes were the CDS, finger, core body, and air temperature, and questions about cold experiences.ResultsStudy I:Patients suffered more because of the cold than from the pain of their injuries. The patients were in a desperate need of heat.Study II:Patients are exposed to cold stress due to cold environments. There was a significant decrease from the first measurement in finger temperature of patients who were indoors when the ambulance arrived, compared to the measurement taken in the ambulance. In the patient compartment of the ambulance, 85% of the patients had a finger temperature below the comfort zone and almost half of them experienced the patient compartment in the ambulance to be cold. The regular mattress surface temperature at the ambulance ranged from -22.3 to 8.4 ºC.Study III:A statistical increase of the participants’ back temperature was found between those lying on the heated mattress compared to those lying on the regular mattress. The heated mattress was experienced as warm, comfortable, providing security, and easy to relax on.Study IV:Thermal comfort increased for the patients in the intervention group and decreased in the control group. A significant higher proportion of the participants rated the stretcher as cold to lie on in the control group compared to the intervention group.ConclusionThe ambulance milieu is too cold to provide thermal comfort. Heat supply from underneath increased comfort and might prevent cold stress and hypothermia
|
|
| 2. |
- Henriksson, Otto, 1976-
(författare)
-
Protection against cold in prehospital trauma care
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Protection against cold is vitally important in prehospital trauma care to reduce heat loss and prevent body core cooling. Objectives: Evaluate the effect on cold stress and thermoregulation in volunteer subjects byutilising additional insulation on a spineboard (I). Determine thermal insulation properties of blankets and rescue bags in different wind conditions (II). Establish the utility of wet clothing removal or the addition of a vapour barrier by determining the effect on heat loss within different levels of insulation in cold and warm ambient temperatures (III) and evaluating the effect on cold stress and thermoregulation in volunteer subjects (IV). Methods: Aural canal temperature, sensation of shivering and cold discomfort was evaluated in volunteer subjects, immobilised on non-insulated (n=10) or insulated (n=9) spineboards in cold outdoor conditions (I). A thermal manikin was setup inside a climatic chamber and total resultant thermal insulation for the selected ensembles was determined in low, moderate and high wind conditions (II). Dry and wet heat loss and the effect of wet clothing removal or the addition of a vapour barrier was determined with the thermal manikin dressed in either dry, wet or no clothing; with or without a vapour barrier; and with three different levels of insulation in warm and cold ambient conditions (III). The effect on metabolic rate, oesophageal temperature, skin temperature, body heat storage, heart rate, and cold discomfort by wet clothing removal or the addition of a vapour barrier was evaluated in volunteer subjects (n=8), wearing wet clothing in a cold climatic chamber during four different insulation protocols in a cross-over design (IV). Results: Additional insulation on a spine board rendered a significant reduction of estimated shivering but there was no significant difference in aural canal temperature or cold discomfort (I). In low wind conditions, thermal insulation correlated to thickness of the insulation ensemble. In greater air velocities, thermal insulation was better preserved for ensembles that were windproof and resistant to the compressive effect of the wind (II). Wet clothing removal or the use of a vapour barrier reduced total heat loss by about one fourth in the cold environment and about one third in the warm environment (III). In cold stressed wet subjects, with limited insulation applied, wet clothing removal or the addition of a vapour barrier significantly reduced metabolic rate, increased skin rewarming rate, and improved total body heat storage but there was no significant difference in heart rate or oesophageal temperature cooling rate (IV). Similar effects on heat loss and cold stress was also achieved by increasing the insulation. Cold discomfort was significantly reduced with the addition of a vapour barrier and with an increased insulation but not with wet clothing removal. Conclusions: Additional insulation on a spine board might aid in reducing cold stress inprolonged transportations in a cold environment. In extended on scene durations, the use of a windproof and compression resistant outer cover is crucial to maintain adequate thermal insulation. In a sustained cold environment in which sufficient insulation is not available, wet clothing removal or the use of a vapour barrier might be considerably important reducing heat loss and relieving cold stress.
