↓ Direkt till sidans innehåll
↓ Direkt till sidans sekundära innehåll (sidomenyn)

Träfflista för sökning "L773:1049 023X OR L773:1945 1938 "

Sökning: L773:1049 023X OR L773:1945 1938

Resultat 1-50 av 107

Sortera/gruppera träfflistan

Sortering: Träffar per sida:

Numrering	Referens	Omslagsbild	Hitta
1.	Djalali, Ahmadreza, et al. (författare) A fundamental, national, medical disaster management plan : an education-based model 2009 Ingår i: Prehospital and Disaster Medicine. - Stockholm : Karolinska Institutet, Dept of Clinical Science and Education, Södersjukhuset. - 1049-023X .- 1945-1938. Tidskriftsartikel (refereegranskat)abstract During disasters, especially earthquakes, health systems are expected to play an essential role in reducing mortality and morbidity. The most significant naturally occurring disaster in Iran is earthquakes; they have killed >180,000 people in the last 90 years. According to the current plan in 2007, the disaster management system of Iran is composed of three main work groups: (1) Prevention and risk management, (2) Education, and (3) Operation. This organizational separation has resulted in lack of necessary training programs for experts of specialized organizations, e.g., the Ministry of Health and Medical Education (MOHME). The National Board of MOHME arranged a training program in the field of medical disaster management. A qualified training team was chosen to conduct this program in each collaborating center, based on a predefined schedule. All collaborating centers were asked to recall 5–7 experts from each member university. Working in medical disaster management field for ≥2 years was an inclusion criterion. The training programs lasted three days, consisted of all relevant aspects of medical disaster management, and were conducted over a six-month period (November 2007–April 2008). Pretest and post-tests were used to examine the participants’ knowledge regarding disaster management; the mean score on the pre-test was 67.1 ±11.6 and 88.1 ±6.2, respectively. All participants were asked to hold the same training course for their organizations in order to enhance knowledge of related managers, stakeholders, and workers, and build capacity at the local and provincial levels. The next step was supposed to be developing a comprehensive medical disaster management plan in the entire country. Establishing nine disaster management regional collaborating centers in the health system of Iran has provided an appropriate base for related programs to be rapidly and easily accomplished throughout the country. This tree-shaped model is recommended as a cost-benefit and rapid approach for conducting training programs and developing a disaster management plan in the health system of a developing country.
2.	Tivesten, Åsa, 1969, et al. (författare) Circulating estradiol is an independent predictor of progression of carotid artery intima-media thickness in middle-aged men 2006 Ingår i: J Clin Endocrinol Metab. - : The Endocrine Society. - 0021-972X. ; 91:11, s. 4433-7 Tidskriftsartikel (refereegranskat)abstract CONTEXT: Estrogen treatment of men with prostate cancer is associated with increased cardiovascular morbidity and mortality; however, the role of endogenous estrogen levels for atherosclerotic disease in men is unknown. OBJECTIVE: The objective of the study was to determine whether endogenous serum estradiol (E2) levels predict the progression of carotid artery intima-media thickness in men. DESIGN, SETTING AND PARTICIPANTS: This was a population-based, prospective cohort study (the Atherosclerosis and Insulin Resistance study) conducted in Goteborg, Sweden, among 313 Caucasian men without cardiovascular or other clinically overt diseases. Carotid artery intima-media thickness, an index of preclinical atherosclerosis, was measured by ultrasound at baseline (58 yr of age) and after 3 yr of follow-up. Serum sex hormone levels and cardiovascular risk factors (body mass index, waist to hip ratio, systolic blood pressure, serum triglycerides, plasma c-peptide, and smoking status) were assessed at study entry. INTERVENTION: There was no intervention. MAIN OUTCOME MEASURES: Association between baseline total and free E2 levels and progression of carotid intima-media thickness over 3 yr with adjustments for cardiovascular risk factors was measured. RESULTS: In univariate analyses, both total and free E2 levels at baseline were positively associated with the annual change in intima-media thickness. In linear regression models including E2 and cardiovascular risk factors, low-density lipoprotein and high-density lipoprotein cholesterol and E2 were identified as independent predictors of progression of carotid artery intima-media thickness (total E2 beta = 0.187, P = 0.001; and free E2 beta = 0.183, P = 0.003). CONCLUSIONS: Circulating E2 is a predictor of progression of carotid artery intima-media thickness in middle-aged men. Further studies are needed to investigate the role of endogenous E2 for incident cardiovascular disease events.
3.	Englund, Liselotte, 1964- (författare) Healthcare and Media Interaction in Major Incidents and Disasters : Experiences Based on Swedish KAMEDO Reports in 20 years 2023 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 38:S1, s. s96-s96 Tidskriftsartikel (refereegranskat)abstract Introduction: Major Incidents and Disasters are often associated with early, extensive and prolonged media reporting. It is important to understand the interaction between first responders/rescue services and the media to create better conditions for providing and making available correct and objective information to as many people as possible.Method: A systematic literature review and content analysis was made on all Swedish KAMEDO reports (emergency medicine observations published by the National Board of Healthand Welfare) from the last twenty years, in total 39 reports. KAMEDO’s primary task is to feedback experience data (lessons learned) from disasters worldwide, through expert observers at the site of an emergency event. The aim of this study was to evaluate and analyze the experiences made regarding the interaction between media and healthcare in connection with major incidents and disasters, both on site and in hospitals.Results: The analysis resulted in the following main themes:(1) Communication problems and other challenges in Major Incidents and Disasters• No protection and restrictions• Information craving and news hunt• Interviews as intervention(2) Recommendations for efficient interaction between healthcare and the media:• Strategies from alert to action• Satisfying information needs• Clarity measures on site• Key actors of importance• Proactive media alertnessConclusion: Some conclusions regarding lessons learned about interaction between healthcare and the media, as well as about communication with the afflicted and citizens, in brief: The hospital management should take control of the communication through efficient communication strategies. An accommodating approach to the media's presence can facilitate the dissemination of the necessary early, correct and balanced information. Joint authority press conferences are a model tested and positively evaluated. Healthcare communicators are key actors in hospital crisis communication and media management. Healthcare and media both benefit from developing routines and reciprocal respect for proactive and efficient interaction in emergencies.
4.	Andersson, Elin, et al. (författare) Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke. 2018 Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; , s. 63-70 Tidskriftsartikel (refereegranskat)abstract Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke.METHODS: The study had a retrospective observational design. Data were collected from reports on patients who were transported by the EMS and had a final diagnosis of stroke at a single hospital in western Sweden (630 beds) in 2015. The data sources were hospital and prehospital medical journals.RESULTS: In total, 454 patients were included. Among them, the EMS clinician suspected stroke in 52%. The findings and documentation on patients with a suspected stroke differed from the remaining patients as follows: a) More frequently documented symptoms from the face, legs/arms, and speech; b) More frequently assessments of neurology, face, arms/legs, speech, and eyes; c) More frequently addressed the major complaint with regard to time and place of onset, duration, localization, and radiation; d) Less frequently documented symptoms of headache, vertigo, and nausea; and e) More frequently had an electrocardiogram (ECG) recorded and plasma glucose sampled. In addition to the 52% of patients who had a documented initial suspicion of stroke, seven percent of the patients had an initial suspicion of transitory ischemic attack (TIA) by the EMS clinician, and a neurologist was approached in another 10%.CONCLUSION: Among 454 patients with a final diagnosis of stroke who were transported by the EMS, an initial suspicion of stroke was not documented in one-half of the cases. These patients differed from those in whom a suspicion of stroke was documented in terms of limited clinical signs of stroke, a less extensive clinical assessment, and fewer clinical investigations. Andersson E , Bohlin L , Herlitz J , Sundler AJ , Fekete Z , Andersson Hagiwara M . Prehospital identification of patients with a final hospital diagnosis of stroke.
5.	Andrews, RA, et al. (författare) Sharing international experiences in disasters : summary and action plan 2001 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 16:1, s. 42-45 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: The discussions in this theme provided an opportunity to share specific experiences with disasters that occurred outside of the Asia-Pacific Rim. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 7 and Theme 3 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussion included: (1) disaster response planning, (2) predetermined command and organizational structure, (3) rapid response capability, (4) mitigation, and (5) communications and alternatives. DISCUSSION: The action plans presented are in common with those presented by Theme 3, and include: (1) plan disaster responses including the different types, identification of hazards, training based on experiences, and provision of public education; (2) improving coordination and control; (3) maintaining communications assuming infrastructure breakdown; (4) maximizing mitigation through standardized evaluations, creation of a legal framework, and recognition of advocacy and public participation; and (5) providing resources and knowledge through access to existing therapies, using the media, and increasing decentralization of hospital inventories. CONCLUSIONS: Most of the problems that occurred outside the Asia-Pacific rim relative to disaster management are similar to those experienced within it. They should be addressed in common with the rest of the world.
6.	Ardalan, Ali, et al. (författare) Impact of the Bam Earthquake, 26 December 2003, on Activities of Daily Living and Instrumental Activities of Daily Living of Older People 2011 Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 26:2, s. 99-108 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: This study compares self-reported Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) status among elderly survivors of the 2003 Bam Earthquake before, two months after, and five years after the event, and explores related determinants.METHODS: A two-stage cluster survey was conducted on 210 elderly survivors in the earthquake-stricken area five years after the event.RESULTS: Both ADL and IADL scores decreased two months after earthquake compared to prior status (p <0.001). No differences were observed between two months and five years after the event (p >0.05). Access to medical services were not related to level of ADL or IADL (p = 0.52 and p = 0.74, respectively). Elderly survivors with lower functional capability in terms of ADL experienced more problems in access to relief items (p = 0.04), but no similar association was found for IADL (p = 0.26).CONCLUSION: The Bam earthquake adversely affected functional capacity of the elderly. Disaster responders must take into account functional capacity of elders when planning for medical and relief operations.
