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1.
  • Spreco, Armin, et al. (författare)
  • Nowcasting (Short-Term Forecasting) of COVID-19 Hospitalizations Using Syndromic Healthcare Data, Sweden, 2020
  • 2022
  • Ingår i: Emerging Infectious Diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 28:3, s. 564-571
  • Tidskriftsartikel (refereegranskat)abstract
    • We report on local nowcasting (short-term forecasting) of coronavirus disease (COVID-19) hospitalizations based on syndromic (symptom) data recorded in regular healthcare routines in Östergötland County (population ≈465,000), Sweden, early in the pandemic, when broad laboratory testing was unavailable. Daily nowcasts were supplied to the local healthcare management based on analyses of the time lag between telenursing calls with the chief complaints (cough by adult or fever by adult) and COVID-19 hospitalization. The complaint cough by adult showed satisfactory performance (Pearson correlation coefficient r>0.80; mean absolute percentage error <20%) in nowcasting the incidence of daily COVID-19 hospitalizations 14 days in advance until the incidence decreased to <1.5/100,000 population, whereas the corresponding performance for fever by adult was unsatisfactory. Our results support local nowcasting of hospitalizations on the basis of symptom data recorded in routine healthcare during the initial stage of a pandemic. © 2022 Centers for Disease Control and Prevention (CDC). All rights reserved.
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2.
  • Andersson Granberg, Tobias, 1973-, et al. (författare)
  • Sensor Requirements for Logistics Analysis of Emergency Incident Sites
  • 2020
  • Ingår i: Proceedings of the 17th ISCRAM Conference. - : Information Systems for Crisis Response and Management. - 9781949373271 ; , s. 952-960
  • Konferensbidrag (refereegranskat)abstract
    • Using sensors to collect data at emergency incident sites can facilitate analysis of the logistic operations. This can be used to improve planning and preparedness for new operations. Furthermore, real-time information from the sensors can serve as operational decision support. In this work in progress, we investigate the requirements on the sensors, and on the sensor data, to facilitate such an analysis. Through observations of exercises, the potential of using sensors for data collection is explored, and the requirements are considered. The results show that the potential benefits are significant, especially for tracking patients, and understanding the interaction between the response actors. However, the sensors need to be quite advanced in order to capture the necessary data.
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4.
  • Bengtsson, Kristofer, et al. (författare)
  • Framtidens skadeplats : intervjuer med landstingens beredskapssamordnare
  • 2016
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Syftet med föreliggande studie var att genom intervjuer med beredskapssamordnare från Sveriges landsting försöka skapa en bild av hur uppfattningen var att skadeplatsen såg ut idag och skulle kunna kommat att förändras på sikt. Vidare önskade intervjustudien söka svar på frågor som rörde komplexiteten på skadeplatsen genom att diskutera ledningsförhållanden, samverkan med andra aktörer, alarmerings- och dirigeringsfunktionernas roll i det svenska sjukvårdsystemet samt hur ett möjligt arbete med ett återtagande av förmågan till ett civilt försvar skulle påverka systemet i sin helhet. Överlag har detta syfte uppnåtts genom ett rikt material kring relevanta frågeställningar som belyst ett flertal kritiska aspekter både i dagens situation men även för framtiden.Resultatet ger en relativt entydig bild av hur situationen uppfattas på landstingsnivå idag av personalen som behandlar beredskapsfrågorna. Den bild som målas upp fokuserar kanske främst på en upplevd avsaknad av centrala och nationellt övergripande styrningar vilket menligt påverkar förmågan att lyfta ledningsförmågan från regional till nationell nivå vid en större händelse som överstiger den regionala förmågan. Den svenska modellen för att hantera samhällsstörningar av idag är väl anpassad för att hantera händelser inom ramen för det egna länets geografiska område. Befintliga koncept för samverkan och samordning bedöms fungera bra i vardagen, exempelvis vid de vanligaste fallen av skadeplatser: trafik och brand. Detta innebär dock att systemet fungerar väl under förutsättning att händelsen är begränsad i såväl tid och rum som vad avser antalet drabbade. En större händelse eller flera händelser samtidigt på olika platser, särskilt om det finns försvårande faktorer såsom utsläpp av farliga ämnen eller en högre hotbild, skapar försvårande omständigheter som upplevs svårhanterliga idag. I ett framtida scenario upplevs även risken för dessa händelser och terrorattacker att öka. Avhängigheten av IT samt ett samhälle som i allt högre grad förlitar sig på ”just in time”-leveranser gör att sårbarheten har ökat och upplevs fortsätta göra det även i framtiden. Andra viktiga områden som lyfts är nuvarande och befarad framtida brist på kompetent personal samt att utbildnings- och övningsverksamhet inte kan bedrivas i önskvärd utsträckning, delvis på grund av personalbrist och –omsättning.Vidare syns den generella uppfattningen vara att det saknas ett tydligt ledarskap på nationell nivå då det sällan, om alls, utkommer några direkta styrningar rörande vad som skall uppnås och i vilken utsträckning. Detta har också påvisats i avsnittet ovan rörande före-, under- och efterperspektivet där det finns en klart övervägande del synpunkter på de två förstnämnda perspektiven. Nationell styrning är alltså något som uppfattas vara efterfrågat och då inte bara avseende ledning under insats utan även i frågor rörande enhetlig utrustning och metodik samt utbildnings- och övningsfrågor. Få respondenter har tagit upp efterperspektivet i någon större utsträckning men då det har förekommit har det framförallt berört erfarenhetshanteringsfrågor och den brist som upplevs finnas inom detta specifika område idag. Erfarenheter från den egna verksamheten, såväl i vardagen som vid insatser vid allvarliga händelser, behöver tas om hand, följas upp och sedan utgöra grund för ett levande utvecklingsarbete.
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5.
  • Berggren, Peter, 1971-, et al. (författare)
  • The importance of using the designated duty officers when assessing the medical response organization
  • 2017
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • BackgroundAn important aspect of disaster medicine is to be proactive and respond quickly when disaster strikes. In Sweden, the role responsible for swift medical response on the regional level is the designated duty officer.MethodsA large exercise to assess national medical response ability was conducted. Seven medical regional staffs (a total of 93 individuals participated as tested participants) were involved in handling a large train accident scenario. The exercise was run for 5 hours, where the different regional staffs were located at their regular command posts. The exercise was organized using Emergo Train Systems.ResultsSeveral capabilities were identified during the exercise as important for the organization to maintain the ability to handle a similar event: documentation and operational picture, communication and terminology, command of resources, strategy for distribution of resources, national co-ordination, and exercise development.The designated duty officers were central to the exercise in several aspects: 1) in developing and verifying a realistic scenario and preparing background information, 2) as participants in the exercise, 3) assessors of the staffs’ behaviors, and 4) as domain experts when interpreting the exercise outcome.ConclusionsUsing subject matter experts is central to many research domains. However, the more complex a situation is the larger the demand of expertise is. The technical platform allows for coordinating complex exercises, whereas the subject matter expert in terms of the designated duty officer is required to guarantee validity and reliability in these large-scale exercises.Key messages:Running complex scenarios to train and test abilities requires subject matter experts in both planning, preparation, implementation, and assessment.Sophisticated simulator and training platforms, such as Emergo Train Systems, facilitates while the designated duty officers are necessary to guarantee validity and reliability in the exercise.
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6.
  • Björnqvist, Anton, 1995-, et al. (författare)
  • An Analysis of a Swedish Medical Command and Control System’s Situation Reports from the COVID-19 Pandemic
  • 2022
  • Ingår i: ISCRAM 2022 Conference Proceedings – 19th International Conference on Information Systems for Crisis Response and Management. - 9788284270999 ; , s. 334-348
  • Konferensbidrag (refereegranskat)abstract
    • This paper presents an analysis of situation reports used and created by a crisis management team within the Swedish healthcare sector during the early phase of the COVID-19 pandemic. The analysis was conducted through a deductive content analysis, where categories were identified based on the concepts of common operational pictures, sensemaking, and situation awareness. In the analysis, support for all identified categories was found. Based on the analysis and the concepts, future recommendations regarding what type of information that ought to be included in situation reports were created. These recommendations include, amongst others, the categories of consequences, how it is perceived by the public, objectives, status and implications of information, future scenarios, actions, resources, and work procedures.