|
|
| 3. |
- Lundgren, Peter, 1977-
(författare)
-
Protection and treatment of hypothermia in prehospital trauma care : with emphasis on active warming
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In prehospital trauma care active warming is recommended to aid in protection from further cooling. However, scientific evidence of the effectiveness of active warming in a clinical setting is scarce. Also, evaluating the effectiveness of active warming, especially in harsh ambient conditions, by objective measures, is difficult. Objective: To evaluate the effectiveness of field applicabe heat sources (I) and to evaluate active warming intervention in a prehospital clinical setting (II and III). To evaluate reliability and validity of the Cold Discomfort Scale (CDS), a subjective judgement scale for assessment of the thermal state of patients in a cold environment (IV). Methods: In a laboratory trial, non-shivering hypothermic subjects (n=5), were cooled in 8 ºC water followed by spontaneous warming, a charcoal heater, two flexible hot-water bags or two chemical heat pads, all applied to the chest and upper back (I). Oesophageal temperature, skin temperature, heat flux, oxygen consumption, respiratory rate and, heart rate were measured. In two clinical randomized trials, shivering patients during road and air ambulance transport (II) and during field treatment (III) were randomized to either passive warming alone (n=22 and n=9) or to passive warming with the addition of a chemical heat pad (n=26 and n=11). Body core temperature, respiratory rate, heart rate, blood pressure (II) and the patients’ subjective sensation of thermal comfort (II and III) were measured. In a laboratory trial, shivering subjects were exposed to – 20 ºC (n=22). The CDS was evaluated regarding reliability, defined as test-retest stability, and criterion validity, defined as the ability to detect changes in cold discomfort due to changes in cumulative cold stress (IV). Results: In non-shivering hypothermic subjects postcooling afterdrop was significantly less for the chemical heat pads, but not for the hot water bags and the charcoal heater, compared to spontaneous warming (I). Temperature drop during the entire warming phase was significantly less for all the heat sources respectively, compared to spontaneous warming (I). During road and air ambulance transport, ear canal temperature was significantly increased and cold discomfort significantly decreased, both in patients assigned to passive warming only, and in patients assigned to additional active warming (II). During field treatment, cold discomfort was significantly reduced in patients assigned to additional active warming, but remained the same in patients assigned to passive warming only (III). Weighted kappa coefficient, describing test-retest stability, was 0.84 (IV). CDS ratings were significantly increased during each 30 minutes interval (IV). Conclusion: In non-shivering hypothermic subjects, heat sources were effective to attenuate afterdrop, when providing high heat content over a large surface area and effective to continue to increase body core temperature when providing sustained high heat content. In shivering trauma patients, adequate passive warming were sufficient treatment to prevent afterdrop, to slowly increase body core temperature, and to reduce cold discomfort. If inadequate passive warming, additional active warming was required to reduce cold discomfort. The CDS, a subjective judgement scale for assessment of the thermal state of patients in a cold environment seemed to be reliable regarding test-retest stability and valid regarding ability to detect change in cumulative cold stress.
