| 1. |
- Pettersson, Jenny, et al.
(författare)
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Resilience Training of Regional Medical Command and Control
- 2019
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:1, s. 164-165
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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.
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| 2. |
- Andersson Granberg, Tobias, 1973-, et al.
(författare)
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Sensor Requirements for Logistics Analysis of Emergency Incident Sites
- 2020
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Ingår i: Proceedings of the 17th ISCRAM Conference. - : Information Systems for Crisis Response and Management. - 9781949373271 ; , s. 952-960
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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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| 3. |
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| 4. |
- Berggren, Peter, 1971-, et al.
(författare)
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The importance of using the designated duty officers when assessing the medical response organization
- 2017
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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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| 5. |
- Björnqvist, Anton, 1995-, et al.
(författare)
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An Analysis of a Swedish Medical Command and Control System’s Situation Reports from the COVID-19 Pandemic
- 2022
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Ingår i: ISCRAM 2022 Conference Proceedings – 19th International Conference on Information Systems for Crisis Response and Management. - 9788284270999 ; , s. 334-348
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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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| 6. |
- Björnstig, Ulf, et al.
(författare)
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Tågolyckan på Once station, Buenos Aires 2012
- 2019
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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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| 7. |
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| 8. |
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| 9. |
- Brodin, Wilhelm, et al.
(författare)
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The Effect of Presence of Blood on Medical Laypeople’s Ability to Perform First Aid for Massive Bleeding
- 2022
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Ingår i: Proceedings of the Human Factors and Ergonomics Society Annual Meeting. ; , s. 251-255
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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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| 10. |
- Cedrini, V, et al.
(författare)
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Improving resilience management for critical infrastructures : strategies and practices across air traffic management and healthcare
- 2018
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Ingår i: Safety and Reliability – Safe Societies in a Changing World. - London : Taylor & Francis. - 9780815386827 - 9781351174664 ; , s. 1319-1327
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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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| 11. |
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| 12. |
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| 13. |
- Friberg, Marc, et al.
(författare)
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The Effects of Stress on Tourniquet Application and CPR Performance in Layperson and Professional Civilian Populations
- 2023
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Ingår i: Human Factors. - : SAGE PUBLICATIONS INC. - 0018-7208 .- 1547-8181. ; 65:3, s. 496-507
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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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| 14. |
- Friberg, Marc, et al.
(författare)
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Training Effectiveness Factors Associated with Laypeople Hemorrhage Control Training : A Systematic Literature Review
- 2023
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Ingår i: Framtidens Skadeplats 2023. - Linköping : Linköping University Electronic Press.
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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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| 15. |
- Gonzalez, Jose, et al.
(författare)
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Elicitation, analysis and mitigation of systemic pandemic risks
- 2021
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Ingår i: Proceedings of the 18th ISCRAM Conference. - 9781949373615 ; , s. 581-596
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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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| 16. |
- Goralnick, Eric, et al.
(författare)
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Defining a Research Agenda for Layperson Prehospital Hemorrhage Control A Consensus Statement
- 2020
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Ingår i: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 3:7
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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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| 17. |
- Hermelin, Jonas, et al.
(författare)
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Operationalising resilience for disaster medicine practitioners : capability development through training, simulation and reflection
- 2020
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Ingår i: Cognition, Technology & Work. - : Springer. - 1435-5558 .- 1435-5566. ; 22:3, s. 667-683
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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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| 18. |
- Hindorf, Marie, et al.
(författare)
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Workload of Swedish Special Forces Operators Experienced During Stressful Simulation Training: A Pilot Study
- 2022
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Ingår i: Journal of Special Operations Medicine. - : Breakaway Media, LLC. - 1553-9768. ; 22:3, s. 42-48
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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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| 19. |
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| 20. |
- Iversen, Katarina, et al.
(författare)
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Uppföljning av Stop the Bleed-utbildning för räddningstjänsten
- 2021
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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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| 21. |
- Jonson, Carl-Oscar, Docent, 1978-, et al.