7.	Axelsson, Christer, et al. (författare) A description of the prehospital phase of aortic dissection in terms of early suspicion and treatment. 2015 Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 30:2 Tidskriftsartikel (refereegranskat)abstract PURPOSE: Aortic dissection is difficult to detect in the early phase due to a variety of symptoms. This report describes the prehospital setting of aortic dissection in terms of symptoms, treatment, and suspicion by the Emergency Medical Service (EMS) staff.BASIC PROCEDURES: All patients in the Municipality of Gothenburg, Sweden, who, in 2010 and 2011, had a hospital discharge diagnosis of aortic dissection (international classification of disease (ICD) I 71,0) were included. The exclusion criteria were: age<18 years of age and having a planned operation. This was a retrospective, descriptive study based on patient records. In the statistical analyses, Fisher's exact test and the Mann-Whitney U test were used for analyses of dichotomous and continuous/ordered variables.MAIN FINDINGS: Of 92 patients, 78% were transported to the hospital by the EMS. The most common symptom was pain (94%). Pain was intensive or very intensive in 89% of patients, with no significant difference in relation to the use of the EMS. Only 47% of those using the EMS were given pain relief with narcotic analgesics. Only 12% were free from pain on admission to the hospital. A suspicion of aortic dissection was reported by the EMS staff in only 17% of cases. The most common preliminary diagnosis at the dispatch center (31%) and by EMS clinicians (52%) was chest pain or angina pectoris. In all, 79% of patients were discharged alive from the hospital (75% of those that used the EMS and 95% of those that did not).CONCLUSION: Among patients who were hospitalized due to aortic dissection in Gothenburg, 78% used the EMS. Despite severe pain in the majority of patients, fewer than half received narcotic analgesics, and only 12% were free from pain on admission to the hospital. In fewer than one-in-five patients was a suspicion of aortic dissection reported by the EMS staff.
8.	Axelsson, Christer, et al. (författare) The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting 2016 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 31:3, s. 272-277 Tidskriftsartikel (refereegranskat)abstract There is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.All patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.In all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs.The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with “true pathogens” were one hour and 19 minutes versus three hours and 15 minutes (P =.009).Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment.
9.	Bremer, Anders, 1957-, et al. (författare) Balancing Between Closeness and Distance : Emergency medical services personnel’s experiences of caring for families at out-of-hospital cardiac arrests and deaths 2012 Ingår i: Prehospital and Disaster Medicine. - Cambridge : Cambridge University Press. - 1049-023X .- 1945-1938. ; 27:1, s. 42-52 Tidskriftsartikel (refereegranskat)abstract Introduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem thataffects between 236,000 and 325,000 people in the United States each year. As resuscitationattempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services(EMS) personnel often face the needs of bereaved family members.Problem: Decisions to continue or terminate resuscitation at OHCA are influenced byfactors other than patient clinical characteristics, such as EMS personnel’s knowledge,attitudes, and beliefs regarding family emotional preparedness. However, there is littleresearch exploring how EMS personnel care for bereaved family members, or how theyare affected by family dynamics and the emotional contexts. The aim of this study is toanalyze EMS personnel’s experiences of caring for families when patients suffer cardiacarrest and sudden death.Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviewswere conducted with 10 EMS personnel from an EMS agency in southern Sweden.Results: The EMS personnel interviewed felt responsible for both patient care and familycare, and sometimes failed to prioritize these responsibilities as a result of their ownperceptions, feelings and reactions. Moving from patient care to family care implied amovement from well-structured guidance to a situational response, where the personnelwere forced to balance between interpretive reasoning and a more direct emotionalresponse, at their own discretion. With such affective responses in decision-making, thepersonnel risked erroneous conclusions and care relationships with elements of dishonesty,misguided benevolence and false hopes. The ability to recognize and respond to people’sexistential questions and needs was essential. It was dependent on the EMS personnel’sbalance between closeness and distance, and on their courage in facing the emotionalexpressions of the families, as well as the personnel’s own vulnerability. The presence offamily members placed great demands on mobility (moving from patient care to familycare) in the decision-making process, invoking a need for ethical competence.Conclusion: Ethical caring competence is needed in the care of bereaved family membersto avoid additional suffering. Opportunities to reflect on these situations within a frameworkof care ethics, continuous moral education, and clinical ethics training are needed.Support in dealing with personal discomfort and clear guidelines on family support couldbenefit EMS personnel.Bremer A, Dahlberg K, Sandman
10.	Brokopp, T, et al. (författare) KAMEDO Report No. 91: 2004 tsunami disaster in Asia--home transport and emergency care in Sweden 2008 Ingår i: Prehospital and disaster medicine. - : Cambridge University Press (CUP). - 1049-023X .- 1945-1938. ; 23:5, s. 472-5 Tidskriftsartikel (refereegranskat)abstract This is a descriptive report of the Swedish authorities' responses to the tsunami that affected Southeast Asia in December 2004. The main focus is the care of survivors and the injured during their transportation from Thailand and their return to Sweden. The psychological and physical after-effects also are presented based on a poll conducted one year after the tsunami.
11.	Celik, Daniel H., et al. (författare) Triage Performance of School Personnel Using the SALT System 2019 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:4, s. 401-406 Tidskriftsartikel (refereegranskat)abstract Introduction: The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control.Methods: School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm.Results: Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n = 104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD = 10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE.Conclusions: After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population's baseline knowledge of medical care, among others.
12.	Deverell, Edward, 1971-, et al. (författare) KAMEDO Report No. 87: Bomb Attack in Finnish Shopping Center, 2002 2007 Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 22:1, s. 86-88 Tidskriftsartikel (refereegranskat)
13.	Djalali, Ahmadreza, et al. (författare) Hospital disaster preparedness as measured by functional capacity : a comparison between Iran and Sweden 2013 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 28:5, s. 454-461 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: Hospitals are expected to continue to provide medical care during disasters. However, they often fail to function under these circumstances. Vulnerability to disasters has been shown to be related to the socioeconomic level of a country. This study compares hospital preparedness, as measured by functional capacity, between Iran and Sweden.METHODS: Hospital affiliation and size, and type of hazards, were compared between Iran and Sweden. The functional capacity was evaluated and calculated using the Hospital Safety Index (HSI) from the World Health Organization. The level and value of each element was determined, in consensus, by a group of evaluators. The sum of the elements for each sub-module led to a total sum, in turn, categorizing the functional capacity into one of three categories: A) functional; B) at risk; or C) inadequate.RESULTS: The Swedish hospitals (n = 4) were all level A, while the Iranian hospitals (n = 5) were all categorized as level B, with respect to functional capacity. A lack of contingency plans and the availability of resources were weaknesses of hospital preparedness. There was no association between the level of hospital preparedness and hospital affiliation or size for either country.CONCLUSION: The results suggest that the level of hospital preparedness, as measured by functional capacity, is related to the socioeconomic level of the country. The challenge is therefore to enhance hospital preparedness in countries with a weaker economy, since all hospitals need to be prepared for a disaster. There is also room for improvement in more affluent countries.
14.	Doohan, Isabelle, et al. (författare) Exploring injury panorama, consequences, and recovery among bus crash survivors : a mixed-methods research study 2017 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 32:2, s. 165-174 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery.METHODS: The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis.RESULTS: Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors' recoveries. The integrated findings are in the form of four "core cases" of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash.CONCLUSION: The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery. Doohan I , Björnstig U , Östlund U , Saveman BI . Exploring injury panorama, consequences, and recovery among bus crash survivors: a mixed-methods research study. Prehosp Disaster Med. 2017;32(2):165-174.
15.	Forsberg, Rebecca, et al. (författare) A Case Study of the High-speed Train Crash Outside Santiago de Compostela, Galicia, Spain 2016 Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 31:2, s. 163-168 Tidskriftsartikel (refereegranskat)abstract Introduction: The worldwide use of rail transport has increased, and the train speeds are escalating. Concurrently, the number of train disasters has been amplified globally. Consequently, railway safety has become an important issue for the future. High-velocity crashes increase the risk for injuries and mortality; nevertheless, there are relatively few studies on high-speed train crashes and the influencing factors on travelers' injuries occurring in the crash phase. The aim of this study was to investigate the fatal and non-fatal injuries and the main interacting factors that contributed to the injury process in the crash phase of the 2013 high-velocity train crash that occurred at Angrois, outside Santiago de Compostela, Spain. Methods: Hospital records (n = 157) of all the injured who were admitted to the six hospitals in the region were reviewed and compiled by descriptive statistics. The instant fatalities (n = 63) were collected on site. Influencing crash factors were observed on the crash site, by carriage inspections, and by reviewing official reports concerning the approximated train speed. Results: The main interacting factors that contributed in the injury process in the crash phase were, among other things, the train speed, the design of the concrete structure of the curve, the robustness of the carriage exterior, and the interior environment of the carriages. Of the 222 people on board (218 passengers and four crew), 99% (n = 220) were fatally or non-fatally injured in the crash. Thirty-three percent (n = 72) suffered fatal injuries, of which 88% (n = 63) died at the crash site and 13% (n = 9) at the hospital. Twenty-one percent (n = 32) of those admitted to hospital suffered multi-trauma (ie, extensive, severe, and/or critical injuries). The head, face, and neck sustained 42% (n = 123) of the injuries followed by the trunk (chest, abdomen, and pelvis; n = 92; 32%). Fractures were the most frequent (n = 200; 69%) injury. Conclusion: A mass-casualty incident with an extensive amount of fatal, severe, and critical injuries is most probable with a high-velocity train; this presents prehospital challenges. This finding draws attention to the importance of more robust carriage exteriors and injury minimizing designs of both railway carriages and the surrounding environment to reduce injuries and fatalities in future high-speed crashes.
16.	Garfield, R, et al. (författare) Changes in mortality rates and humanitarian conditions in Darfur, Sudan 2003-2007 2010 Ingår i: Prehospital and disaster medicine. - : Cambridge University Press (CUP). - 1049-023X .- 1945-1938. ; 25:6, s. 496-502 Tidskriftsartikel (refereegranskat)abstract The Darfur region of Sudan has been an intense focus of humanitarian concern since rebellions began there early in 2003. In 2004, the US Secretary of State declared that conflict in Darfur represented genocide. Since 2003, many sample surveys and various mortality estimates for Darfur have been made. Nonetheless, confusion and controversy surrounding mortality levels and trends have continued. For this project, results were reviewed from the highest quality field surveys on mortality in Darfur conducted between 2003 and 2008. Trend analysis demonstrated a dramatic decline in mortality over time in Darfur. By 2005, mortality levels had fallen below emergency levels and have continued to decline. Deaths directly due violence have declined as a proportion of all of the deaths in Darfur. Declining mortality in Darfur was not associated with other proximate improvements in well-being, such as improved nutrition. Without large-scale, humanitarian intervention, continuing high rates of mortality due to violence likely would have occurred. If mortality had continued at the high rate documented in 2004, by January 2009, there would have been 330,000 additional deaths. With the humanitarian assistance provided through the United Nations and non-governmental organizations, these people are alive today. A focus on excess deaths among non-combatants may draw attention away from other needs, such as establishing better security, improving service delivery to the displaced, and advocating for internally displaced persons to be reached today and to re-establish their lives and livelihoods tomorrow.