|
|
| 4. |
- Forsberg, Rebecca, 1976-
(författare)
-
Train crashes : consequences for passengers
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Globally, and in Sweden, passenger railway transport is steadily increasing. Sweden has been relatively free from severe train crashes in the last decades, but the railway infrastructure is alarmingly worn and overburdened, which may be one reason for an increasing number of reported mishaps. Worldwide, major train crashes/disasters are a frequent cause of mass casualty incidents. Several shortcomings, especially within the crash and post-crash phases cause severe consequences for the passengers.Aim: To investigate the consequences of train crashes on passengers, focusing on factors of importance in the crash and post-crash phases. The specific aims are: (I) to identify the historical development and magnitude of passenger train disasters globally on various continents and countries, (II, III) to identify injury panorama and injury objects in two train crashes, (IV) to explore survivor´s experiences from a train crash, and (V) to explore their experiences of journalists and media coverage.Methods: Study I is a register study based on 529 railway disasters worldwide, whereas studies II-V are case studies from the two latest severe train crashes in Sweden (Nosaby and Kimstad). These studies are based on 73 and 21 passengers respectively. Studies I-III is essentially quantitative where descriptive statistics (I, III), multivariate analysis (III), and content analysis (II, III) are used. Studies II and III are also supplemented by semi-structured interviews. Studies IV and V are qualitative and the interviews (n=14, n=30) have been analyzed with qualitative content analysis. Study IV is also supplemented with quantitative data.Results: The number of railway disasters, fatalities, and non-fatally injured passengers has increased throughout the last hundred years - particularly during the last four decades (1970–2009) when 88% of all disasters occurred (I). Passengers in the first overturned carriage suffered most severe and lethal injuries (III). Internal structures such as tables, chairs, internal walls, as well as luggage, other passengers (II, III), glass (II), and wood pellets (III) induced many of the injuries. Those who traveled facing forward with a table in front of them, in carriages that did not overturn, were more likely to sustain injuries to their abdomen/pelvis than those without a table (III). Passengers who traveled rear facing had higher rates of whiplash injuries. Surviving a train crash was experienced as "living in a mode of existential threat". The long term consequences however were diverse for different persons (IV). All experienced that they had cheated death, but some became "shackled by history", whereas others overcame the "haunting of unforgettable memories." The centrality of others and the importance of reconstructing the turn of events were important when "dealing with the unthinkable". The media coverage were experienced as positive in the recovery process and the journalists were also perceived as helpful (V). By some the journalist’s nevertheless were also perceived as harmful or negligible, and the subsequent media coverage as either uncomfortable or insignificant.Conclusion: Despite extensive crash avoidance systems severe railway crashes still occur. Improved interior safety, as has been implemented in the automobile and aviation industries, would have an important reduction in injuries and facilitate evacuation. Being surrounded by family, friends, fellow passengers and participating in crash investigations, and experiencing descriptive media coverage were some crucial factors when dealing with the traumatic event and should be promoted.
|
|
| 5. |
- Iraeus, Johan, 1973-
(författare)
-
Stochastic finite element simulations of real life frontal crashes : With emphasis on chest injury mechanisms in near-side oblique loading conditions
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction. Road traffic injuries are the eighth leading cause of death globally and the leading cause of death among young people aged 15-29. Of individuals killed or injured in road traffic injuries, a large group comprises occupants sustaining a thorax injury in frontal crashes. The elderly are particularly at risk, as they are more fragile. The evaluation of the frontal crash performance of new vehicles is normally based on barrier crash tests. Such tests are only representative of a small portion of real-life crashes, but it is not feasible to test vehicles in all real-life conditions. However, the rapid development of computers opens up possibilities for simulating whole populations of real-life crashes using so-called stochastic simulations. This opportunity leads to the aim of this thesis, which is to develop and validate a simplified, parameterized, stochastic vehicle simulation model for the evaluation of passive restraint systems in real-life frontal crashes with regard to rib fracture injuries.Methods. The work was divided into five phases. In phase one, the geometry and properties of a finite element (FE) generic vehicle buck model were developed based on data from 14 vehicles. In the second phase, a human FE model was validated for oblique frontal crashes. This human FE model was then used to represent the vehicle occupant. In the third phase, vehicle buck boundary conditions were derived based on real-life crash data from the National Automotive Sampling System (NASS) and crash test data from the Insurance Institute for Highway Safety. In phase four, a validation reference was developed by creating risk curves for rib fracture in NASS real-life crashes. Next, these risk curves were compared to the risk of rib fractures computed using the generic vehicle buck model. In the final phase, injury mechanisms in nearside oblique frontal crashes were evaluated.Results. In addition to an averaged geometry, parametric distributions for 27 vehicle and boundary condition parameters were developed as guiding properties for the stochastic model. Particular aspects of the boundary conditions such as pulse shape, pulse angle and pulse severity were analyzed in detail. The human FE model validation showed that the kinematics and rib fracture pattern in frontal oblique crashes were acceptable for this study. The validation of the complete FE generic vehicle buck model showed that the model overestimates the risk of rib fractures. However, if the reported under-prediction of rib fractures (50-70%) in the NASS data is accounted for using statistical simulations, the generic vehicle buck model accurately predicts injury risk for senior (70-year-old) occupants. The chest injury mechanisms in nearside oblique frontal crashes were found to be a combination of (I) belt and airbag loading and (II) the chest impacting the side structure. The debut of the second mechanism was found for pulse angles of about 30 degrees.Conclusion. A parameterized FE generic passenger vehicle buck model has been created and validated on a population of real life crashes in terms of rib fracture risk. With the current validation status, this model provides the possibility of developing and evaluating new passive safety systems for fragile senior occupants. Further, an injury mechanism responsible for the increased number of outboard rib fractures seen in small overlap and near-side oblique frontal impacts has been proposed and analyzed.