(författare)
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Efficacy of Video-Based Instructions for Laypeople Bleeding Control Education
- 2019
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:s1, s. 90-90
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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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| 22. |
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| 23. |
- Junker, Johan, 1980-, et al.
(författare)
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Prehospital Monitoring of Vital Parameters Using a Novel Device - RespiHeart
- 2017
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 32:Suppl. 1, s. S165-S166
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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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| 24. |
- Junker, Johan, 1980-, et al.
(författare)
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Standardized Measurement of Capillary Refill Time using Novel Technology
- 2019
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:s1, s. 167-168
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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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| 25. |
- Lantz Cronqvist, Mattias, et al.
(författare)
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Development and Initial Validation of a Stochastic Discrete Event Simulation to Assess Disaster Preparedness
- 2019
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 34:1, s. 118-118
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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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| 26. |
- Norrblom, Petter, et al.
(författare)
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Vad motiverar frivilliga att fortsätta vara frivilliga?
- 2023
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Ingår i: Framtidens Skadeplats 2023. - Linköping : Linköping University Electronic Press.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Organiserade frivilliga är en allt viktigare del av samhällets beredskap. Initiativ som Sms-livräddare och Civila Insatspersoner (CIP) kan stötta professionella responsorganisationer och möjliggöra snabbare respons till händelser som hjärtstopp eller mindre bränder. Att få personer att ställa upp som frivilliga och sedan fortsätta vara frivilliga är väsentligt för att dessa initiativ ska ha en samhällsnytta. Tidigare studier har visat att det finns många faktorer som motiverar personer att bli frivilliga. Det saknas dock forskning på vilka faktorer som är mest avgörande för att personer ska fortsätta vara engagerade som frivilliga.Därför genomfördes våren 2022 en enkätstudie av forskare inom Centrum för Forskning i Respons- och Räddningssystem (CARER), där 5 300 personer som var engagerade antingen som Sms-livräddare eller CIP:ar svarade på frågor om vad som motiverade dem att vara frivilliga och om de hade för avsikt att fortsätta vara frivilliga i framtiden. En explorativ faktor-analys genomfördes för att visa på de underliggande faktorer som var gemensamma i svaren. I denna faktoranalys upptäcktes totalt 12 underliggande faktorer baserat på de 48 frågorna i enkäten. Dessa faktorer analyserades därefter med en regressionsanalys för att undersöka vilka av dessa som är mest avgörande i frivilligas motivation att fortsätta vara frivilliga.Resultatet visade att de faktorer som hade störst positiv inverkan på motivationen att fortsätta vara frivillig var Socialt sammanhang, Självbild, och Kompetens. De faktorer som hade störst negativ inverkan var Larmtrötthet och Negativa upplevelser. Resultaten från studien kan användas för att genomföra interventioner för att öka frivilligas motivation, genom att till exempel motverka larmtrötthet genom smartare utlarmningsalgoritmer eller utbildningsinsatser som ökar de frivilligas kompetens, och då förhoppningsvis även behålla fler frivilliga över tid.
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| 27. |
- Norrblom, Petter, et al.
(författare)
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Where and how do people search for medical emergency equipment in public buildings?
- 2023
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Ingår i: 67th Annual Meeting of the Human Factors and Ergonomics Society. - Washington, D.C..
-
Konferensbidrag (refereegranskat)abstract
- Exsanguinating trauma is a common cause of death. Placing bleeding control kits in public areas has been suggested as a countermeasure. Similarly, automatic external defibrillators (AEDs) are placed in public areas in case of cardiac arrests. Both severe bleeding and cardiac arrests require rapid care and people must be able to quickly find relevant emergency equipment. This study explores where and how people search for such equipment. Twenty participants wearing eye-tracking glasses searched for bleeding control kits and AEDs in a public building. The participants visually searched features such as signs with maps, written information, and other emergency equipment. The participants expressed elevators and staircases, open areas, entrances, and the reception to be places where medical emergency equipment would likely be placed. The results suggest that these features and places may be suitable for medical emergency equipment or directions.