17.	Gryth, Dan, et al. (författare) Evaluation of medical command and control using performance indicators in a full-scale, major aircraft accident exercise. 2010 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 25:2, s. 118-123 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: Large, functional, disaster exercises are expensive to plan and execute, and often are difficult to evaluate objectively. Command and control in disaster medicine organizations can benefit from objective results from disaster exercises to identify areas that must be improved.OBJECTIVE: The objective of this pilot study was to examine if it is possible to use performance indicators for documentation and evaluation of medical command and control in a full-scale major incident exercise at two levels: (1) local level (scene of the incident and hospital); and (2) strategic level of command and control. Staff procedure skills also were evaluated.METHODS: Trained observers were placed in each of the three command and control locations. These observers recorded and scored the performance of command and control using templates of performance indicators. The observers scored the level of performance by awarding 2, 1, or 0 points according to the template and evaluated content and timing of decisions. Results from 11 performance indicators were recorded at each template and scores greater than 11 were considered as acceptable.RESULTS: Prehospital command and control had the lowest score. This also was expressed by problems at the scene of the incident. The scores in management and staff skills were at the strategic level 15 and 17, respectively; and at the hospital level, 17 and 21, respectively.CONCLUSIONS: It is possible to use performance indicators in a full-scale, major incident exercise for evaluation of medical command and control. The results could be used to compare similar exercises and evaluate real incidents in the future.
18.	Gustavsson, Martina, et al. (författare) Moral Distress among Disaster Responders : What is it? 2020 Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 35:2, s. 212-219 Tidskriftsartikel (refereegranskat)abstract Introduction:Current research of moral distress is mainly derived from challenges within high-resource health care settings, and there is lack of clarity among the different definitions. Disaster responders are prone to a range of moral challenges during the work, which may give rise to moral distress. Further, organizations have considered increased drop-out rates and sick leaves among disaster responders as consequences of moral distress. Therefore, initiatives have been taken to address and understand the impacts of moral distress and its consequences for responders. Since there is unclarity among the different definitions, a first step is to understand the concept of moral distress and its interlinkages within the literature related to disaster responders.Hypothesis/Problem:To examine how disaster responders are affected by moral challenges, systematic knowledge is needed about the concepts related to moral distress. This paper aims to elucidate how the concept of moral distress in disaster response is defined and explained in the literature.Methods:The paper opted to systematically map the existing literature through the methods of a scoping review. The searches derived documents which were screened regarding specific inclusion criteria. The included 16 documents were analyzed and collated according to their definitions of moral distress or according to their descriptions of moral distress.Results:The paper provides clarity among the different concepts and definitions of moral distress within disaster response. Several concepts exist that describe the outcomes of morally challenging situations, centering on situations when individuals are prevented from acting in accordance with their moral values. Their specific differences suggest that to achieve greater clarity in future work, moral stress and moral distress should be distinguished.Conclusion:Based on the findings, a conceptual model of the development of moral distress was developed, which displays a manifestation of moral distress with the interplay between the responder and the context. The overview of the different concepts in this model can facilitate future research and be used to illuminate how the concepts are interrelated.
19.	Hagiwara, Magnus, et al. (författare) Decision Support Tool in Prehospital Care : A systematic Review of Randomized Trials 2011 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 26:5, s. 319-329 Forskningsöversikt (refereegranskat)abstract Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient.Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials.Results: Use of the DST in prehospital care may have the possibility to decrease “time to definitive care” and improve diagnostic accuracy among prehospital personnel, but more studies are needed.Conclusions: The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care.
20.	Heldring, Sara, et al. (författare) Using High-Fidelity Virtual Reality for Mass-Casualty Incident Training by First Responders : A Systematic Review of the Literature 2024 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 39:1, s. 94-105 Forskningsöversikt (refereegranskat)abstract Introduction: First responders’ training and learning regarding how to handle a mass-casualty incident (MCI) is traditionally based on reading and/or training through computer-based scenarios, or sometimes through live simulations with actors. First responders should practice in realistic environments to narrow the theory-practice gap, and the possibility of repeating the training is important for learning. High-fidelity virtual reality (VR) is a promising tool to use for realistic and repeatable simulation training, but it needs to be further evaluated. The aim of this literature review was to provide a comprehensive description of the use of high-fidelity VR for MCI training by first responders.Methods: A systematic integrative literature review was used according to Whittemore and Knafl’s descriptions. Databases investigated were PubMed, CINAHL Complete, Academic Search Ultimate, Web of Science, and ERIC to find papers addressing the targeted outcome. The electronic search strategy identified 797 potential studies. Seventeen studies were deemed eligible for final inclusion.Results: Training with VR enables repetition in a way not possible with live simulation, and the realism is similar, yet not as stressful. Virtual reality offers a cost-effective and safe learning environment. The usability of VR depends on the level of immersion, the technology being error-free, and the ease of use.Conclusions: This integrative review shows that high-fidelity VR training should not rule out live simulation, but rather serve as a complement. First responders became more confident and prepared for real-life MCIs after training with high-fidelity VR, but efforts should be made to solve the technical issues found in this review to further improve the usability.
21.	Heldring, Sara, et al. (författare) Using high-fidelity virtual reality for mass-casualty incident training by first responders - a systematic review of the literature 2024 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 39:1, s. 94-105 Forskningsöversikt (refereegranskat)abstract INTRODUCTION: First responders' training and learning regarding how to handle a mass-casualty incident (MCI) is traditionally based on reading and/or training through computer-based scenarios, or sometimes through live simulations with actors. First responders should practice in realistic environments to narrow the theory-practice gap, and the possibility of repeating the training is important for learning. High-fidelity virtual reality (VR) is a promising tool to use for realistic and repeatable simulation training, but it needs to be further evaluated. The aim of this literature review was to provide a comprehensive description of the use of high-fidelity VR for MCI training by first responders.METHODS: A systematic integrative literature review was used according to Whittemore and Knafl's descriptions. Databases investigated were PubMed, CINAHL Complete, Academic Search Ultimate, Web of Science, and ERIC to find papers addressing the targeted outcome. The electronic search strategy identified 797 potential studies. Seventeen studies were deemed eligible for final inclusion.RESULTS: Training with VR enables repetition in a way not possible with live simulation, and the realism is similar, yet not as stressful. Virtual reality offers a cost-effective and safe learning environment. The usability of VR depends on the level of immersion, the technology being error-free, and the ease of use.CONCLUSIONS: This integrative review shows that high-fidelity VR training should not rule out live simulation, but rather serve as a complement. First responders became more confident and prepared for real-life MCIs after training with high-fidelity VR, but efforts should be made to solve the technical issues found in this review to further improve the usability.
22.	Henriksson, Otto, 1976-, et al. (författare) Protection against cold in prehospital care : evaporative heat loss reduction by wet clothing removal or the addition of a vapour barrier - a thermal manikin study 2012 Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 26:6, s. 1-6 Tidskriftsartikel (refereegranskat)abstract Introduction: In the prehospital care of a cold and wet person, early application of adequate insulation is of utmost importance to reduce cold stress, limit body core cooling, and prevent deterioration of the patient’s condition. Most prehospital guidelines on protection against cold recommend the removal of wet clothing prior to insulation, and some also recommend the use of a waterproof vapor barrier to reduce evaporative heat loss. However, there is little scientific evidence of the effectiveness of these measures.Objective: Using a thermal manikin with wet clothing, this study was conducted to determine the effect of wet clothing removal or the addition of a vapor barrier on thermal insulation and evaporative heat loss using different amounts of insulation in both warm and cold ambient conditions.Methods: A thermal manikin dressed in wet clothing was set up in accordance with the European Standard for assessing requirements of sleeping bags, modified for wet heat loss determination, and the climatic chamber was set to -15 degrees Celsius (°C) for cold conditions and +10°C for warm conditions. Three different insulation ensembles, one, two or seven woollen blankets, were chosen to provide different levels of insulation. Five different test conditions were evaluated for all three levels of insulation ensembles: (1) dry underwear; (2) dry underwear with a vapor barrier; (3) wet underwear; (4) wet underwear with a vapor barrier; and (5) no underwear. Dry and wet heat loss and thermal resistance were determined from continuous monitoring of ambient air temperature, manikin surface temperature, heat flux and evaporative mass loss rate.Results: Independent of insulation thickness or ambient temperature, the removal of wet clothing or the addition of a vapor barrier resulted in a reduction in total heat loss of 19-42%. The absolute heat loss reduction was greater, however, and thus clinically more important in cold environments when little insulation is available. A similar reduction in total heat loss was also achieved by increasing the insulation from one to two blankets or from two to seven blankets.Conclusion: Wet clothing removal or the addition of a vapor barrier effectively reduced evaporative heat loss and might thus be of great importance in prehospital rescue scenarios in cold environments with limited insulation available, such as in mass-casualty situations or during protracted evacuations in harsh conditions.