|
|
| 6. |
- Styrke, Johan, 1980-
(författare)
-
Traumatic brain injuries and whiplash injuries : epidemiology and long-term consequences
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundThe incidence of traumatic brain injuries (TBI) is about 500 cases per 100,000 inhabitants per year, a majority of which are mild TBI (MTBI). The incidence of whiplash injuries is about 300/100,000/year. There are several similarities between MTBI and whiplash injuries with regard to the causes of injury (traffic crashes and falls), the demographic profile of the injured (mostly young persons), and the type of symptoms exhibited by some of the injured (for example head/neck pain, fatigue, irritability, impaired cognitive functioning, and depression). Main aimTo investigate the epidemiology and long-term consequences in terms of symptoms, disability, and life satisfaction in cases of TBI and whiplash injuries in a well-defined population.Material and methodsData on frequencies and characteristics of TBI and whiplash injuries were extracted from the injury database at the emergency department (ED) of Umeå University Hospital (UUH). The results were presented as descriptive epidemiology.The 18-65 year-old persons who sustained an MTBI or whiplash injury in 2001, were provided a questionnaire three and five years after injury respectively, in which questions were asked about:Symptoms; Rivermead Post Concussion Symptoms Questionnaire (RPQ) Disability; Rivermead Head Injury Follow Up Questionnaire (RHFUQ)Life satisfaction; LiSat-11A local reference population was used for comparison of the RPQ. A national cohort was used as reference for LiSat-11. Data on sick leave for the cases of whiplash injuries were analysed to calculate the cost to society for loss of productivity.ResultsIn 2001, the incidence of TBI was 354/100,000/year. The mean age was 23 and 55% were men. Ninety-seven percent of the injuries were classified as mild (Glasgow coma scale 13-15). The main causes were falls (55%) and traffic related injury events (30%). In 8% of the cases (17% of the elderly persons) an intracranial bleeding was detected by using CT.The 3-year follow-up of the MTBI patients showed that women had more symptoms and disability (~50%) than men (~30%). Both women and men had more symptoms and lower life satisfaction compared with the reference population.The incidence of traffic-related whiplash injuries in adults was 235/100,000/year and the annual incidences were relatively stable during 2000-2009. Combining the incidences with national insurance data showed that the proportion of insurance claims decreased during the period.When looking at whiplash trauma following all causes of injury in 2001, traffic crashes caused 61% of the injuries and falls caused 14%. Neck fractures occurred in 3% of the cases.Five years after whiplash injury, the injured persons had more symptoms and lower life satisfaction than the references. Sick leave ≥15 days was granted in 14% of the cases of whiplash injuries. The median number of sick days was 298 and the cost of loss of productivity during the follow-up was 5.6 million USD.The frequencies of symptoms were relatively alike when comparing subjects with whiplash injuries to subjects with MTBI.ConclusionTBI and whiplash injuries are common, especially among young people, and the injuries render long-term symptoms, disability, and impaired life satisfaction in up to 50% of the cases. Symptoms exhibited are alike between the two types of injuries. The cost to society for loss of productivity is high, and there is a need for enhanced preventive measures aiming at reducing traffic-related injuries, sports injuries, alcohol-related injuries, and falls. Physical, mental, and social factors are important and should be addressed when examining and treating patients with persisting symptoms following TBI and whiplash injuries.