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| 28. |
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| 29. |
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| 30. |
- Pettersson, Jenny, et al.
(författare)
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Functional quality indicators for assessing health care initial response to societal disturbances for education
- 2017
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 32:Suppl. 1, s. 66-66
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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.
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| 31. |
- Phillips, Rachel, et al.
(författare)
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Visual Blood Loss Estimation Accuracy : Directions for Future Research Based on a Systematic Literature Review
- 2020
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Ingår i: Proceedings of the 2020 HFES 64th International Annual Meeting. - : Sage Publications. ; , s. 1411-1415
-
Konferensbidrag (refereegranskat)abstract
- Visual blood loss estimation occurs in a variety of medical contexts and may impact everything from interventions by immediate responders to the likelihood of receiving blood transfusions in a hospital setting. However, research suggests that visual blood loss estimation is inaccurate for laypeople and medical professionals. The aim of the current study was to conduct a systematic literature review to determine the current state of knowledge on visual blood loss estimation accuracy and identify directions for future research. A structured search resulted in 1799 titles that were subsequently screened. A total of 72 articles were coded for comparison. Based on the evaluation, several gaps were identified, most notably related to factors of the situation that may influence estimation accuracy such as blood flow and victim/patient gender. Directions for future research are proposed based on identified gaps.
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| 32. |
- Prytz, Erik, 1985-, et al.
(författare)
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A pilot investigation of the effect of transport-related factors on care quality in a moving ambulance
- 2019
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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.
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| 33. |
- Prytz, Erik, 1985-, et al.
(författare)
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Evaluating the Effect of Bleeding Control Kit Locations for a Mass Casualty Incident Using Discrete Event Simulation
- 2020
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Ingår i: Proceedings of the 17th ISCRAM Conference. - : Information Systems for Crisis Response and Management. - 9781949373271 ; , s. 167-178
-
Konferensbidrag (refereegranskat)abstract
- The purpose of this study was to develop a simulation model to evaluate bleeding control kit location strategies for a mass casualty incident scenario. Specifically, the event simulated was an explosion at a large sports arena. The model included a representation of the arena itself, simulated crowd movements following the detonation of an improvised explosive device, injuries and treatments, and different ways for immediate responders to help injured patients using tourniquets. The simulation model gave logically consistent results in the validation scenarios and the simulation outcomes were in line with the expected outcomes. The results of the different tourniquet location scenarios indicated that decentralized placement (more than one location) is better, easy access is important (between rather than at emergency exits) and that an increased number of available tourniquets will result in an increased number of survivors.
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| 34. |
- Prytz, Erik, 1985-, et al.
(författare)
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First and Immediate Responders : Current capability needs and research challenges
- 2019
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Ingår i: Proceedings of the Human Factors and Ergonomics Society Annual Meeting. ; , s. 640-641
-
Konferensbidrag (refereegranskat)abstract
- The purpose of this panel will be to discuss current research and challenges relating to the work of first and immediate responders. The main discussion of the panel will have panelist challenge human factors researchers to consider new directions of research addressing current capability and knowledge gaps faced by the first and immediate responder communities.
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| 35. |
- Prytz, Erik, 1985-, et al.
(författare)
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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
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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.
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| 36. |
- Prytz, Erik, 1985-, et al.