23.	Hugelius, Karin, 1977-, et al. (författare) Being Both Helpers and Victims : Health Professionals' Experiences of Working During a Natural Disaster 2017 Ingår i: Prehospital and Disaster Medicine. - New York, USA : Cambridge University Press. - 1049-023X .- 1945-1938. ; 32:2, s. 117-123 Tidskriftsartikel (refereegranskat)abstract Background: In November 2013, the Haiyan typhoon hit parts of the Philippines. The typhoon caused severe damage to the medical facilities and many injuries and deaths. Health professionals have a crucial role in the immediate disaster response system, but knowledge of their experiences of working during and in the immediate aftermath of a natural disaster is limited. Aim The aim of this study was to explore health professionals' experiences of working during and in the immediate aftermath of a natural disaster.Method: Eight health professionals were interviewed five months after the disaster. The interviews were analyzed using phenomenological hermeneutic methods.Results: The main theme, being professional and survivor, described both positive and negative emotions and experiences from being both a helper, as part of the responding organization, and a victim, as part of the surviving but severely affected community. Sub-themes described feelings of strength and confidence, feelings of adjustment and acceptance, feelings of satisfaction, feelings of powerless and fear, feelings of guilt and shame, and feelings of loneliness.Conclusion: Being a health professional during a natural disaster was a multi-faceted, powerful, and ambiguous experience of being part of the response system at the same time as being a survivor of the disaster. Personal values and altruistic motives as well as social aspects and stress-coping strategies to reach a balance between acceptance and control were important elements of the experience. Based on these findings, implications for disaster training and response strategies are suggested. Hugelius K , Adolfsson A , Örtenwall P , Gifford M . Being both helpers and victims: health professionals' experiences of working during a natural disaster.
24.	Hugelius, K., et al. (författare) Being Both Helpers and Victims: Health Professionals' Experiences of Working During a Natural Disaster 2017 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press (CUP). - 1049-023X .- 1945-1938. ; 32:2, s. 117-123 Tidskriftsartikel (refereegranskat)abstract Background In November 2013, the Haiyan typhoon hit parts of the Philippines. The typhoon caused severe damage to the medical facilities and many injuries and deaths. Health professionals have a crucial role in the immediate disaster response system, but knowledge of their experiences of working during and in the immediate aftermath of a natural disaster is limited. Aim The aim of this study was to explore health professionals' experiences of working during and in the immediate aftermath of a natural disaster. Method Eight health professionals were interviewed five months after the disaster. The interviews were analyzed using phenomenological hermeneutic methods. Results The main theme, being professional and survivor, described both positive and negative emotions and experiences from being both a helper, as part of the responding organization, and a victim, as part of the surviving but severely affected community. Sub-themes described feelings of strength and confidence, feelings of adjustment and acceptance, feelings of satisfaction, feelings of powerless and fear, feelings of guilt and shame, and feelings of loneliness. Conclusion Being a health professional during a natural disaster was a multi-faceted, powerful, and ambiguous experience of being part of the response system at the same time as being a survivor of the disaster. Personal values and altruistic motives as well as social aspects and stress-coping strategies to reach a balance between acceptance and control were important elements of the experience. Based on these findings, implications for disaster training and response strategies are suggested.
25.	Hugelius, Karin, 1977- (författare) Consular Crisis Management Operations : Special Considerations and Challenges 2020 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 35:4, s. 447-450 Tidskriftsartikel (refereegranskat)abstract Assisting the increasing number of tourists and foreign nationals exposed to crises situations in third countries-many of them far from home and extremely vulnerable-presents significant challenges. Despite the need to explore consular crisis management from an operational perspective, there are few studies that address the issue. This paper aims to describe the characteristics and context of consular crisis management operations based on personal experiences, scientific papers, grey literature, and key informant interviews.Consular crisis management operations are conducted in a context where the stakeholders and the legal environment may differ from humanitarian or civil protection operations. The physical distance causes logistical challenges and demands specific considerations for both civilian and medical evacuation. Consular crisis management operations often include medical care, psychosocial support activities, and disaster victim identification (DVI) activities. Political and media interest may also add significant challenges to such operations. Therefore, specific knowledge, skills, and preparations are needed for both diplomatic crisis management professionals and health professionals. Further research on consular crisis management activities-as well as the concept of consular crisis management itself-is strongly needed.
26.	Hugelius, Karin, 1977-, et al. (författare) Medical Experiences from a Consular Repatriation and Evacuation Operation from Afghanistan in August 2021 : A Field Report 2022 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 37:1, s. 139-141 Tidskriftsartikel (refereegranskat)abstract Following the Taliban influx in August 2021, several Western countries repatriated nationals and evacuated others from Kabul Airport in Afghanistan. This report aimed to describe medical experiences from the consular repatriation and evacuation operation.Memos from personal conversations with seven professionals involved in these operations formed the basis for this report.Minor trauma, gastrointestinal symptoms, dehydration, fever, and mental distress were common. Bandages, oral rehydration solution, and the administration of paracetamol were needed, in addition to medical evaluation of acuity. In consular repatriation and humanitarian evacuations, medical attendance should be prioritized to manage medical needs of individuals being evacuated, but also from a public health perspective. The medical needs covered a broad specter of infection disease symptoms, trauma, and mental health problems among patients of all ages. Since the nature of consular repatriations and evacuations can be challenging from safety and infrastructural aspects, general medical emergency awareness with an ability to effectively evaluate and manage both somatic and mental health emergencies on the ground and in the air, among both children and adults, is needed.
27.	Hugelius, Karin, 1977-, et al. (författare) Swedish ambulance managers descriptions of crisis support for ambulance staff after potentially traumatic events 2014 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 29:6, s. 589-592 Tidskriftsartikel (refereegranskat)abstract Introduction:Ambulance staff face complex and sometimes stressful or potentially traumaticsituations, not only in disasters but also in theirroutine daily work. The aim of this study wasto survey ambulance managers’ descriptions of crisis support interventions for ambulance staffafter potential traumatic events (PTEs).Methods:Semistructured interviews with a qualitative descriptive design were conductedwith six ambulance managers in a health care region in central Sweden. The data wasanalyzed using content analysis.Result:Five categories were found in the result: (1) description of a PTE; (2) descriptionand performance of crisis support interventions; (3) impact of working in potentiallytraumatic situations; (4) the ambulance managers’ role in crisis support interventions;and (5) the ambulance managers’ suggestions for improvement.Ambulance managersdescribed crisis support interventions after a PTE as a single, mandatory group meetingwith a structure reminiscent of debriefing. The ambulance managers also expressed doubtsabout the present structures for crisis support and mentioned an alternative approachwhich is more in line with present evidence-based recommendations.Conclusion:The results indicated a need for increased understanding of the importanceof the managers’ attitudes for ambulance staff; a need for further implementation ofevidence-based recommendations for crisis support interventions was also highlighted.
28.	Jokela, Jorma, et al. (författare) Increased situation awareness in major incidents - radio frequency identification (RFID) technique : a promising tool 2012 Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 1, s. 1-7 Tidskriftsartikel (refereegranskat)
29.	Jonson, Carl-Oscar, Docent, 1978-, et al. (författare) Efficacy of Video-Based Instructions for Laypeople Bleeding Control Education 2019 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:s1, s. 90-90 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Introduction:The Stop the Bleed campaign in the United States aims to teach bleeding control techniques, such as tourniquets, to the public. Educational consortium guidelines advocate using brief web- or video-based material. Another option is posters or flyers distributed at, for example, workplaces or public spaces.Aim:The aim of the current study was to evaluate the relative efficacy between a flyer and a video to teach tourniquet application skills to members of the public in Sweden.Methods:A total of 38 participants (27 male, 11 female) from the general public completed the study. Their ages ranged from 19 to 73 (M=32, SD=14). None had prior experience with tourniquet applications. One group (n=18) received tourniquet instructions on a flyer and one (n=20) received a 5-minute video instruction. Both groups completed pre- and post-questionnaires and a practical tourniquet application test.Results:Independent samples t-tests showed that the video-based instructions resulted in fewer application errors (M=1.40 out of 10, SD=1.19) compared to the flyer group (M=3.61, SD=2.40), t(36)=3.651, p=0.001, and higher post-task satisfaction (M=3.89 out of 5, SD=0.74 compared to M=3.39, SD=1.15). However, the flyer-group was faster (M=86.22 seconds, SD=27.28) compared to the video group (M=112.25, SD=42.22), t(36)=2.229, p=0.032.Discussion:Video instructions appear superior to flyers in terms of teaching correct tourniquet application to the general public. The longer total application time includes steps taken after bleeding control has been achieved (e.g. securing tourniquet straps and time notation), which may have contributed to the application time difference. The results support the educational guidelines that suggest video-based instructions for teaching basic tourniquet skills to laypeople are more effective.
30.	Jonson, Carl-Oscar, et al. (författare) Hierarchical task analysis as a method to support emergency response planning 2017 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 32, s. S19-S20 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
31.	Jonsson, Anders, 1955-, et al. (författare) Daily stress and conception of self in Swedish ambulance personnel 2004 Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 19:3, s. 226-234 Forskningsöversikt (refereegranskat)
32.	Junker, Johan, 1980-, et al. (författare) Prehospital Monitoring of Vital Parameters Using a Novel Device - RespiHeart 2017 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 32:Suppl. 1, s. S165-S166 Tidskriftsartikel (refereegranskat)abstract Study/Objective: The study aims at validating a novel device (RespiHeart) for monitoring vital parameters in traumatically injured patients. Background: There is a need for a simple-to-use method for monitoring of vital parameters in the prehospital setting. RespiHeart is a small medical device that is attached to the sternum. It sends light of defined wavelengths into the underlying vasculature, and measures the reflected light. The resulting signals are then treated using proprietary algorithms to obtain heart rate and respiratory rate. The device has the capability to also measure oxygen saturation, temperature and movement. Methods: The device was tested during training sessions for medical personnel, where various traumatic wounds were inflicted on anesthetized pigs. The training was primarily focused on teaching acute lifesaving interventions. The RespiHeart device was applied to the animal and used to monitor vital parameters throughout the training session. A total of 22 animals were included in the study. The data gathered from Respiheart were compared to results from a pulse oximeter and ventilator connected to the animal. Statistical comparison were performed using linear regression and Bland-Altman plots to analyze agreement of methods. Results: The heart rate as measured by the pulse oximeter was correlated to the rate reported by RespiHeart. The R2 was 0.9946 with a p-value of less than 0.0001. Bland-Altman analysis of heart rate revealed a bias of -0.06127 (95% CI -2.219- 2.097). The respiratory rate as set on the ventilator was correlated to the rate reported by RespiHeart. The R2 was 0.9978 with a p-value of less than 0.0001. Bland-Altman analysis of respiratory rate revealed a bias of -0.008584 (95% CI -0.42-0.4028). Conclusion: The results obtained in this study demonstrate a high degree of correlation between the data obtained from RespiHeart and the pulse oximeter and ventilator. This renders RespiHeart as a promising device for prehospital use.