|
|
| 7. |
- Doohan, Isabelle, 1985-
(författare)
-
Surviving a major bus crash : experiences from the crash and five years after
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Major road traffic crashes (RTCs) can have a significant impact on the survivors, their family, and their friends, as well as on emergency personnel, volunteers, and others involved. However, survivors’ perspectives are rare or missing in research on major RTCs in Sweden. A comprehensive understanding of the survivors and their experiences is also lacking. By studying what it is like to survive a major RTC, the care and support provided to survivors can be adapted and improved.The overall aim is to broaden the understanding of the short- and long-term consequences and experiences of surviving a major bus crash.Methods The contexts are two bus crashes that occurred in Sweden, in February 2007 and December 2014. In total, the participants are 110 out of the 112 survivors, and the data is collected through telephone interviews, official reports, and medical records at one month, three months, and five years after the crashes. Analysis methods include qualitative content analysis, descriptive statistics, thematic analysis, and mixed methods research analysis.Results One month after the crash, most of the survivors were experiencing minor or major physical and/or psychological stress in their everyday lives (Study I). Four main findings were identified regarding their experiences of immediate care (Study II): prehospital discomfort, lack of compassionate care, dissatisfaction with crisis support, and satisfactory initial care and support. The importance of compassion and being close to others was also highlighted. Five years after the bus crash in Rasbo (Study III), survivors were still struggling with physical injuries and mental problems. Other long-term consequences were a lasting sense of connectedness among fellow passengers, a gratitude for life, as well as feelings of distress in traffic, especially in regard to buses. The main findings from study IV indicated that injury severity did not seem to affect mental health, and that social aspects were important to the recovery process. There was an interconnection among survivors in which they seemed to be linked to each other’s recovery.Conclusion A strong need for short- and long-term social and psychological support in terms of compassion and community is evident in all the studies. The survivors ought to be acknowledged as capable and having the resources to contribute to their own and their fellow survivors’ recovery and health. There is a need for greater understanding of how different the survivors are, with each one of them having various physical, psychological, social, and existential needs.
|
|
| 8. |
- Holgersson, Annelie, 1985-
(författare)
-
Preparedness for mass-casualty attacks on public transportation
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Public transportation constitutes a vulnerable sector in modern day society with a high probability of generating mass casualties if attacked. By preparing for mass-casualty attacks (MCAs), response can become more effective and public transportation can become a less rewarding target. However, preparedness for attacks, much like response, implies resource constraints, and this dissertation pinpoints some major dilemmas that inhibit achieving preparedness for MCAs on public transportation in Sweden.Aim: The aim of this dissertation was to investigate preparedness for mass-casualty attacks on public transportation. This allowed for identification of major challenges for preparedness and response with a particular focus on the Swedish context.Methods: Study I included 477 MCAs identified through searches of the Global Terrorism Database, journals, newspapers and websites, which were examined with descriptive statistics. Study II thematically analyzed 105 articles attained by systematic searches of the PubMed and Scopus databases. Study III and IV statistically analyzed data from 864 responses to a purposive-designed questionnaire, from operational personnel of the Swedish emergency organizations. Study V entailed validation of a finite element (FE) simulation model of a bombing in a train carriage compared to the bombings in Madrid 2004.Results: International trends of MCAs (≥ 10 fatally injured and/or ≥ 100 non-fatally injured) on public transportation, during the years 1970-2009 (I) showed that the average number of injured increased considerably, despite a quite stable incidence rate since the 1980s. High numbers of injured people were connected to attacks on terminal buildings, multiple targets and complex tactical approaches. Few MCAs occurred in Europe, but the average number of fatalities per incident and injured per incident were the second highest among regions. The literature study (II) of previous on-scene management showed that commonly encountered challenges during unintentional incidents were added to during MCAs, implying specific issues for safety, assessment, triage and treatment, which require collaborative planning and specific training. The study regarding the Swedish emergency organizations’ perceptions of terrorist attacks (III) showed significant differences on perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence in knowledge of tasks to be performed on scene. The police respondents stood out; e.g., fewer police personnel had high estimates of their organizations’ management capability and knowledge of tasks on-scene compared to the other organizations. The study of factors that influence responders’ perceptions of preparedness for terrorism (IV) showed that these were influenced by the responders’ sex, work experience, organizational affiliation, various training arrangements and access to personal protective equipment (PPE). Investing in amenable factors, such as terrorism-related management training and provision of PPE, could improve responders’ perceptions of preparedness for terrorism. A finite-element (FE) model of an explosion in a train carriage (V) was developed and showed that FE modeling techniques could effectively model damage and injuries for explosions with applicability for preparedness and injury mitigation efforts, but, also, there was room for improvement of the model in terms of injuries.Conclusion: Achieving preparedness for MCAs on public transportation is a multiple choice balancing act between ostensible dilemmas regarding investments, disaster plans, training, response strategies, collaboration and inventions.