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  • Björnstig, Ulf, et al. (författare)
  • Tågolyckan på Once station, Buenos Aires 2012
  • 2019
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Händelsen: Tågolyckan inträffade på morgonen den 22 februari 2012 när ett lokaltåg okontrollerat körde in i stoppanordningen i slutet av perrongen på Once station, i centrala Buenos Aires. Hastigheten var mellan 20 och 27 km i timmen, men stoppet var så kraftigt att vagn nummer två trängde sex meter in i vagn nummer ett. Sammanlagt skadades cirka 850 personer varav 51 avled, de flesta omkom i samband med att de två första vagnarna klämdes ihop. Bidragande faktorer till att så många skadades var, ett överfullt tåg av äldre modell, som var dåligt underhållet, och kördes av en organisation med låg säkerhetsmedvetenhet. Händelsen visar att en masskadesituation kan uppstå även vid låga hastigheter. Räddningsinsatsen var omfattande: ett hundratal ambulanser, tre helikoptrar och mer än 500 räddningsarbetare engagerades för att omhänderta skadade och fördela dem mellan huvudstadens 13 akutsjukhus. Beredskapen i Buenos Aires var god vid denna händelse, tack vare genomförda risk- och sårbarhetsanalyser, övningar och utbildningsinsatser. Den argentinska akutmedicinska responsorganisationen och sjukhusen arbetade i stor utsträckning enligt samma katastrofmedicinska principer som i Sverige. Händelsen kunde därför analyseras utifrån ett svenskt perspektiv.Erfarenheter: Sverige har varit relativt förskonat från tågolyckor med många svårt skadade. Däremot har tillbuden ökat kraftigt och järnvägssystemet är idag slitet och överbelastat. Det finns därför anledning att studera inträffade tågolyckor i världen för att dra lärdom av internationella erfarenheter av olika skadebegränsande faktorer som kan vara av betydelse för svensk katastrofmedicinsk beredskap. Det går att dra flera lärdomar ifrån tågolyckan på Once-stationen.Nedan redovisas ett antal sammanfattande slutsatser från händelsen med relevans för den svenska beredskapen:• Det finns en risk att händelser med många svårt skadade kan inträffa även vid låga hastigheter.• Tågens konstruktion, utformningen av koppel och deformationszoner, samt materielens förslitningsgrad är av stor betydelse för säkerheten.• Risken att passagerare, bagage och lösa föremål kastas runt i tågvagnen vid en häftig inbromsning är påtaglig.• Buffertstopp som är konstruerade så att de ger upphov till ett abrupt stopp, utgör en riskfaktor för allvarliga deformationsförlopp och skador, även vid låga hastigheter. TÅGOLYCKAN PÅ ONCE STATION, BUENOS AIRES 2012 SOCIALSTYRELSEN 9• Brister i företags och myndigheters kvalitetssäkring av sin verksamhet bidrar till att risken för händelser som tågolyckan på Once-stationen inträffar.• Varningar om tekniska fel som inte tas på allvar i organisationens säkerhetsarbete utgör en riskfaktor.• Bristande träning bland räddningspersonal i de räddningstekniska svårigheter som kan uppstå vid en tågolycka, till exempel att ta loss fastklämda, kan bidra till att hantering av drabbade fördröjs.• Förmågan att bedöma situationen och prioritera bland de drabbade i samråd med medicinskt ansvarig kan sannolikt vara av stor betydelse för att minska insatstiden till de svårast klämda och skadade.• Samtliga sjukhus bör ha en i förväg fastställd förmåga att ta emot patienter vid förstärknings- respektive katastrofläge, så att särskild sjukvårdsledning på regional nivå har möjlighet att snabbt fördela ett stort antal skadade.• En väl fungerande plan för krisstöd och samlad anhörigupplysning underlättar för den somatiska vården. Brister i en sådan plan får stora konsekvenser för allmänhetens förtroende.• För att hantera en lika stor tågolycka i Sverige kan flera regioner behöva engageras, vilket ställer stora krav på ledningsförmågan i den drabbade regionen. Dessutom behövs en effektiv samverkan mellan lokal, regional och nationell nivå. Det är därför nödvändigt med en gemensam nationell ledningsmodell vid särskild händelse, gemensamma kris- och katastrofmedicinska utbildningar och regelbundna övningar.
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10.
  • Brodin, Wilhelm, et al. (författare)
  • The Effect of Presence of Blood on Medical Laypeople’s Ability to Perform First Aid for Massive Bleeding
  • 2022
  • Ingår i: Proceedings of the Human Factors and Ergonomics Society Annual Meeting. ; , s. 251-255
  • Konferensbidrag (refereegranskat)abstract
    • There are currently several educational initiatives to teach first aid courses for medical laypeople, such as the Stop the Bleed campaign. Although much research on educational initiatives has been conducted, there are still factors that remain unexplored, such as the potential effects of blood itself on laypeople’s first aid performance and educational experience. This study investigates such potential effects for performance of the first aid techniques tourniquet application and wound packing, in relation to individual differences in disgust sensitivity and medical fear of blood. The results show that the presence of blood will increase the time a medical layperson takes to apply a tourniquet and pack a wound but does not affect the quality of the aid. Additionally, the disgust sensitivity of the medical layperson was found to predict an increase in application time for the wound packing task, but not the tourniquet application task, when blood was present.
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11.
  • Cedrini, V, et al. (författare)
  • Improving resilience management for critical infrastructures : strategies and practices across air traffic management and healthcare
  • 2018
  • Ingår i: Safety and Reliability – Safe Societies in a Changing World. - London : Taylor & Francis. - 9780815386827 - 9781351174664 ; , s. 1319-1327
  • Konferensbidrag (refereegranskat)abstract
    • Recent natural and man-made disasters highlight that a more resilient approach to preparing for and dealing with such events is needed. To address this challenge, the main objective of the research and innovation H2020 project DARWIN is the development of European resilience management guidelines for Critical Infrastructures (CI). Based on a systematic literature survey with a world-wide scope and prioritization of resilience concepts, the guidelines have been developed taking into account everyday operations, contingency plans, training, etc. This paper describes insights gained from the adaptation of these guidelines in the domains of Air Traffic Management (ATM) and Healthcare (HC). A collaborative and iterative process has been defined involving relevant experts and practitioners. To ensure transnational, cross-sector applicability and uptake, a Community of Crisis and Resilience Practitioners (DARWIN DCoP) has been involved. The preliminary results indicate that a big step has been taken in moving from the resilience theory to practice
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12.