33.	Junker, Johan, 1980-, et al. (författare) Standardized Measurement of Capillary Refill Time using Novel Technology 2019 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:s1, s. 167-168 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Introduction: In a patient going into shock, blood is redistributed from the periphery to the central circulation, making an assessment of skin perfusion useful in a prehospital setting. Capillary refill time (CRT) is the time required for a pressure blanched skin site to reperfuse. Currently, CRT is tested by manually applying pressure for 5s to the skin and observing the time before reperfusion. Guidelines state that CRT should be 2-3s in a healthy patient. Shortcomings in this procedure include lack of standardization of pressure, subjective assessment of the time for reperfusion, and not accounting for the patient’s skin temperature.Aim: To develop a standardized objective procedure for testing CRT in the prehospital setting.Method: The study protocol was approved by the Ethics Committee at Linköping University (M200-07, 2015-99-31). An electro-pneumatic device exerting constant force (9N) over 5s was developed. CRT was measured using the Tissue Viability Imager (Wheelsbridge AB, Sweden) which relies on polarization spectroscopy. To simulate hypothermic conditions, healthy volunteers were subjected to low ambient temperature (8°C). Blood loss was simulated using a custom-built lower body negative pressure (LBNP) chamber. In both scenarios, the CRT test was carried out on three test sites (finger pulp, forehead, and sternum).Results: CRT on the finger pulp and sternum was shown to be increased following the hypothermic conditions, but not on the forehead. Skin temperature on the three sites followed the same pattern, with the forehead being virtually unchanged. Tests performed during LBNP revealed an apparent effect on CRT following the simulated blood loss, with prolonged CRT for all sites tested.Discussion: A successful methodology for objective assessment of CRT was developed, which was validated on healthy volunteers following hypothermia or simulated blood loss. Ongoing work will investigate a combination of hypothermia and blood loss to more accurately simulate the prehospital setting.
34.	Karlsson, Kåre, et al. (författare) Heart rate as a marker of stress in ambulance personnel : A pilot study of the body's response to the ambulance alarm 2011 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 26:1, s. 21-26 Tidskriftsartikel (refereegranskat)abstract Introduction: Studies have demonstrated the presence of stress and post-traumatic stress among ambulance personnel, but no previous research has focused on the body's reaction in the form of the change in heart rate of ambulance staff in association with specific occupational stress.Hypothesis: The purpose of this study is to investigate whether work as an ambulance professional generates prolonged physiological arousal that can be measured by heart rate in different situations.Methods: Twenty participants carried a pulse-meter in the form of a wristwatch, which continuously measured and stored their heart rate 24 hours per day for a period of seven days. All ambulance alarms that occurred during the test period were recorded in journals, and the participants completed diaries and a questionnaire describing their experiences. The alarms were divided into different phases. Correlations between heart rate in the different phases were computed.Results: Analysis of study data indicated a significant rise of heart rate unrelated to physical effort during an emergency alarm and response. This increased heart rate was noticed throughout the mission and it was not related to the length of experience the staff had in the ambulance profession. In addition, a non-significant trend suggested that alarms involving acutely ill children lead to an even higher increase in heart rate. In addition, this research showed that constant tension existed during sleep, while available for an emergency, indicated by a noticeable increase in heart rate during sleep at work compared to sleeping at home.Conclusions: A rise in heart rate was experienced during all acute emergency missions, regardless of a subject's experience, education, and gender. Missions by themselves generated a rate increase that did not seem to correlate with physical effort required during an emergency response. This study shows that working on an ambulance that responds to medical emergencies is associated with a prolonged physiological arousal.
35.	Khankeh, Hamidreza, et al. (författare) Life recovery after disasters : a qualitative study in the Iranian context 2013 Ingår i: Prehospital and Disaster Medicine. - New York, USA : Cambridge University Press. - 1049-023X .- 1945-1938. ; 28:6, s. 573-9 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: Planned and organized long-term rehabilitation services should be provided to victims of a disaster for social integration, economic self-sufficiency, and psychological health. There are few studies on recovery and rehabilitation issues in disaster situations. This study explores the disaster-related rehabilitation process.METHOD: This study was based on qualitative analysis. Participants included 18 individuals (eight male and ten female) with experience providing or receiving disaster health care or services. Participants were selected using purposeful sampling. Data were collected through in-depth and semi-structured interviews. All interviews were transcribed and content analysis was performed based on qualitative content analysis.RESULTS: The study explored three main concepts of recovery and rehabilitation after a disaster: 1) needs for health recovery; 2) intent to delegate responsibility; and 3) desire for a wide scope of social support. The participants of this study indicated that to provide comprehensive recovery services, important basic needs should be considered, including the need for physical rehabilitation, social rehabilitation, and livelihood health; the need for continuity of mental health care; and the need for family re-unification services. Providing social activation can help reintegrate affected people into the community.CONCLUSION: Effective rehabilitation care for disaster victims requires a clear definition of the rehabilitation process at different levels of the community. Involving a wide set of those most likely to be affected by the process provides a comprehensive, continuous, culturally sensitive, and family-centered plan.
36.	Lantz Cronqvist, Mattias, et al. (författare) Development and Initial Validation of a Stochastic Discrete Event Simulation to Assess Disaster Preparedness 2019 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:1, s. 118-118 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Introduction:Assessing disaster preparedness in a given region is a complex problem. Current methods are often resource-intensive and may lack generalizability beyond a specific scenario. Computer-based stochastic simulations may be an additional method but would require systems that are valid, flexible, and easy to use. Emergo Train System (ETS) is an analog simulation system used for disaster preparedness assessments.Aim:To digitalize the ETS model and develop stochastic simulation software for improved disaster preparedness assessments.Methods:A simulation software was developed in C#. The simulation model was based on ETS. Preliminary verification and validation (V&V) tests were performed, including unit and integration testing, trace validation, and a comparison to a prior analog ETS disaster preparedness assessment exercise.Results:The software contains medically validated patients from ETS and is capable of automatically running disaster scenarios with stochastic variations in the injury panorama, available resources, geographical location, and other variables. It consists of two main programs: an editor where scenarios can be constructed and a simulation system to evaluate the outcome. Initial V&V testing showed that the software is reliable and internally consistent. The comparison to the analog exercise showed a general high agreement in terms of patient outcome. The analog exercise featured a train derailment with 397 injured, of which 45 patients suffered preventable death. In comparison, the computer simulation ran 100 iterations of the same scenario and indicated that a median of 41 patients (IQR 31 to 44) would suffer a preventable death.Discussion:Stochastic simulation methods can be a powerful complement to traditional capability assessments methods. The developed simulation software can be used for both assessing emergency preparedness with some validity and as a complement to analog capability assessment exercises, both as input and to validate results. Future work includes comparing the simulation to real disaster outcomes.
37.	Löfqvist, Erika, et al. (författare) Evacuation preparedness in the event of fire in intensive care units in Sweden : more is needed 2017 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 32:3, s. 317-320 Tidskriftsartikel (refereegranskat)abstract Introduction: Hospitals, including intensive care units (ICUs), can be subject to threat from fire and require urgent evacuation. Hypothesis: The hypothesis was that the current preparedness for ICU evacuation for fire in the national public hospital system in a wealthy country was very good, using Sweden as model. Methods: An already validated questionnaire for this purpose was adapted to national/local circumstances and translated into Swedish. It aimed to elicit information concerning fire response planning, personnel education, training, and exercises. Questionnaire results (yes/no answers) were collected and answers collated to assess grouped responses. Frequencies of responses were determined. Results: While a written hospital plan for fire response and evacuation was noted by all responders, personnel familiarity with the plan was less frequent. Deficiencies were reported concerning all categories: lack of written fire response plan for ICU, lack of personnel education in this, and lack of practical exercises to practice urgent evacuation in the event of fire. Conclusions: These findings were interpreted as an indication of risk for worse consequences for patients in the event of fire and ICU evacuation among the hospitals in the country that was assessed, despite clear regulations and requirements for these. The exact reasons for this lack of compliance with existing laws was not clear, though there are many possible explanations. To remedy this, more attention is needed concerning recognizing risk related to lack of preparedness. Where there exists a goal of high-quality work in the ICU, this should include general leadership and medical staff preparedness in the event of urgent ICU evacuation.
38.	Olander, Agnes, et al. (författare) Prediction of the Risk of Sepsis by Using Analysis of Plasma Glucose and Serum Lactate in Ambulance Services : A Prospective Study 2023 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 38:2, s. 160-167 Tidskriftsartikel (refereegranskat)abstract Introduction:The early recognition of patients with sepsis is difficult and the initial assessment outside of hospitals is challenging for ambulance clinicians (ACs). Indicators that ACs can use to recognize sepsis early are beneficial for patient outcomes. Research suggests that elevated point-of-care (POC) plasma glucose and serum lactate levels may help to predict sepsis in the ambulance service (AS) setting. Study Objective:The aim of this study was to test the hypothesis that the elevation of POC plasma glucose and serum lactate levels may help to predict Sepsis-3 in the AS. Methods:A prospective observational study was performed in the AS setting of Gothenburg in Sweden from the beginning of March 2018 through the end of September 2019. The criteria for sampling POC plasma glucose and serum lactate levels in the AS setting were high or intermediate risk according to the Rapid Emergency Triage and Treatment System (RETTS), as red, orange, yellow, and green if the respiratory rate was >22 breaths/minutes. Sepsis-3 were identified retrospectively. A primary and secondary analyses were carried out. The primary analysis included patients cared for in the AS and emergency department (ED) and were hospitalized. In the secondary analysis, patients who were only cared for in the AS and ED without being hospitalized were also included. To evaluate the predictive ability of these biomarkers, the area under the curve (AUC), sensitivity, specificity, and predictive values were used. Results:A total of 1,057 patients were included in the primary analysis and 1,841 patients were included in the secondary analysis. In total, 253 patients met the Sepsis-3 criteria (in both analyses). The AUC for POC plasma glucose and serum lactate levels showed low accuracy in predicting Sepsis-3 in both the primary and secondary analyses. Among all hospitalized patients, regardless of Sepsis-3, more than two-thirds had elevated plasma glucose and nearly one-half had elevated serum lactate when measured in the AS. Conclusions:As individual biomarkers, an elevated POC plasma glucose and serum lactate were not associated with an increased likelihood of Sepsis-3 when measured in the AS in this study. However, the high rate of elevation of these biomarkers before arrival in hospital highlights that their role in clinical decision making at this early stage needs further evaluation, including other endpoints than Sepsis-3.