(författare)
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Tillbaka till Framtidens Skadeplats : Scenarier och resultat
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport presenterar ett nytt kunskapsläge om framtidens skadeplats utifrån de resultat som kommit från forskningsprogrammet Effektiva räddningsinsatser på Framtidens Skadeplats 2015–2020. Rapporten är en omarbetad version baserad på rapporten Att hantera framtidens skadeplatser: scenarier och utgångspunkter för kunskapsutveckling runt räddningsinsatser och skadeplatsarbete som gavs ut av Centrum för forskning inom respons- och räddningssystem (CARER) 2016. I den rapporten presenterades ett underlag för de kommande aktiviteterna som var planerade att genomföras inom forskningsprogrammet. Rapporten beskrev också åtta olika skadeplatsscenarier som togs fram i linje med Myndigheten för samhällsskydd och beredskaps (MSB:s) dåvarande framtidsanalyser samt en analys av då tillgänglig litteratur om olyckor och katastrofer. Dessa scenarier beskrev på ett strukturerat och detaljerat sätt möjliga framtida skadeplatser av särskilt intresse ur ett praktiker- och forskningsperspektiv. I denna rapport har dessa åtta scenarier arbetats om och uppdaterats utifrån rådande läge i samhället i dag. De har också utökats med en beskrivning av en möjlig respons så som den kan se ut i framtiden inom tidsramen 10 till 15 år. Denna rapport innehåller också en övergripande beskrivning av de resultat som framkommit från de sex arbetspaketen (AP) i programmet. Inom AP2 redovisas teman om a) frivilliga och civila insatspersoner, b) semi-professionella som första insatsaktörer, c) genus, etnicitet och utsatthet, samt d) efterforskning av försvunna personer. AP3 redovisar teman om a) effektiv utlarmning av frivilliga och semiprofessionella resurser, b) prediktering, c) skadeplatslogistik, samt d) alarmering och effektivare räddningstjänst. AP4 går igenom a) IT-plattformen OP-SENS och b) lägesbilder, medan AP5 redovisar teman om a) utvärdering av ny teknik, b) utvärdering av utbildning och övning, samt c) utvärdering av ny metodik. Slutligen har AP6 redovisat teman om a) nya metoders och resurser effekt på systemnivå, samt b) värdering av frivilliga och semiprofessionella. Dessa forskningsresultat återkommer i scenarierna för att exemplifiera hur de kan omsättas i praktiskt skadeplatsarbete innan, under och efter en insats.
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| 37. |
- Prytz, Erik, 1985-, et al.
(författare)
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Utveckling av ett svenskt utbildningskoncept utifrån det amerikanska konceptet Stop the Bleed
- 2019
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Inom ramen för denna studie har ett utbildningskoncept för första-hjälpen åtgärder vid livshotande blödning utvecklats utifrån det amerikanska konceptet "Stop the bleed". Utbildningen riktar sig till räddningstjänstpersonal och har validerats i en pilotutbildning. Utbildningskonceptet kan ligga till grund för en nationellt likriktad och kvalitetssäkrad utbildning av blödningskontrollerande åtgärder för räddningstjänstpersonal.
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| 38. |
- Prytz, Erik, 1985-, et al.
(författare)
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What motivates and demotivates emergency response volunteers? A survey-based factor analysis study
- 2023
-
Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BMC. - 1757-7241. ; 31:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundOrganized volunteer initiatives can reduce response times and improve outcomes in emergencies such as cardiac arrests or fires. Retention of volunteers is important to maintain good coverage and capabilities. The current study explores factors underlying volunteers motivation to continue as volunteers.MethodsData from 5347 active volunteers were collected through an online survey. An exploratory factor analysis was used to identify underlying factors that were then used in a regression analysis to predict intention to continue as a volunteer. Group differences based on, among others, number of alarms and prior professional experience in emergency response were explored.ResultsThe results showed that the factors community, self-image, and competence were the strongest positive predictors for the motivation to continue, whereas alarm fatigue and negative experience were the strongest negative predictors. Volunteers with professional background had higher competence and lower Alarm fatigue. Volunteers from rural areas and small cities had higher community than those in large cities.ConclusionsAlarm fatigue can make it hard to retain volunteers, which could be addressed using improved dispatch algorithms. Support after dispatch is important to prevent negative experiences. Finally, increased competence, e.g. through education and training, can improve volunteers motivation to continue.
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| 39. |
- Strauss-Riggs, Kandra, et al.