  • Forsyth, Katherine, et al. (författare)
  • Improving Instructions to Stop the Bleed
  • 2017
  • Ingår i: Proceedings of the Human Factors and Ergonomics Society 2017 Annual Meting. - Santa Monica : Human Factors and Ergonomics Society, HFES. - 2169-5067 .- 1071-1813. ; , s. 588-592
  • Konferensbidrag (refereegranskat)abstract
    • The Stop The Bleed initiative was developed by the Department of Homeland Security to educate lay providers in bleeding reduction strategies. The current study evaluated: (1)three tourniquet instructions using a simulated tourniquet task and (2)participant confidence levels in tourniquet use and lay provider training. Thirty participants with limited clinical experience applied a tourniquet to a simulated limb using one of three instruction sets. Twelve of these participants (40%) participated in a tourniquet training session and focus group to discuss each instruction set. Participants preferred the most simple and pictoral instruction set, and identified opportunities for improvement in each set. Participant confidence in tourniquet use increased significantly following the task and the focus group. After the focus group, participant confidence in instructing lay providers on proper tourniquet use significantly increased. Adding key steps, contextual pictures, and indicators of success to instructions could support lay providers stop the bleed in life-threatening situations
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  • Friberg, Marc, et al. (författare)
  • The Effects of Stress on Tourniquet Application and CPR Performance in Layperson and Professional Civilian Populations
  • 2023
  • Ingår i: Human Factors. - : SAGE PUBLICATIONS INC. - 0018-7208 .- 1547-8181. ; 65:3, s. 496-507
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective The purpose of this study was to compare laypeoples and professional first responders ability to perform tourniquet application and cardiopulmonary resuscitation (CPR) during calm and stressful circumstances. Background Life-threatening bleeding is a major cause of death that could be prevented by fast and appropriate first aid interventions. Therefore, laypeople are now being trained in bleeding control skills, transforming them from bystanders to immediate responders. However, critics have questioned whether laypeople are able to perform during more stressful conditions. Method Twenty-four laypersons and 31 professional first responders were tested in two conditions: a calm classroom scenario and a stressful scenario consisting of paintball fire and physical exertion. Stress and workload were assessed along with task performance. Results The experimental manipulation was successful in terms of eliciting stress reactions. Tourniquet application performance did not decline in the stressful condition, but some aspects of CPR performance did for both groups. First responders experienced higher task engagement and lower distress, worry and workload than the laypeople in both the calm and stressful conditions. Conclusion Stress did not affect first responders and laypeople differently in terms of performance effects. Stress should therefore not be considered a major obstacle for teaching bleeding control skills to laypeople. Application Tourniquet application can be taught to laypeople in a short amount of time, and they can perform this skill during stress in controlled settings. Concerns about laypeoples ability to perform under stress should not exclude bleeding control skills from first aid courses for civilian laypeople.
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16.
  • Friberg, Marc, et al. (författare)
  • Training Effectiveness Factors Associated with Laypeople Hemorrhage Control Training : A Systematic Literature Review
  • 2023
  • Ingår i: Framtidens Skadeplats 2023. - Linköping : Linköping University Electronic Press.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • IntroductionHemorrhage control initiated by laypeople, or immediate responders, can be a crucial link for increased survival among victims with hemorrhage. An increased interest in hemorrhage control training for laypeople have resulted in numerous publications in the area, showing that training laypeople in hemorrhage control can be successful (Nichols & Horstman, 2022; Tang et al., 2022). To this date, it is unknown which training factors are associated with successful training outcomes and to what extent. The objective of this study is to review and analyze past and present literature on hemorrhage control training for laypeople, in order to highlight current knowledge gaps, and direct future research.MethodA systematic literature review was performed by reviewing and analyzing the literature. Five electronic databases, CINAHL, Embase, PubMed, Scopus, and Web of Science, were used in the literature search. Search keywords were chosen among the variations and synonyms to the words: “laypeople” AND “hemorrhage” AND “training” AND “stop the bleed”. To examine where the knowledge gaps exist in terms of training effectiveness, a theoretical model by Cannon-Bowers et al. (1995) was chosen as theoretical lens, and each record was categorized into six training outcome categories: reactions, attitude change, learning, training performance, job performance, and results/organizational effectiveness, according to the content of the reviewed studies.Preliminary resultsIn total, 2962 records were initially identified for screening, and 1186 records were kept after duplicate removal and deletion of incomplete records. After title and abstract review, 186 records were sought for retrieval. This will be further reduced into a fewer number of records for full text review after additional screening. By categorizing the records into the six training outcome categories, previous research efforts can be highlighted, as well as it creates an opportunity for future research suggestions.ConclusionBy equipping the public with the necessary knowledge and tools for hemorrhage control, lives can be saved. By examining the literature on hemorrhage control training effectiveness, suggestions for future research and educational practice can be made.
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17.
  • Gonzalez, Jose, et al. (författare)
  • Elicitation, analysis and mitigation of systemic pandemic risks
  • 2021
  • Ingår i: Proceedings of the 18th ISCRAM Conference. - 9781949373615 ; , s. 581-596
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • The Covid-19 pandemic has disrupted the health care system and affected all sectors of society, including criticalinfrastructures. In turn, the impact on society’s infrastructures has impacted back on the health care sector. Theseinteractions have created a system of associated risks and outcomes, where the outcomes of risks are risksthemselves and where the resulting consequences are complex vicious cycles. Traditional risks assessmentmethods cannot cope with interdependent risks.This paper describes a novel risk systemicity approach to elicit and mitigate the systemic risks of a majorpandemic. The approach employed the internet-based software strategyfinder™ in workshops to elicit relevantrisk information from sixteen appropriately selected experts from the health care sector and major sectors impactedby and impacting back on the health care sector. The risk information was processed with powerful analyticaltools of strategyfinder to allow the experts to prioritise portfolios of strategies attacking the vicious cycles. 
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18.
  • Goolsby, Craig, et al. (författare)
  • The Untrained Publics Ability to Apply the Layperson Audiovisual Assist Tourniquet vs a Combat Application Tourniquet: A Randomized Controlled Trial
  • 2023
  • Ingår i: Journal of the American College of Surgeons. - : LIPPINCOTT WILLIAMS & WILKINS. - 1072-7515 .- 1879-1190. ; 236:1, s. 178-186
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Although the Stop the Bleed campaigns impact is encouraging, gaps remain. These gaps include rapid skill decay, a lack of easy-to-use tourniquets for the untrained public, and training barriers that prevent scalability. A team of academic and industry partners developed the Layperson Audiovisual Assist Tourniquet (LAVA TQ)& mdash;the first audiovisual-enabled tourniquet for public use. LAVA TQ addresses known tourniquet application challenges and is novel in its design and technology. STUDY DESIGN: This study is a prospective, randomized, superiority trial comparing the ability of the untrained public to apply LAVA TQ to a simulated leg vs their ability to apply a Combat Application Tourniquet (CAT). The study team enrolled participants in Boston, MA; Frederick, MD; and Linkoping, Sweden in 2022. The primary outcome was the proportion of successful applications of each tourniquet. Secondary outcomes included: mean time to application, placement position, reasons for failed application, and comfort with the devices. RESULTS: Participants applied the novel LAVA TQ successfully 93% (n = 66 of 71) of the time compared with 22% (n = 16 of 73) success applying CAT (relative risk 4.24 [95% CI 2.74 to 6.57]; p < 0.001). Participants applied LAVA TQ faster (74.1 seconds) than CAT (126 seconds ; p < 0.001) and experienced a greater gain in comfort using LAVA TQ than CAT. CONCLUSIONS: The untrained public is 4 times more likely to apply LAVA TQ correctly than CAT. The public also applies LAVA TQ faster than CAT and has more favorable opinions about its usability. LAVA TQs highly intuitive design and built-in audiovisual guidance solve known problems of layperson education and skill retention and could improve public bleeding control. (c) 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
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19.
  • Goralnick, Eric, et al. (författare)
  • Defining a Research Agenda for Layperson Prehospital Hemorrhage Control A Consensus Statement
  • 2020
  • Ingår i: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 3:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Importance  Trauma is the leading cause of death for US individuals younger than 45 years, and uncontrolled hemorrhage is a major cause of trauma mortality. The US military’s medical advancements in the field of prehospital hemorrhage control have reduced battlefield mortality by 44%. However, despite support from many national health care organizations, no integrated approach to research has been made regarding implementation, epidemiology, education, and logistics of prehospital hemorrhage control by layperson immediate responders in the civilian sector.Objective  To create a national research agenda to help guide future work for prehospital hemorrhage control by laypersons.Evidence Review  The 2-day, in-person, National Stop the Bleed (STB) Research Consensus Conference was conducted on February 27 to 28, 2019, to identify and achieve consensus on research gaps. Participants included (1) subject matter experts, (2) professional society–designated leaders, (3) representatives from the federal government, and (4) representatives from private foundations. Before the conference, participants were provided a scoping review on layperson prehospital hemorrhage control. A 3-round modified Delphi consensus process was conducted to determine high-priority research questions. The top items, with median rating of 8 or more on a Likert scale of 1 to 9 points, were identified and became part of the national STB research agenda.Findings  Forty-five participants attended the conference. In round 1, participants submitted 487 research questions. After deduplication and sorting, 162 questions remained across 5 a priori–defined themes. Two subsequent rounds of rating generated consensus on 113 high-priority, 27 uncertain-priority, and 22 low-priority questions. The final prioritized research agenda included the top 24 questions, including 8 for epidemiology and effectiveness, 4 for materials, 9 for education, 2 for global health, and 1 for health policy.Conclusions and Relevance  The National STB Research Consensus Conference identified and prioritized a national research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage. Investigators and funding agencies can use this agenda to guide their future work and funding priorities.