39.	Olander, Agnes, et al. (författare) Prediction of the Risk of Sepsis by Using Analysis of Plasma Glucose and Serum Lactate in Ambulance Services: A Prospective Study 2023 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press (CUP). - 1049-023X .- 1945-1938. ; 38:2, s. 160-167 Tidskriftsartikel (refereegranskat)abstract Introduction: The early recognition of patients with sepsis is difficult and the initial assessment outside of hospitals is challenging for ambulance clinicians (ACs). Indicators that ACs can use to recognize sepsis early are beneficial for patient outcomes. Research suggests that elevated point-of-care (POC) plasma glucose and serum lactate levels may help to predict sepsis in the ambulance service (AS) setting. Study Objective: The aim of this study was to test the hypothesis that the elevation of POC plasma glucose and serum lactate levels may help to predict Sepsis-3 in the AS. Methods: A prospective observational study was performed in the AS setting of Gothenburg in Sweden from the beginning of March 2018 through the end of September 2019. The criteria for sampling POC plasma glucose and serum lactate levels in the AS setting were high or intermediate risk according to the Rapid Emergency Triage and Treatment System (RETTS), as red, orange, yellow, and green if the respiratory rate was >22 breaths/minutes. Sepsis-3 were identified retrospectively. A primary and secondary analyses were carried out. The primary analysis included patients cared for in the AS and emergency department (ED) and were hospitalized. In the secondary analysis, patients who were only cared for in the AS and ED without being hospitalized were also included. To evaluate the predictive ability of these biomarkers, the area under the curve (AUC), sensitivity, specificity, and predictive values were used. Results: A total of 1,057 patients were included in the primary analysis and 1,841 patients were included in the secondary analysis. In total, 253 patients met the Sepsis-3 criteria (in both analyses). The AUC for POC plasma glucose and serum lactate levels showed low accuracy in predicting Sepsis-3 in both the primary and secondary analyses. Among all hospitalized patients, regardless of Sepsis-3, more than two-thirds had elevated plasma glucose and nearly one-half had elevated serum lactate when measured in the AS. Conclusions: As individual biomarkers, an elevated POC plasma glucose and serum lactate were not associated with an increased likelihood of Sepsis-3 when measured in the AS in this study. However, the high rate of elevation of these biomarkers before arrival in hospital highlights that their role in clinical decision making at this early stage needs further evaluation, including other endpoints than Sepsis-3.
40.	Pettersson, Jenny, et al. (författare) Functional quality indicators for assessing health care initial response to societal disturbances for education 2017 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 32:Suppl. 1, s. 66-66 Tidskriftsartikel (refereegranskat)abstract Study/Objective: The purpose of this paper is to describe the procedure of identifying and developing quality indicators during educational activities. In addition, the steps taken to assure the validity and reliability of the indicators are presented.Background: In Sweden a national effort has been made to structure the work processes for crisis preparedness. That is, the process for regional health point of contact and the designated duty officer, has been modified in an attempt to support a shared view regarding collaboration and command during societal disturbances. The effort consists of education and training of designated duty officers, while also developing quality indicators for assessing the work process before the designated duty officer declare a major incident.Methods: The work of identifying and developing the quality indicators was carried out in focus groups with domain experts.Results: Initially the work processes of the designated duty officer were thoroughly analyzed and described. The work process was separated into three distinct phases. Focus was on the first two phases. These process steps, have thereafter been connected to concrete behaviors or products that are assessed. The quality indicators are directed towards two levels; if a process step has been carried out within the time-frame, and also the performance quality of an indicator. For example, has an operational picture been established within three minutes of the alarm call? If so, what was the quality of the decision based on, the event description, the consequence description, or the measures description?Conclusion: The aim of the quality indicators is to make sure that educational activities that are performed does in fact result in actual, and measurable impact. This approach confirms to what extent the activities are successful.
41.	Pettersson, Jenny, et al. (författare) Resilience Training of Regional Medical Command and Control 2019 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:1, s. 164-165 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Introduction:Resilience is often described as a desirable holistic approach to disaster preparedness. However, the term has a wide variety of meanings and is hard to operationalize and implement in disaster management. A goal for the EU H2020 project DARWIN was to operationalize resilience for incident management teams.Aim:To test the resilience operationalization by analyzing command team behaviors in a major incident exercise and trace observations to resilience theory.Methods:A regional medical command and control team (n=11) was observed when performing in a functional simulation exercise of a mass casualty incident (300 injured, 1800 uninjured) following the collision of a cruise ship and an oil tanker close to the Swedish coast. Audio and video recordings of behaviors and communications were reviewed for resilient behaviors based on the DARWIN guidelines using the “resilience markers for small teams” framework (Furniss et al., 2011).Results:A total of 121 observed instances of resilient behaviors were found in the material. In 95 cases (79%) the observed behaviors followed a priori hypothesized connections between resilient strategies and general markers. Certain marker-strategy combinations occurred frequently, such as 18 observations where the strategy “understand crucial assumptions” occurred together with the marker “adapting to expected and unexpected events.”Discussion:Resilience has the potential to contribute to a more holistic disaster management approach. The findings that the observations, in general, correspond to the expected relationship between theoretical concretization and contextualization supports the DARWIN effort to operationalize resilience theory. This is a prerequisite for developing observational protocols for training and further studies of resilient behaviors in disaster management teams.
42.	Pilemalm, Sofie, 1973- (författare) Using Security Guards and Civil Volunteers as First Responders inMedical Emergency Response - Tasks, Needs, and Challenges 2019 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:1, s. 175-176 Tidskriftsartikel (refereegranskat)abstract Introduction:Public sector challenges have initiated new forms of collaboration between emergency response organizations, occupations from other societal sectors, and civil citizens, not the least in socio-economically vulnerable areas. As collaborations emerge, there is a need to explore the tasks, needs, and challenges of the new resources when providing medical emergency response.Aim:To explore two cases of 1) security guards and 2) organized civil volunteers collaborating with the ambulance services and municipal rescue services, and identifying relevant tasks, needs and challenges. The presentation will focus on their dispatch on medical alerts. A brief comparison of the two groups will also be performed.Methods:A case study approach was applied involving interviews and workshops with security guards, civil volunteers, ambulance services, and rescue services personnel.Results:The civil volunteers are dispatched on medical alerts concerning heart failures and accidents requiring first aid, including stopping major bleedings. The scope of tasks of security guards is broader since they are also dispatched on suicide and assault alerts. Needs in both cases include, e.g., proper training, joint exercises, equipment in terms of defibrillators, torquedos, and first aid kits, and proper ICT/GPS positioning support for dispatching. Challenges are mainly organizational and legal where security guards are somewhat protected by their own employer (e.g., through agreements, trauma support, and safety measures such as receiving a hepatitis vaccine) while civil volunteers do not have sufficient protection in any of these respects.Discussion:Both groups are useful resources in future medical emergency response since they are often close to the incident site and can provide first response while waiting for the professional resources, thereby saving lives and reducing consequences of trauma. However, they need to be better integrated into the professional emergency response system.
43.	Prytz, Erik, 1985-, et al. (författare) A pilot investigation of the effect of transport-related factors on care quality in a moving ambulance 2019 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:1, s. 158-158 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Introduction:Providing patient care in a moving ambulance can be difficult due to various transport-related factors, (e.g., accelerations, lateral forces, and noise). Previous research has primarily focused on cardiopulmonary resuscitation (CPR) performance effects but has neglected to investigate other care interventions.Aim:To test a range of different care interventions during different driving scenarios.Methods:A workshop with ambulance practitioners was held to create a list of care interventions to be tested. Two ambulance practitioners were recruited to drive an ambulance on a closed test-track while performing care interventions on simulation models. Three driving scenarios of differing difficulty were used. Main outcome measures were estimates of workload using the NASA Task Load Index (TLX) and task difficulty. G-forces and video-data were also collected.Results:Estimated workload increased overall as the difficulty of the driving scenario increased, as did task difficulty estimates. However, some care scenarios and interventions were affected less. For example, placing intravenous access increased greatly in difficulty, whereas saturation and blood pressure measurements had more modest increases. TLX scores showed that the primarily estimated physical workload and effort that increased, but also mental and temporal demands for some care scenarios. The more difficult driving scenarios primarily increased the variability of measured G-forces but not necessarily the overall driving speed, indicating that force variability is an important factor to study further.Discussion:The study was intended as an initial pilot test of a wide range of care interventions. It will serve as input to future, larger studies of specific interventions and transport-related factors. Overall, this small pilot indicates that more interventions than only CPR should be studied in moving ambulances to investigate potential performance effects. This is important for traffic, patient, and work safety for ambulance workers and patients.
44.	Prytz, Erik, 1985-, et al. (författare) The effect of moulage on immersion, realism and learning in a traffic accident training scenario for police, rescue service and ambulance students 2019 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:1, s. 17-18 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Introduction:Moulage is the art of creating faked injuries on actors for training purposes. Moulage is commonly used in disaster and emergency medicine training, as it is believed to improve learning through enhanced realism.Aim:The aim of the current study was to test the effect of moulage on perceived realism and learning during a joint exercise featuring students from the police, rescue service, and ambulance service.Methods:The scenario was a car accident with two victims. Students (n = 135) were divided into 12 groups. Moulage was applied to the victim actors for half the groups (n = 67), whereas the other half (n = 68) experienced the scenario without moulage. Victim cards were used in both scenarios. Immersion, realism, and learning was measured on a 100-point scale immediately post-scenario using a questionnaire.Results:Two (moulage group) by three (student population and police, rescue service, or ambulance) ANOVAS on realism, immersion, and learning found no effects on realism or immersion (all p>0.10). There was an effect of student group on learning, F(2, 92) = 3.518, p = 0.034, partial eta square = 0.071, such that the rescue service students had overall lower scores on learning (M = 53.87, SD = 28.29) compared to the police (M = 66.07, SD = 27.55) and ambulance students (M = 74.99, SD = 24.51). Cohen’s ds for moulage effect was calculated to 0.144 for immersion, 0.112 for realism, and 0.003 for learning.Discussion:The current study did not find any effects of moulage on immersion, realism, or learning. The effect sizes indicate that any effect of moulage on realism and immersion, should it exist, is in the approximate size of 2-3 points on a 100-point scale. The lack of effect may be due to limitations in the study design, but may also indicate that the use of moulage in addition to victim cards is not necessarily beneficial for novice students’ learning.