(författare)
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Recommended Process Outcome Measures for Stop the Bleed Education Programs
- 2021
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Ingår i: AEM Education and Training. - : John Wiley and Sons Inc.. - 2472-5390. ; 5:1, s. 139-142
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Tidskriftsartikel (refereegranskat)abstract
- Trauma is a critical public health issue as the lead-ing cause of death for Americans between theages of 1 and 44 years.1In response to this reality, anumber of Stop the Bleed educa tion programs arebeing implemented to teach the lay public how to stopexsanguinating hemorrhage in preventable deaths.2Todate, there are limited data available to compare effec-tiveness of these programs. Because there is limitedcapacity to track outcome measures at this time,authors offer direction to practitioners on 12 processmeasures that will best allow comparisons among pro-grams to make informed decisions when implement-ing Stop the Bleed education
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| 40. |
- Toll John, Rani, 1975-, et al.
(författare)
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A cool response : the influence of ambient temperature on capillary refill time
- 2018
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Ingår i: Journal of Biophotonics. - : Wiley-VCH Verlagsgesellschaft. - 1864-063X .- 1864-0648. ; 11:6
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo describe the effect of low ambient temperature on skin temperature and capillary refill (CR) time in forehead, sternum and finger pulp.MethodsAn observational, nonrandomized experimental study on 15 healthy subjects (6 females) in a cold room (8°C). Outcome measures were skin temperature and quantified CR test after application of a standardized blanching pressure (9 N/cm2) using digital photographic polarization spectroscopy to generate CR times.ResultsThe finger pulp showed marked temperature fall and prolonged CR times (>10 seconds). The CR registrations of the forehead and sternum were more comparable to curves observed in a control material at room temperature, and skin temperature falls were less marked. CR times were not prolonged in forehead measurements. At the sternum, some individuals showed CR times beyond guideline recommendations despite only a marginal reduction in skin temperature.ConclusionsLow ambient temperature is a strong independent factor for CR time at peripheral sites. Reservation about sternum as a site of measurement is warranted since cold provocation produced prolonged CR times in some individuals. We found that the forehead is the most thermostable of the 3 sites and thus the preferred site to avoid ambient temperature artifact in measuring CR time.
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| 41. |
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Traumavård vid allvarlig händelse
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Socialstyrelsens uppdrag kring traumavård har utförts mot bakgrund av ett antal allvarliga händelser i omvärlden. Flera av de lärdomar som har dragits av sådana händelser, exempelvis händelserna i Norge sommaren 2011, har relevans även för utvecklingen av den svenska traumavården. En av lärdomarna för möjligheten att hantera en allvarlig händelse med ett stort antal skadade är betydelsen av att ha en väl fungerande traumavård i vardagen. Det är därför viktigt att betona att krisberedskap måste utgå från och bygga på den förmåga som finns i aktörernas dagliga verksamhet. Socialstyrelsen har inom ramen för uppdraget kartlagt den vardagliga traumavården både genom en bred enkätundersökning samt genom regionala platsbesök. Dessutom har internationella besök i länder som har erfarenhet av särskilt inrättade system för traumavård genomförts. Landstingen organiserar sin hälso- och sjukvård, och däribland sin traumavård på olika sätt. Detta leder i sin tur till att dokumentation och arbetssätt skiljer sig åt vilket kan medföra problem särskilt i samband med allvarliga händelser vilka ofta kräver omfattande samarbete såväl mellan sjukhus som mellan landsting och andra aktörer. För att överbrygga sådana skillnader krävs enligt Socialstyrelsen noggrant, och i möjligaste mån, enhetligt utarbetade planer och rutiner liksom en väl utvecklad, reglerad och inövad samverkan. Kartläggningen visar dock att detta brister i många fall i dagsläget. Socialstyrelsen har mot bakgrund av detta lämnat åtgärdsförslag i syfte att stärka traumavården i hela dess kedja, från det prehospitala omhändertagandet och transportmedicin - till frågor kring