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20.
  • Hermelin, Jonas, et al. (författare)
  • Operationalising resilience for disaster medicine practitioners : capability development through training, simulation and reflection
  • 2020
  • Ingår i: Cognition, Technology & Work. - : Springer. - 1435-5558 .- 1435-5566. ; 22:3, s. 667-683
  • Tidskriftsartikel (refereegranskat)abstract
    • Resilience has in recent decades been introduced as a term describing a new perspective within the domains of disaster management and safety management. Several theoretical interpretations and definitions of the essence of resilience have been proposed, but less work has described how to operationalise resilience and implement the concept within organisations. This case study describes the implementation of a set of general resilience management guidelines for critical infrastructure within a Swedish Regional Medical Command and Control Team. The case study demonstrates how domain-independent guidelines can be contextualised and introduced at an operational level, through a comprehensive capability development programme. It also demonstrates how a set of conceptual and reflective tools consisting of educational, training and exercise sessions of increasing complexity and realism can be used to move from high-level guidelines to practice. The experience from the case study demonstrates the value of combining (1) developmental learning of practitioners’ cognitive skills through resilience-oriented reflection and interaction with dynamic complex open-ended problems; (2) contextualisation of generic guidelines as a basis for operational methodological support in the operational environment; and (3) the use of simulation-based training as part of a capability development programme with increasing complexity and realism across mixed educational, training and exercise sessions. As an actual example of a resilience implementation effort in a disaster medicine management organisation, the study contributes to the body of knowledge regarding how to implement the concept of resilience in operational practice.
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21.
  • Herrera, I., et al. (författare)
  • Applying resilience concepts in crisis management and critical infrastructures-the DARWIN project
  • 2017
  • Ingår i: RISK, RELIABILITY AND SAFETY: INNOVATING THEORY AND PRACTICE. - : CRC PRESS. - 9781315374987 - 9781138029972 ; , s. 2137-2144
  • Konferensbidrag (refereegranskat)abstract
    • Recent crises and disasters, both natural and man-made have led to the conclusion that there is a need for a resilient approach to preparing for and dealing with such events is needed. In this context, the DARWIN project aims to improve response to expected and unexpected crises affecting critical infrastructures and social structures by developing management guidelines on resilience concepts and innovative training modules for crisis management. The guidelines will cover essential resilience abilities of stakeholders to anticipate, monitor, respond, adapt, learn and evolve, to ensure efficient operation in face of crises. This paper uses a selection of resilience concepts to illustrate how resilience management guidelines can be used to understand and improve crises management. The application of the concepts to this specific case is an experiment to guide further work. This experiment shows that resilience guidelines should enable discovery on how multiple actors operate in a flexible manner and adapt in rapidly changing environment. Further work, needs to specify a set of guidelines co-developed and tested with end-users.
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22.
  • Hindorf, Marie, et al. (författare)
  • Workload of Swedish Special Forces Operators Experienced During Stressful Simulation Training: A Pilot Study
  • 2022
  • Ingår i: Journal of Special Operations Medicine. - : Breakaway Media, LLC. - 1553-9768. ; 22:3, s. 42-48
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Stress week was included during training of Special Forces (SF) Operators in Sweden to test their ability and limits for handling stress in different unknown situations and environments at a military training facility in Sweden. The aim of the study was to examine the effects of stress and workload experienced in various tasks during firefighting and military medicine simulation training.Methods: This pilot study was performed during the second day of stress week. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) is a validated, subjective, and multidimensional assessment tool for rating perceived workload with six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration. These subscales were used as an indicator of stress experienced. The different tasks were assessed by the SF Operators by rating the NASA-TLX subscales for each task, which were then analyzed and compared using ANOVA.Results: There was a significant difference between the two simulation exercises assessed by the participants and instructors, and both groups considered firefighting to be more demanding than medical. The participants perceived the mental and physical demands as more demanding in the firefighting exercises, as well as for the level of frustration and effort. However, no differences regarding performance or temporal demands between the simulation exercises were found.Conclusion: The principle "train as you fight" implies difficult and demanding situations. When exposing Swedish SF Operators to challenging situations, assessment of perceived stress and performance are possible.
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23.
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24.
  • Hooke, Alexander W., et al. (författare)
  • Mechanical Assessment of Tissue Properties During Tourniquet Application
  • 2021
  • Ingår i: Military medicine. - : OXFORD UNIV PRESS. - 0026-4075 .- 1930-613X. ; 186, s. 378-383
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Successful tourniquet application increases survival rate of exsanguinating extremity hemorrhage victims. Tactile feedback during tourniquet application training should reflect human tissue properties in order to increase success in the field. This study aims to understand the mechanical properties of a human limb during tourniquet application. Method: Six cadaveric extremities-three uppers and three lowers-were tested from three body mass index groups: low (<19) healthy (19-24), and overweight (>24). Each specimen donned with a tourniquet and mounted to a servo-hydraulic testing machine, which enabled controlled tightening of the tourniquet while recording the tourniquet tension force and strap displacement. A thin-film pressure sensor placed between the specimen and the tourniquet recorded contact pressure. Each limb was tested with the tourniquet applied at two different sites resulting in testing at the upper arm, forearm, thigh, and shank. Results: The load displacement curves during radial compression were found to be nonlinear overall, with identifiable linear regions. Average contact pressure under the tourniquet strap at 200N and 300N of tension force was 126.3 (sigma= 41.2) mm Hg and 205.3 (sigma = 75.3) mm Hg, respectively. There were no significant differences in tissue stiffness or contact pressure at 300N of tension force between limb (upper vs. lower) or body mass index. At 200N of tension, the upper limb had significantly higher contact pressure than the lower limb (P= 0.040). Relative radial compression was significantly different between upper (16.74, sigma = 4.16%) and lower (10.15, sigma = 2.25%) extremities at 200N tension (P= 0.005). Conclusions: Simulation of tissue compression during tourniquet application may be achieved with a material exhibiting elastic properties to mimic the force-displacement behavior seen in cadaveric tissue or with different layers of material. Different trainers for underweight, healthy, and overweight limbs may not be needed. Separate tourniquet training fixtures should be created for the upper and lower extremities.
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25.