45.	Radestad, M., et al. (författare) Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents: A Mixed Method Study 2016 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press (CUP). - 1049-023X .- 1945-1938. ; 31:4, s. 376-385 Tidskriftsartikel (refereegranskat)abstract Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs). Methods A mixed method design was used. The first part of the study was in the form of a web-survey of attitudes answered by ambulance personnel. The question explored was: Is it likely that systems that are not used in everyday practice will be used during MIs? Two identical web-based surveys were conducted, before and after implementing a new strategy for triage tagging. This strategy consisted of a time-limited triage routine where ambulance services assigned triage category and applied triage tags in day-to-day trauma incidents in order to improve field triage. The second part comprised three focus group interviews (FGIs) in order to provide a deeper insight into the attitudes towards, and experience of, the use of triage tags. Data were analyzed using qualitative content analysis. Results The overall finding was the need for daily routine when failure in practice. Analysis of the web-survey revealed three changes: ambulance personnel were more prone to use tags in minor accidents, the sort scoring system was considered to be more valuable, but it also was more time consuming after the intervention. In the analysis of FGIs, four categories emerged that describe the construction of the overall category: perceived usability, daily routine, documentation, and need for organizational strategies. Conclusion Triage is part of the foundation of ambulance skills, but even so, ambulance personnel seldom use this in routine practice. They fully understand the benefit of accurate triage decisions, and also that the use of a triage algorithm and color coded tags is intended to make it easier and more secure to perform triage. However, despite the knowledge and understanding of these benefits, sparse incidents and infrequent exercises lead to ambulance personnel's uncertainty concerning the use of triage tagging during a MI and will therefore, most likely, avoid using them.
46.	Roy, N, et al. (författare) Where there are no emergency medical services-prehospital care for the injured in Mumbai, India 2010 Ingår i: Prehospital and disaster medicine. - : Cambridge University Press (CUP). - 1049-023X .- 1945-1938. ; 25:2, s. 145-151 Tidskriftsartikel (refereegranskat)abstract Introduction:In a populous city like Mumbai, which lacks an organized pre-hospital emergency medical services (EMS) system, there exists an informal network through which victims arrive at the trauma center. This baseline study describes the prehospital care and transportation that currently is available in Mumbai.Methods:A prospective trauma database was created by interviewing 170 randomly selected patients from a total of 454 admitted over a two-month period (July–August 2005) at a Level-I, urban, trauma center.Results:The injured victim in Mumbai usually is rescued by a good Samaritan passer-by (43.5%) and contrary to popular belief, helped by the police (89.7%). Almost immediately after rescue, the victim begins transport to the hospital. No one waits for the EMS ambulance to arrive, as there is none. A taxi cab is the most popular substitute for the ambulance (39.3%). The trauma patient in India usually is a young man in his late-twenties, from a lower socioeconomic class. He mostly finds himself in a government hospital, as private hospitals are reluctant to provide trauma care to the seriously injured. The injured who do receive prehospital care receive inadequate and inappropriate care due to the high cost of consumables in resuscitation, and in part due to the providers' lack of training in emergency care. Those who were more likely to receive prehospital care suffered from road traffic injuries (odds ratio (OR) = 2.3) and those transported by government ambulances (OR = 10.83), as compared to railway accident victims (OR = 0 .41) and those who came by taxi (OR = 0.54).Conclusions:Currently, as a result of not having an EMS system, prehospital care is a citizen responsibility using societal networks. It is easy to eliminate this system and shift the responsibility to the state. The moot point is whether the state-funded EMS system will be robust enough in a resource-poor setting in which public hospitals are poorly funded. Considering the high funding cost of EMS systems in developed countries and the insufficient evidence that prehospital field interventions by the EMS actually have improved outcomes, Mumbai must proceed with caution when implementing advanced EMS systems into its congested urban traffic. Similar cities, such as Mexico City and Jakarta, have had limited success with implementing EMS systems. Perhaps reinforcing the existing network of informal providers of taxi drivers and police and with training, funding quick transport with taxes on roads and automobile fuels and regulating the private ambulance providers, could be more cost-effective in a culture in which sharing and helping others is not just desirable, but is necessary for overall economic survival.
47.	Rüter, Anders, et al. (författare) Improved Staff Procedure Skills Lead to Improved Management Skills : An Observational Study in an Educational Setting 2009 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 24:5, s. 376-379 Tidskriftsartikel (refereegranskat)abstract Introduction: Good staff procedure skills in a management group during incidents and disasters are believed to be a prerequisite for good management of the situation. However, this has not been demonstrated scientifically. Templates for evaluation results from performance indicators during simulation exercises have previously been tested. The aim of this study was to demonstrate the possibility that these indicators can be used as a tool for studying the relationship between good management skills and good staff procedure skills.Hypothesis: Good and structured work (staff procedure skills) in a hospital management group during simulation exercises in disaster medicine is related to good and timely decisions (good management skills).Methods: Results from 29 consecutive simulation exercises in which staff procedure skills and management skills were evaluated using quantitative measurements were included. The statistical analysis method used was simple linear regression with staff procedure skills as the response variable and management skills as the predictor variable.Results: An overall significant relationship was identified between staff pro-cedure skills and management skills (p ≤0.05).Conclusions: This study suggests that there is a relationship between staff procedure skills and management skills in the educational setting used. Future studies are needed to demonstrate if this also can be observed during actual incidents.
48.	Rüter, Anders, 1954-, et al. (författare) Performance indicators as quality control for testing and evaluating hospital management groups : a pilot study. 2006 Ingår i: Prehospital and Disaster Medicine. - Cambridge, UK : Cambridge University Press. - 1049-023X .- 1945-1938. ; 21:6, s. 423-426 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: An important issue in disaster medicine is the establishment of standards that can be used as a template for evaluation. With the establishment of standards, the ability to compare results will improve, both within and between different organizations involved in disaster management.OBJECTIVE: Performance indicators were developed for testing in simulations exercises with the purpose of evaluating the skills of hospital management groups. The objective of this study is to demonstrate how these indicators can be used to create numerically expressed results that can be compared.METHODS: Three different management groups were tested in standardized simulation exercises. The testing took place according to the organization's own disaster plan and within their own facilities. Trained observers used a pre-designed protocol of performance indicators as a template for the evaluation.RESULTS: The management group that scored lowest in management skills also scored lowest in staff skills. CONCLUSION: The use of performance indicators for evaluating the management skills of hospital groups can provide comparable results in testing situations and could provide a new tool for quality improvement of evaluations of real incidents and disasters.
49.	Rüter, Anders, et al. (författare) Staff procedure skills in management groups during exercise in disaster medicine 2006 Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 22:4, s. 318-324 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: In stressful situations such as the management of major incidents and disasters, the ability to work in a structured way is important. Medical management groups initially are formed by personnel from different operations that are on-call when the incident or disaster occurs.OBJECTIVE: The aim of this study was to test if performance indicators for staff procedure skills in medical management groups during simulations could be used as a quality control tool for finding areas that require improvement.METHODS: A total of 44 management groups were evaluated using performance indicators in which results could be expressed numerically during simulations.RESULTS: The lowest scores were given to documentation and to the introduction of new staff members. The highest score was given the utilization of technical equipment.CONCLUSIONS: Staff procedure skills can be measured during simulations exercises. A logging system may lead to enhancing areas requiring improvement.
50.	Rådestad, Monica, et al. (författare) Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents : A Mixed Method Study 2016 Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 31:4, s. 376-85 Tidskriftsartikel (refereegranskat)abstract Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs).METHODS: A mixed method design was used. The first part of the study was in the form of a web-survey of attitudes answered by ambulance personnel. The question explored was: Is it likely that systems that are not used in everyday practice will be used during MIs? Two identical web-based surveys were conducted, before and after implementing a new strategy for triage tagging. This strategy consisted of a time-limited triage routine where ambulance services assigned triage category and applied triage tags in day-to-day trauma incidents in order to improve field triage. The second part comprised three focus group interviews (FGIs) in order to provide a deeper insight into the attitudes towards, and experience of, the use of triage tags. Data were analyzed using qualitative content analysis.RESULTS: The overall finding was the need for daily routine when failure in practice. Analysis of the web-survey revealed three changes: ambulance personnel were more prone to use tags in minor accidents, the sort scoring system was considered to be more valuable, but it also was more time consuming after the intervention. In the analysis of FGIs, four categories emerged that describe the construction of the overall category: perceived usability, daily routine, documentation, and need for organizational strategies.CONCLUSION: Triage is part of the foundation of ambulance skills, but even so, ambulance personnel seldom use this in routine practice. They fully understand the benefit of accurate triage decisions, and also that the use of a triage algorithm and color coded tags is intended to make it easier and more secure to perform triage. However, despite the knowledge and understanding of these benefits, sparse incidents and infrequent exercises lead to ambulance personnel's uncertainty concerning the use of triage tagging during a MI and will therefore, most likely, avoid using them. Rådestad M , Lennquist Montán K , Rüter A , Castrén M , Svensson L , Gryth D , Fossum B . Attitudes towards and experience of the use of triage tags in major incidents: a mixed method study. Prehosp Disaster Med. 2016;31(4):1-10.