|
|
| 9. |
- Ahlm, Kristin, 1956-
(författare)
-
Traffic and drowning incidents with emphasis on the presence of alcohol and drugs
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine.In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p<0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II).We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p<0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p<0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively. In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention.
|
|
| 10. |
- Albertsson, Pontus, 1958-
(författare)
-
Occupant casualties in bus and coach traffic : injury and crash mechanisms
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The relevance of conducting this thesis is evident by the fact that bus and coach casualties have been “stubbornly stable” in Europe recent years and a need for investigating if a similar trend could be found in Sweden is therefore obvious. It was also important to add new knowledge to the bus and coach research in Sweden, since many areas were scarcely addressed. Aims: To describe bus and coach occupants’ injuries, crash and injury mechanisms generated in a traffic environment based on data from the medical sector. Additional aims were to investigate the injury reducing effect of a 3-point belt, the effect of cross-winds, and crucial factors in the emergency- and rescue response. Material and methods: Injury data analyses were based on a complete ten-year medical data set from a catchment-area with about 130,000 inhabitants. A number of crash studies with the scope in different crash phases were conducted by applying and elaborating the Haddon matrix as a framework. An additional framework, Protocol for Major Incidents was used in order to investi-gate the emergency- and rescue response to a severe coach crash. Results: Between the first and second five-year period, the incidence of injured in non-crash in-cidents was increased by 24%. In non-crash incidents, 54% were injured; 2/3 while alighting from a bus or coach. The pre-crash factor cross-wind, in addition to vehicle design, vehicle speed and road friction, was investigated in ten crashes. It was confirmed that cross-wind, in relation to vehicle speed and slippery road conditions, needs more attention. The importance of goods load-ing and passengers’ position in the bus, was indicated by the fact that a displacement of the cen-tre of mass rearwards with 10% increased the necessary coefficient of friction with, on average 45%, which in many cases corresponded to dry road conditions. Three Swedish rollover crashes were analysed with regard to the injury outcome, mechanisms and the possible injury reduction for occupants using a safety belt. A considerable increase in safety for occupants belted with 3-point belts was shown through limiting interior contacts, occupant interaction and the possibility of ejection. Crucial post-crash factors in the emergency- and rescue response showed that ordi-nary ways of working and equipment are not always useful and proper equipment for lifting a coach body is essential in the case of a rollover. Finally, the communication between the hospitals is important, and the telephone systems may be overloaded by calls from worried relatives and media. Conclusions: In non-crash events: Non-crash events constitute a majority of all bus and coach casualties with a high proportion of elderly female occupants among the MAIS 2+ injury cases. Boarding and, especially alighting causes many injuries to the lower extremities. In the pre-crash phase: Cross-winds do affect the safety of buses and coaches and requires more at-tention. Seat belt usage among bus and coach occupants has to be increased. In the crash phase: Rollover and ejection are the major causes behind serious and fatal injuries to bus and coach occupants, consequently, retentive glazing, pillars or rails need more attention. An upgrade from 2-point seat belts to 3-point seat belts yields an increase in the estimated injury re-duction from approximately 50% up to 80% for the MAIS 2+ casualties in a rollover crash. In the post-crash phase: In order to be able to lift a coach body proper equipment originated from experience and development is essential in a rescue operation of a crashed bus or coach. Fur-thermore, to improve the emergency response inside crashed coaches proper methods originated from experience need to be developed. Euro NBAP: Based on the results and conclusions generated in this thesis, a European New Bus and Coach Assessment Programme is suggested, which would provide bus and coach occupants with a assessment programme similar to the Euro NCAP.
|
|