  • Hälso- och sjukvårdens förmåga att hantera en allvarlig händelse med många skadade : erfarenheter och lärdomar av Övning TYKO
  • 2016
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Den 3 mars 2016 fick Socialstyrelsen i uppdrag av regeringen att öva hälsooch sjukvårdens förmåga att hantera en allvarlig händelse med många skadade. Myndigheten beslutade att genomföra övningen som en funktionell simuleringsövning med motspel. De övade utvärderades med hjälp av mätbara kvalitetsindikatorer som tidigare identifierats inom ramen för Socialstyrelsens arbete med att ta fram en gemensam modell för särskild sjukvårdsledning vid allvarlig händelse. Inför övningen skapades ett scenario som var utmanande för hälso- och sjukvården men, för att möjliggöra genomförandet inte innefattade alla potentiella komplexa faktorer. En kritisk observation är att analysen utifrån en övning bör vara restriktiv med slutsatser ifall dessa inte samtidigt kan styrkas utifrån tidigare övningar eller verkliga händelser. Övningens scenario samt patienternas skadepanorama och utfall visualiserades med hjälp av simuleringsverktyget Emergo Train System® och dess instruktörer vid Katastrofmedicinskt Centrum i Linköping. Ett väsentligt mål med övningen var att den ska utgöra ett underlag för att stärka förmågan inom hälso- och sjukvården genom att identifiera utvecklingsområden. I rapporten redovisas under övningen identifierade förmågor och utvecklingsområden som myndigheten bedömer som viktiga för att upprätthålla, säkra och förbättra förmågan att hantera allvarliga händelser: • Dokumentation och lägesbild • Kommunikation och terminologi • Mobilisering och dirigering av resurser • Fördelningsstrategi och gränssättande kapacitet • Nationell samordning • Övningsteknisk utveckling En gemensam lägesbild är viktig efter som det stödjer de involverade aktörerna i arbetet med att värdera behovet av stöd under pågående händelse. Därför var en viktig del i övningens utvärdering huruvida påverkade landsting hade förmågan att snabbt skapa sig en uppfattning om aktuellt behov, tillgängliga resurser och hur ytterligare pre- hospitala samt hospitala resurser skulle kunna mobiliseras. Dessa kritiska faktorer skapar förutsättningar för att korrekta fördelningsstrategier för de skadande patienterna ska kunna utarbetas. Övning Tyko visade att staber med hög upplevd arbetsbelastning och låg upplevd situationsmedvetenhet hade svårt att värdera sitt eget behov av stöd från andra aktörer. Att i förväg ha kännedom om vilken typ av stöd man behöver och kan förvänta sig i olika situationer kräver ett arbete för att identifiera detta redan i före-perspektivet. Det går inte att utesluta att en annan överblick av tillgängliga resurser och en annan förutsägbarhet i vad som kan förväntas av andra hade föranlett en annan fördelningsstrategi som hade förbättrat patientfallet i övningen. För att avgöra effektiviteten av fattade beslut i enlighet med framtagna strategier behövs även en förmåga till 8 HÄLSO- OCH SJUKVÅRDENS FÖRMÅGA ATT HANTERA EN ALLVARLIG HÄNDELSE MED MÅNGA SKADADE SOCIALSTYRELSEN uppföljning huruvida tagna beslut får förväntad effekt inom rimlig tid, under övningen observerades kommunikationsproblem gällande kvittens, förfrågan och bekräftelse. En viktig sammanfattande slutsats som Socialstyrelsen drar inför fortsatt arbete är att myndigheten ska verka för att etablera en funktion för nationell samordning med syfte att ge förutsättningar till en bättre behovs- och resursmatchning vid stora skadeutfall. Inom ramen för en sådan samordning bör gemensamma triage och larmkriterier, medicinska bedömningskriterier och skadeklassificeringar, gemensamma rapportmallar och system för distribution av diagnostiskt material samt gemensam terminologi m.m. inkluderas. Metoder och teknik för framtagandet och kommunikationen av fördelningsnycklar och aktuella kapacitetsbedömningar över tid behöver tas fram för att skapa förutsättningar för en aktuell bild av resurstillgången. Socialstyrelsen vill skapa förutsättningar för ett nationellt kompetenscentrum med inriktning på ökad förmåga och samordning i hela traumavårskedjan. I detta arbete kan även arbetet med Socialstyrelsens förmåga till nationell samordning under pågående händelse utarbetas, definieras och implementeras. Myndigheten vill slutligen lyfta fram att en samlad nationell plan för både trauma- och katastrofmedicinsk utbildning och övning ger ytterligare förutsättningar att upprätthålla och öka förmågan att hantera allvarliga händelser. Dessa viktiga slutsatser avser myndigheten ta med sig in i sitt fortsatta arbete med att stärka hälso-och sjukvårdens förmåga vid allvarlig händelse.
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26.
  • Iversen, Katarina, et al. (författare)
  • Uppföljning av Stop the Bleed-utbildning för räddningstjänsten
  • 2021
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • I ett samarbete mellan Linköpings universitet och MSB (Myndigheten för samhällsskydd och beredskap) har ett utbildningskoncept baserat på STB (Stop the Bleed) för svensk räddningstjänst tagits fram (Prytz & Jonson, 2019). I samband med utvecklingen av utbildningen genomfördes pilotutbildningar under 2018 och 2019 med Sörmlandskustens Räddningstjänst, Räddningstjänsten i Eskilstuna och Västra Sörmlands Räddningstjänst. Forskning har visat att kunskaperna från utbildning i blödningskontrollerande åtgärder börjar förfalla så snart som 30 dagar efter genomförd utbildning (Pasley et al., 2018), liksom för andra kunskaper som hjärt-lungräddning (HLR; Madden, 2006; Moser & Coleman, 1992; Broomfield, 1996, Zieber & Sedgewick, 2018). Det finns därför ett behov av fler uppföljningsstudier efter utbildningar i blödningskontroll för att förstå hur kunskaper bibehålls över tid (Goralnick et al., 2020). Vidare finns även ett behov att följa upp den praktiska nyttan av utbildningar i blödningskontrollerande första hjälpen-åtgärder och effekten på räddningstjänstens förmåga. Den aktuella studien är en uppföljningsstudie av pilotutbildningen som genomfördes 2018/2019. Forskningsfrågorna som ämnades besvaras i studien var:Hur har kunskaperna om blödningskontroll förändrats under den tid som gått sedan utbildningen 2018/2019? Har den räddningstjänstpersonal som utbildades i blödningskontroll haft praktisk nytta av utbildningen? Hur förberedda upplevde de sig vara i de situationerna? Har erfarenheter av skarpa situationer påverkat tilltron personalen har till sin egen förmåga att hantera svåra blödningar? Studien genomfördes som en kvantitativ enkätstudie. Totalt deltog 48 representanter från räddningstjänsterna i Sörmland i studien. Resultatet visar inledningsvis att kunskapsnivån hos räddningstjänstpersonalen är fortsatt hög med goda resultat på kunskapsprovet. Nivån är dock något lägre 2021 än vad den var 2018/2019. Vidare visade resultaten att en majoritet av den räddningstjänstpersonal som svarade på enkäten har hanterat skarpa situationer med blödningar efter att de genomfört pilotutbildningen och att den upplevda nyttan med utbildningen var hög. Deltagarnas självförtroenden gällande hanteringen av skarpa situationer var högre efter utbildningen, jämfört med skarpa situationer de upplevt innan utbildningen. Över lag visar resultatet att denna typ av utbildning ökar räddningstjänstens förmåga att hantera händelser där det förekommer allvarliga blödningar, och att räddningstjänstpersonalen är positivt inställda till utbildningar i den form som gavs i pilotutbildningen 2018/2019.
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27.
  • Jogi, R., et al. (författare)
  • Serum eosinophil cationic protein (S-ECP) in a population with low prevalence of atopy
  • 2002
  • Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 96:7, s. 525-529
  • Tidskriftsartikel (refereegranskat)abstract
    • The study is a part of the European Community Respiratory Health Survey. A random sample (n=351) of 20-44-year olds and persons of the same age with asthma-like symptoms or current asthma medication according to a postal questionnaire (n=95) were studied. Interview was taken, methacholine challenge was done and ECP, total and specific IgE were measured from serum. The median S-ECP value was 8.0 µg/l in the random sample. The geometric mean of S-ECP was higher in subjects with, than without atopy (10.2. vs 8.9 µg/l, P < 0.01) and in subjects with bronchial hyperresponsiveness (BHR) than in subjects without BHR (9.9 vs 8.0 µg/l, P <0.01).The levels correlated weakly to forced expiratory volume in one second (FEV1) (r=0.13, P <0.01) and were not independently correlated with respiratory symptoms, asthma or FEV1 after adjusting for BHR, IgE, sensitisation and smoking. Our results indicate that the level of eosinophil activation is low in a population with a low prevalence of atopy even when BHR is common. © 2002 Published by Elsevier Science Ltd.