Skapa referenser, mejla, bekava och länka

Länka till träfflistan

Resultat 1-50 av 107

Avgränsa träffmängd

Typ av publikation: tidskriftsartikel (100); forskningsöversikt (7)

Typ av innehåll: refereegranskat (96); övrigt vetenskapligt/konstnärligt (11)

Författare/redaktör: Von Schreeb, J (11); Khorram-Manesh, Amir ... (9); Jonson, Carl-Oscar, ... (8); Örtenwall, Per, 1951 (8); Riddez, L (7); Rüter, Anders (6); visa fler...; Castrén, Maaret (6); Axelsson, Christer (5); Andersson Hagiwara, ... (5); Prytz, Erik, 1985- (5); Castrén, M (5); Nilsson, Heléne (4); Eriksson, A (4); Goniewicz, Krzysztof (4); Kurland, Lisa, 1960- (4); Jonsson, Anders, 195 ... (4); Gryth, D (4); Örtenwall, Per (4); Hugelius, Karin, 197 ... (4); Herlitz, Johan, 1949 (3); Svensson, Leif (3); Herlitz, Johan (3); Suserud, Björn-Ove (3); Roy, N (3); Jonsson, Anders (3); Björnstig, Ulf, 1943 ... (3); Gellerfors, M (3); Lundin, T (2); Svensson, L (2); Singh, P (2); Kuklane, Kalev (2); Holmér, Ingvar (2); Larsson, E (2); Adolfsson, Annsofie, ... (2); Bremer, Anders, Doce ... (2); Linde, J (2); Lindstrom, V (2); Sundler, Annelie Joh ... (2); Hahn, RG (2); Norton, I (2); Bremer, Anders, 1957 ... (2); Andersson, Henrik, 1 ... (2); Brändström, Helge (2); Gifford, Mervyn, 195 ... (2); Svensen, C (2); Junker, Johan, 1980- (2); Forsberg, Rebecca (2); Pettersson, Jenny (2); Vikström, Tore (2); Hedelin, Annika (2); visa färre...

Lärosäte: Karolinska Institutet (38); Göteborgs universitet (19); Linköpings universitet (18); Högskolan i Borås (14); Umeå universitet (8); Örebro universitet (7); visa fler...; Uppsala universitet (4); Linnéuniversitetet (4); Lunds universitet (3); Sophiahemmet Högskola (3); Jönköping University (2); Högskolan Dalarna (2); Röda Korsets Högskola (2); Högskolan i Gävle (1); Högskolan Väst (1); Mälardalens universitet (1); Malmö universitet (1); Högskolan i Skövde (1); Karlstads universitet (1); Försvarshögskolan (1); visa färre...

Språk: Engelska (107)

Forskningsämne (UKÄ/SCB): Medicin och hälsovetenskap (45); Samhällsvetenskap (9); Teknik (5)

År

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

LIBRIS.kb.se

Stäng

Kopiera och spara länken för att återkomma till aktuell vy