kompetensutveckling och tillgång till utrustning inom ramen för den hospitala traumavården. Socialstyrelsens förslag riktas till de enskilda landstingen och utgår från vad som behöver finnas på plats för att stärka ledning, styrning och kompetensförsörjning, exempelvis vad gäller framtagande av kriterier och dokumentation. Förslagen är av övergripande karaktär och ska ses som ett första steg i ett arbete där gemensamma insatser mellan olika aktörer, inte minst mellan landstingen själva, kommer att vara nödvändiga för att åstadkomma dessa förbättringar. I rapporten presenteras även ett antal strategiska vägval som i huvudsak riktar sig till den nationella nivån. Det mest centrala vägvalet, som kräver ett nationellt initiativ, är införandet av ett nivåindelat traumavårdsystem i likhet med vad som finns internationellt. Ett sådant system skulle kunna organiseras i nätverk med prehospital vård, traumaenheter samt traumacentrum på nationell nivå med möjligheter att ta emot patienter från olika regioner beroende på skadetyp. Sådana centrum skulle också kunna tillhandahålla kompetens och stöd till andra nivåer i systemet samt utveckla forskning, kvalitetsuppföljning m.m. Det system som beskrivs i denna rapport knyter på många sätt an till utredningen om den högspecialiserade vården (dir 2014:56 Utveckling av den högspecialiserade vården). Föreliggande rapport och det betänkande som ska lämnas den 25 november 2015 bör således läsas i ett sammanhang. Ytterligare strategiska vägval som bör hanteras är enligt Socialstyrelsen en utveckling av den nationella samverkan inom det civil-militära området, utbildnings- och kompetensfrågor samt deltagandet i det nordiska samarbetet. Det är Socialstyrelsens förhoppning att denna rapport, tillsammans med den nationella statliga nivåns arbete med kunskapsstyrning av svensk krisberedskap och traumavård, kan ligga till grund för ett fortsatt arbete med att utveckla förmågan att hantera en allvarlig händelse med ett stort antal skadade.
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- Weilandt, Jacob, et al.
(författare)
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Information overload in Swedish emergency response command and control functions
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Informationsöverbelastning är fenomenet där mängden tillgänglig information en beslutsfattare har tillgång till är så stor att den i sig leder till försämrade förutsättningar för beslutsfattande. Informationsöverbelastning är ett potentiellt framtida problem inom ledningssystem för respons och räddning, då nya informationskällor och mer effektiva datainsamlingsmöjligheter kan leda till en kraftigt ökad mängd information. En studie i två delar genomfördes för att undersöka informationsöverbelastning. Den första delen bestod av en litteraturöversikt över fenomenet både individuellt sett och från ett systemperspektiv. Den andra delen var en intervjustudie med 13 deltagare från svenska blåljusorganisationer som inkluderar polis, räddningstjänst och akutsjukvård. Deltagarna som intervjuades arbetar med ledning av räddning- och responsinsatser för mindre och större händelser på olika nivåer, från det operativa till det strategiska perspektivet. En tematisk analys på intervjumaterialet visade på fem teman rörande informationsöverbelastning i det svenska räddningssystemet:Man behöver information för att förstå lägesbilden, och man behöver en lägesbild för att förstå informationenInformationshantering är en medveten och manuell processInformation är nyckeln till framgång men all information är inte användbarInformationsöverbelastning orsakad av mängden information är inte ett problemInformationsöverbelastning är ett strukturellt problemSammantaget visar dessa teman att beslutsfattare i de svenska räddningssystemen arbetar manuellt, aktivt och medvetet med information och att de förlitar sig på sin tidigare erfarenhet för att kunna utföra sitt uppdrag effektivt. Vidare förlitar beslutsfattarna sig på själva ledningsstrukturen för att säkerställa att den information de tar del av är strukturerad, meningsfull och relevant för uppdraget och beslutsfattarens roll i ledningssystemet. Informationsöverbelastning sågs inte som ett aktuellt problem, då ledningsstrukturen ska fungera som ett filter mot irrelevant eller dåligt strukturerad information. Dock såg de intervjuade att informationsöverbelastning kan bli ett problem om beslutsstöd eller nya informationsflöden införs i ledningssystemen, utan att dessa är utvecklade specifikt för att fungera i det existerande arbetsflödet i ledningssystemen.
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