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28.
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29.
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30.
  • Jonson, Carl-Oscar, et al. (författare)
  • CTLA-4 Polymorfism, Type 1 Diabetes-risk Human Leukocyte Antigen-genotypes, insulin gene polymorphism and Regulatory T-cell Marker Expression in 5-year-old children
  • 2006
  • Ingår i: Clinical & Experimental Immunology. - : Oxford University Press (OUP). - 0009-9104 .- 1365-2249. ; 145:1, s. 48-55
  • Tidskriftsartikel (refereegranskat)abstract
    • Regulatory T cells (Treg) are involved in the maintenance of peripheral tolerance by suppression of autoreactive lymphocytes that have avoided thymic depletion. The defective function of Treg cells has recently attracted attention in autoimmune diseases such as type 1 diabetes (T1D), rheumatoid arthritis and multiple sclerosis. Susceptibility to these diseases is associated with specific human leucocyte antigen (HLA) class II and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) gene polymorphisms. This study aimed to investigate the relationship between HLA class II and CTLA +49 A/G polymorphisms associated with susceptibility to T1D and the number and characteristics of Treg cells in children. Samples from 47 5-year-old children who participated in the All Babies in South-east Sweden (ABIS) follow-up study were grouped according to the presence of the T1D risk-associated HLA genotype (DQA1*0501–DQB1*0201, DQA1*0301–DQB1*0302) or neutral HLA genotypes. Lower percentages of CD4+ T cells (P = 0·03) and CD4+ CD25high cells (P = 0·06) expressing intracellular CTLA-4 were detected in samples from children with CTLA-4 +49GG compared to children with the +49AA genotype. Similarly, lower percentages of CD4+ (P = 0·002) and CD4+ CD25high (P = 0·002) cells expressing CTLA-4 were observed in children positive for HLA DQA1*0501–DQB1*0201 and DQA1*0301–DQB1*0302 (P = 0·04 for CD4+ and P = 0·02 for CD4+ CD25high) risk haplotypes when compared to children without these alleles. The percentage of CD25high cells among CD4+ cells was correlated inversely with CTLA-4 mRNA expression in PBMC (r = –0·56, P = 0·03). Decreased levels of CTLA-4 in CD4+ and CD4+ CD25high cells in individuals with CTLA-4 and HLA class II alleles associated with T1D may contribute to the initiation and/or progression of autoimmune response.
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31.
  • 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.
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32.
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33.
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34.
  • Jonson, Carl-Oscar, et al. (författare)
  • Regulatory T-cell associated activity in Photopheresis-induced Immune tolerance in Recent Onset Type 1 Diabetes Children
  • 2008
  • Ingår i: Clinical and Experimental Immunology. - : Oxford University Press (OUP). - 0009-9104 .- 1365-2249. ; 153:2, s. 174-181
  • Tidskriftsartikel (refereegranskat)abstract
    • Extracorporeal photochemotherapy (ECP) has demonstrated immunological effects. The proposed cytotoxic lymphocyte antigen 4 (CTLA-4) involvement, together with forkhead box P3 (FoxP3) and transforming growth factor (TGF)-β are associated with regulatory T cell activity. The aim of the study was to evaluate the regulatory T cell-associated effect of ECP in recent onset type 1 diabetic (T1D) children. Children (n = 20) with T1D received photopheresis 8-methoxypsoralen + ECP or placebo + shampheresis. Peripheral blood mononuclear cells (PBMC) collected pretreatment (day 1) and post-treatment (day 90) were stimulated with phytohaemagglutinin (PHA) and T1D-associated glutamic acid decarboxylase 65 (GAD65) peptide a.a. 247–279. CTLA-4, sCTLA-4, FoxP3 and TGF-β mRNA transcription was quantified. Photopheresis-treated individuals' relative mRNA expression was generally maintained during the course of the study. Placebo individuals increased in spontaneous CTLA-4 mRNA (P < 0·05) but decreased in expression after stimulation with GAD65-peptide (P < 0·05) and PHA (P < 0·05). Spontaneous TGF-β (P < 0·05) increased whereas PHA- (P < 0·01) and GAD65-peptide (P < 0·01)-induced TGF-β expression decreased in the placebo group, whereas it was maintained in the treated group. Without intervention, expression of CTLA-4 and TGF-β, stimulated with PHA and GAD65 peptide, decreased with time, with a parallel reduction of GAD65-peptide and PHA-stimulated TGF-β expression. These parameters were counteracted by ECP. In conclusion, our results indicate that ECP maintains regulatory T cell-associated activity in recent-onset T1D.
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35.
  • Jonson, Carl-Oscar, 1978-, et al. (författare)
  • Short simulation exercises to improve emergency department nurses self-efficacy for initial disaster management: Controlled before and after study
  • 2017
  • Ingår i: Nurse Education Today. - : CHURCHILL LIVINGSTONE. - 0260-6917 .- 1532-2793. ; 55, s. 20-25
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Head nurses at emergency departments often assume responsibility for managing the initial response to a major incident, and to create surge capacity. Training is essential to enable these nurses to perform an effective disaster response. Evaluating the effects of such training is however complicated as real skill only can be demonstrated during a real major incident. Self-efficacy has been proposed as an alternative measure of training effectiveness. Purpose: The aim of this study was to examine if short, small-scale computer-based simulation exercises could improve head emergency nurses general and specific self-efficacy and initial incident management skills. Method: A within-group pretest-posttest design was used to examine 13 head nurses general and specific self efficacy before and after an intervention consisting of three short computer based simulation exercises during a 1-h session. Management skills were assessed using the computer simulation tool DigEmergo. Results: The exercises increased the head nurses general self-efficacy but not their specific self-efficacy. After completing the first two exercises they also exhibited improved management skills as indicated by shorter time to treatment for both trauma and in-hospital patients. Conclusion: This study indicates that short computer based simulation exercises provide opportunities for head nurses to improve management skills and increase their general self-efficacy.
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36.
  • Jonson, Carl-Oscar, 1978- (författare)
  • The Importance of CTLA-4 and HLA Class II for Type 1 Diabetes Immunology
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Type 1 Diabetes (T1D) is a serious chronic disease that results from an autoimmune destruction of the insulin-producing beta cells. Sweden has the second highest incidence of T1D in the world, and it affects more and more children each year. Genes controlling key functions of the immune system regulation of autoimmunity has been associated to T1D. Polymorphism in the Human Leukocyte Antigen (HLA) Class II is a major risk determinant for T1D but also Cytotoxic T lymphocyte Antigen 4 (CTLA-4) polymorphism can affect predisposition. Immune responses towards Glutamic Acid Decarboxylase 65 (GAD65), Insulin, insulinoma-associated antigen 2 (IA-2) and Heat Shock protein 60 have all been implicated in T1D pathogenesis.We aimed to study the effect and role of CTLA-4 and HLA Class II in the T1D immunity. By focusing on the immune responses associated to T1D in healthy children with risk genotypes we aimed to study immunological effects of T1D risk.We found that HSP60-peptide induced a higher IFN- response in subjects with risk associated CTLA-4 +49GG allele while GAD65 induced IL-4 secretion was lower in risk subjects. Individuals with T1D neutral HLA showed higher IFN- responses to GAD65 than DR3-DQ2 and DR4-DQ8 positive children. We did also detect that T1D patients have reduced IFN- responses to GAD65 compared to healthy children. Interestingly, HLA and CTLA-4 risk genotype seem to reduce those responses to become similar to responses of T1D patients. We also found that CTLA-4 and HLA risk is associated to reduced percentages of lymphocytes expressing intracellular CTLA-4 in healthy children. In another study we recorded maintained levels of CTLA-4 and TGF- mRNA responsiveness to GAD65 in recent onset T1D patients receiving ECP treatment although clinical outcome was certainly limited.In conclusion, HLA Class II risk genes but also CTLA-4 +49A/G to some extent, influence CTLA-4 capacity and T1D protective antigen-specific responses in a manner that might explain the genes’ predisposing and pathogenic capability.
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37.
  • Jonson, Carl-Oscar, et al. (författare)
  • The importance of CTLA-4 polymorphism and Human leukocyte antigen genotype for the induction of diabetes-associated cytokine response in healthy school children
  • 2007
  • Ingår i: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 8:4, s. 185-192
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Type 1 diabetes (T1D) is an autoimmune disease associated with the destruction of pancreatic β cells and genetically linked to human leukocyte antigen (HLA) class II DR3-DQ2 and DR4-DQ8 haplotypes. The +49A/G polymorphism of the immunoregulatory cytotoxic T-lymphocyte antigen 4 (CTLA-4) gene is also associated with T1D. Genetic and environmental risk factors precede the onset of T1D, which is characterized by a T helper 1 cell-dominating cytokine response to diabetes-related autoantigens. Aim: To investigate immunological differences between healthy children with and without CTLA-4 +49A/G and HLA genetic susceptibility for T1D. Study design: Young, 7–15 years of age, healthy subjects (n = 58) were investigated to test whether CTLA-4 +49A/G genotype was associated with enzyme-linked immunospot assay T-cell responses to T1D-related autoantigens. Because T1D is primarily HLA-DQ associated, we stratified the healthy subjects by HLA genotypes associated with the disease. Results: Peptide of heat shock protein 60 induced a higher interferon-γ (IFN-γ) response in subjects with risk-associated CTLA-4 polymorphism (GG genotype) (p = 0.02) while glutamic acid decarboxylase 65-induced interleukin-4 (IL-4) secretion was lower in GG genotype subjects (p = 0.02). Conclusion: The increased IFN-γ response and lower IL-4 response toward diabetes-related autoantigens shown in CTLA-4 +49 GG risk subjects show a possible mechanism for the association between CTLA-4 and T1D.
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38.
  • 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.
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39.
  • 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.
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40.
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41.
  • Lampi, Maria, 1967-, et al. (författare)
  • Potential benefits of triage for the trauma patient in a Kenyan emergency department
  • 2018
  • Ingår i: BMC Emergency Medicine. - : Springer. - 1471-227X. ; 18
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundImproved trauma management can reduce the time between injury and medical interventions, thus decreasing morbidity and mortality. Triage at the emergency department is essential to ensure prioritization and timely assessment of injured patients. The aim of the present study was to investigate how a lack of formal triage system impacts timely intervention and mortality in a sub-Saharan referral hospital. Further, the study attempts to assess potential benefits of triage towards efficient management of trauma patients in one middle income country.MethodsA prospective descriptive study was conducted. Adult trauma patients admitted to the emergency department during an 8-month period at Moi Teaching and Referral Hospital in Eldoret, Kenya, were included. Mode of arrival and vital parameters were registered. Variables included in the analysis were Injury Severity Score, time before physician’s assessment, length of hospital stay, and mortality. The patients were retrospectively categorized according to the Rapid Emergency Triage and Treatment System (RETTS) from patient records.ResultsA total of 571 patients were analyzed, with a mean Injury Severity Score of 12.2 (SD 7.7) with a mean length of stay of 11.6 (SD 18.3) days. The mortality rate was 1.8%. The results obtained in this study illustrate that trauma patients admitted to the emergency department at Eldoret are not assessed in a timely fashion, and the time frame recommendations postulated by RETTS are not adhered to. Assessment of patients according to the triage algorithm used revealed a significantly higher average Injury Severity Score in the red category than in the other color categories.ConclusionThe results from this study clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. This is further demonstrated by the retrospective triage classification of patients, which identified patients with high ISS as in urgent need of care. Since no significant difference in to time to assessment regardless of injury severity was observed, the need for a well-functioning triage system is apparent.
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42.
  • Lampi, Maria, et al. (författare)
  • Pre-hospital triage performance after standardized trauma courses
  • 2017
  • Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BIOMED CENTRAL LTD. - 1757-7241. ; 25
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The pre-hospital triage process aims at identifying and prioritizing patients in the need of prompt intervention and/or evacuation. The objective of the present study was to evaluate triage decision skills in a Mass Casualty Incident drill. The study compares two groups of participants in Advanced Trauma Life Support and Pre-Hospital Trauma Life Support courses. Methods: A questionnaire was used to deal with three components of triage of victims in a Mass Casualty Incident: decision-making; prioritization of 15 hypothetical casualties involved in a bus crash; and prioritization for evacuation. Swedish Advanced Trauma Life Support and Pre-Hospital Trauma Life Support course participants filled in the same triage skills questionnaire just before and after their respective course. Results: One hundred fifty-three advanced Trauma Life Support course participants were compared to 175 Pre-Hospital Trauma Life Support course participants. The response rates were 90% and 95%, respectively. A significant improvement was found between pre-test and post-test for the Pre-Hospital Trauma Life Support group in regards to decision-making. This difference was only noticeable among the participants who had previously participated in Mass Casualty Incident drills or had experience of a real event (pre-test mean +/- standard deviation 2.4 +/- 0.68, post-test mean +/- standard deviation 2.60 +/- 0.59, P = 0.04). No improvement was found between pre-test and post-test for either group regarding prioritization of the bus crash casualties or the correct identification of the most injured patients for immediate evacuation. Conclusions: Neither Advanced Trauma Life Support nor Pre-Hospital Trauma Life Support participants showed general improvement in their tested triage skills. However, participation in Mass Casualty Incident drills or experience of real events prior to the test performed here, were shown to be advantageous for Pre-Hospital Trauma Life Support participants. These courses should be modified in order to assure proper training in triage skills.
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43.
  • Lampi, Maria, 1967- (författare)
  • TRIAGE : Management of the trauma patient
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Triage, derived from the French word for sorting, aims to assess and prioritize injured patients, regardless of whether the injuries are sustained from everyday road traffic accident with few injured or a mass casualty incident. Triage seeks to provide the greatest benefit to the largest number of casualties in order to minimize morbidity and mortality. Triage in a pre-hospital setting entails management and sorting of patients according to an assessment of medical need, prioritization, and evacuation. In-hospital triage aims to rapidly identify the most injured and ensure timely and appropriate treatment according to the patient’s clinical urgency. A number of different systems for performing triage have been established and implemented globally. The methodology is recognized and utilized but there is still a need for an evidence-based strategy to optimize training and the efficacy of the different systems.The main aim of this thesis was to determine triage performance among prehospital personnel and investigate the potential advantage of a triage system for trauma patients. The papers included in this thesis evaluated the triage skills of physicians, pre-hospital personnel, and rescue services personnel by testing their performance before and after an educational intervention. The last paper evaluated potential benefits of using a triage system for trauma patients admitted to the emergency department at MOI Teaching and Referral Hospital in Eldoret, Kenya.The results presented in this thesis illustrate that triage skills are lacking among physicians. Experienced pre-hospital personnel are more skilled in performing triage than physicians. The triage skills of the rescue services personnel improved significantly after the educational intervention. Moreover, the potential benefit to trauma patients of implementing an in-hospital triage system in a resource-poor environment was shown. In conclusion, health care personnel, especially physicians without experience but highly involved in trauma patient management, seem to be in need of triage training. How to train, how to implement, and how to evaluate triage skills must be considered in order to develop effective training.
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44.
  • Lampi, Maria, et al. (författare)
  • Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident : a prospective cross-sectional survey
  • 2013
  • Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central (BMC). - 1757-7241. ; 21:90
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In a mass casualty situation, medical personnel must rapidly assess and prioritize patients for treatment and transport. Triage is an important tool for medical management in disaster situations. Lack of common international and Swedish triage guidelines could lead to confusion. Attending the Advanced Trauma Life Support (ATLS) provider course is becoming compulsory in the northern part of Europe. The aim of the ATLS guidelines is provision of effective management of single critically injured patients, not mass casualties incidents. However, the use of the ABCDE algorithms from ATLS, has been proposed to be valuable, even in a disaster environment. The objective for this study was to determine whether the mnemonic ABCDE as instructed in the ATLS provider course, affects the ability of Swedish physician's to correctly triage patients in a simulated mass casualty incident.Methods: The study group included 169 ATLS provider students from 10 courses and course sites in Sweden; 153 students filled in an anonymous test just before the course and just after the course. The tests contained 3 questions based on overall priority. The assignment was to triage 15 hypothetical patients who had been involved in a bus crash. Triage was performed according to the ABCDE algorithm. In the triage, the ATLS students used a colour-coded algorithm with red for priority 1, yellow for priority 2, green for priority 3 and black for dead. The students were instructed to identify and prioritize 3 of the most critically injured patients, who should be the first to leave the scene. The same test was used before and after the course.Results: The triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass casualty incidents and exercises.Conclusion: The mnemonic ABCDE doesn't significantly affect the ability of triage among Swedish physicians. Actions to increase Swedish physicians' knowledge of triage, within the ATLS context or separately, are warranted.
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45.
  • 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.
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46.
  • Lowndes, Bethany, et al. (författare)
  • A Preliminary Comparison of Three Tourniquet Instructions for Just-in-Time Guidance of a Simulated Tourniquet Application
  • 2017
  • Ingår i: Proceedings of the Human Factors and Ergonomics Society 2017 Annual Meeting. - Santa Monica : Human Factors and Ergonomics Society, HFES. - 2169-5067 .- 1071-1813. ; , s. 1076-1080
  • Konferensbidrag (refereegranskat)abstract
    • The American College of Surgeons (ACS) and the Department of Homeland Security (DHS) encourage the use of tourniquets as part of the “Stop the Bleed” campaign. Both have provided instructions for layperson tourniquet application in order to save the life of a hemorrhaging trauma victim. This study sought to compare the impact of using ACS and DHS instructions with manufacturer-provided instructions for the completion of simulated tourniquet application steps. Thirty surgical trainees completed a simulated tourniquet application with one of the three instruction sets. Their completion time and success for each step were measured. Participants that received ACS instructions failed the fewest number of steps (p < 0.01) and completed the task faster (Mean (SD) = 70 (33) seconds) compared to those with the manufacturer-provided instructions (p < 0.01). Tourniquet instruction sets need to be refined in order to optimize the success rate of just-in-time guidance for tourniquet application.
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47.
  • Lowndes, Bethany, et al. (författare)
  • Preliminary Investigation of Civilian Clinician Perspectives & Just-in-Time Guidance for Tourniquet Use to "Stop the Bleed"
  • 2019
  • Ingår i: Military medicine. - : Oxford University Press. - 0026-4075 .- 1930-613X. ; 184:3-4, s. 28-36
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveThe American College of Surgeons (ACS) encourages clinicians to provide training to laypeople on tourniquet application. It is unclear whether clinicians are confident in their abilities and equipped with adequate knowledge, skills, and resources. This study aimed to determine surgical trainee knowledge and attitudes regarding tourniquet application and compare the effectiveness of instructions.MethodsThirty surgical trainees performed a tourniquet application simulation using a Combat Application Tourniquet and one of the three instructions sets developed by ACS, Department of Homeland Security, and the tourniquet manufacturer. Participants reported tourniquet knowledge, attitudes, and confidence and discussed the instructions. One instruction set was updated and compared to the original set with 20 new trainees.ResultsParticipants with ACS instructions passed the greatest number of steps (p < 0.01) and completed the task significantly faster compared to those with manufacturer instructions (p < 0.01). Participants (80%) reported favorable views toward tourniquets but 30–60% did not align with to ACS tourniquet guidelines. Focus group participants suggested revisions to the ACS instructions. Comparing the original and revised version of these instructions resulted in no significant improvements.ConclusionsACS instructions provide guidance; however, improvements to tourniquet instruction are needed for success in controlling exsanguinating hemorrhage.
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48.
  • Nilsson, Abraham, et al. (författare)
  • Improved and sustained triage skills in firemen after a short training intervention
  • 2015
  • Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BIOMED CENTRAL LTD. - 1757-7241. ; 23:81, s. 1-6
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A previous study has shown no measurable improvement in triage accuracy among physicians attending the Advanced Trauma Life Support (ATLS) course and suggests a curriculum revision regarding triage. Other studies have indicated that cooperative learning helps students acquire knowledge. Objective: The present study was designed to evaluate the effectiveness of trauma cards in triage training for firemen. Methods: Eighty-six firemen were randomly assigned into two groups: the trauma card group and the direct instruction group. Both groups received the same 30-min PowerPoint lecture on how to perform triage according to the Sort Assess Lifesaving interventions Treatment and transport (SALT) Mass Casualty Triage Algorithm. In the trauma card group, the participants were divided into groups of 3-5 and instructed to triage 10 trauma victims according to the descriptions on the trauma cards. In the direct instruction group, written forms about the same 10 victims were used and discussed as a continuation of the PowerPoint lecture. Total training time was 60 min for both groups. A test was distributed before and after the educational intervention to measure the individual triage skills. The same test was applied again 6 months later. Results: There was a significant improvement in triage skills directly after the intervention and this was sustained 6 months later. No significant difference in triage skills was seen between the trauma card group and the direct instruction group. Previous experience of multi-casualty incidents, years in service, level of education or age did not have any measurable effects on triage accuracy. Conclusions: One hour of triage training with the SALT Mass Casualty Triage Algorithm was enough to significantly improve triage accuracy in both groups of firemen with sustained skills 6 months later. Further studies on the first assessment on scene versus patient outcome are necessary to provide evidence that this training can improve casualty outcome. The efficacy and validity of trauma cards for disaster management training need to be tested in future studies.
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49.
  • Nilsson, Heléne, et al. (författare)
  • Performance indicators for initial regional medical response to major incidents : a possible quality control tool
  • 2012
  • Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 20:81
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundTimely decisions concerning mobilization and allocation of resources and distribution of casualties are crucial in medical management of major incidents. The aim of this study was to evaluate documented initial regional medical responses to major incidents by applying a set of 11 measurable performance indicators for regional medical command and control and test the feasibility of the indicators.MethodsRetrospective data were collected from documentation from regional medical command and control at major incidents that occurred in two Swedish County Councils. Each incident was assigned to one of nine different categories and 11 measurable performance indicators for initial regional medical command and control were systematically applied. Two-way analysis of variance with one observation per cell was used for statistical analysis and the post hoc Tukey test was used for pairwise comparisons.ResultsThe set of indicators for regional medical command and control could be applied in 102 of the130 major incidents (78%), but 36 incidents had to be excluded due to incomplete documentation. The indicators were not applicable as a set for 28 incidents (21.5%) due to different characteristics and time frames. Based on the indicators studied in 66 major incidents, the results demonstrate that the regional medical management performed according to the standard in the early phases (1–10 min after alert), but there were weaknesses in the secondary phase (10–30 min after alert). The significantly lowest scores were found for Indicator 8 (formulate general guidelines for response) and Indicator 10 (decide whether or not resources in own organization are adequate).ConclusionsMeasurable performance indicators for regional medical command and control can be applied to incidents that directly or indirectly involve casualties provided there is sufficient documentation available. Measurable performance indicators can enhance follow- up and be used as a structured quality control tool as well as constitute measurable parts of a nationally based follow-up system for major incidents. Additional indicators need to be developed for hospital-related incidents such as interference with hospital infrastructure.
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50.
  • Nilsson, Heléne, et al. (författare)
  • Simulation-assisted burn disaster planning
  • 2013
  • Ingår i: Burns. - : Elsevier. - 0305-4179 .- 1879-1409. ; 39:6, s. 1122-1130
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System (R) (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.
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