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- Aléx, Jonas, 1975-
(författare)
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Cold exposure and thermal comfort among patients in prehospital emergency care : innovation research in nursing
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundPatients’ cold exposure is a neglected problem in prehospital emergency care. Cold stress increases pain and anxiety and contributes to fear and an overall sense of dissatisfaction. When left untreated, cold stress disturbs vital body functions until ultimately reaches hypothermia.AimThe overall aim was to investigate patients’ experiences of thermal comfort and reactions to cold exposure in prehospital emergency care and to evaluate the effects of an intervention using active warming from underneath.MethodStudy I:Persons (n=20) injured in a cold environment in the north of Sweden were interviewed. Active heat was given to 13 of them.Study II:In wintertime, 62 patients were observed during prehospital emergency care. The field study was based on observations, questions about thermal discomfort, vital signs, and temperature measurements.Study III:Healthy young persons (n=23) participated in two trials each. Data were collected inside and outside a cold chamber. In one trial, the participants were lying on a regular ambulance stretcher and in a second trial on a stretcher supplied with a heated mattress. Outcomes were the Cold Discomfort Scale (CDS), back, finger, and core body temperature, four statements from the State-TraitAnxiety-Inventory (STAI), vital signs, and short notes about their experiences of the two stretchers.Study IV:A quantitative intervention study was conducted in prehospital emergency care in the north of Sweden. The patients (n=30) in the intervention group were transported in an ambulance supplemented with a heated mattress on the stretcher, whereas only a regular stretcher was used in the ambulance for the patients (n=30) in the control group. Outcomes were the CDS, finger, core body, and air temperature, and questions about cold experiences.ResultsStudy I:Patients suffered more because of the cold than from the pain of their injuries. The patients were in a desperate need of heat.Study II:Patients are exposed to cold stress due to cold environments. There was a significant decrease from the first measurement in finger temperature of patients who were indoors when the ambulance arrived, compared to the measurement taken in the ambulance. In the patient compartment of the ambulance, 85% of the patients had a finger temperature below the comfort zone and almost half of them experienced the patient compartment in the ambulance to be cold. The regular mattress surface temperature at the ambulance ranged from -22.3 to 8.4 ºC.Study III:A statistical increase of the participants’ back temperature was found between those lying on the heated mattress compared to those lying on the regular mattress. The heated mattress was experienced as warm, comfortable, providing security, and easy to relax on.Study IV:Thermal comfort increased for the patients in the intervention group and decreased in the control group. A significant higher proportion of the participants rated the stretcher as cold to lie on in the control group compared to the intervention group.ConclusionThe ambulance milieu is too cold to provide thermal comfort. Heat supply from underneath increased comfort and might prevent cold stress and hypothermia
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| 2. |
- Doohan, Isabelle, 1985-
(författare)
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Surviving a major bus crash : experiences from the crash and five years after
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Major road traffic crashes (RTCs) can have a significant impact on the survivors, their family, and their friends, as well as on emergency personnel, volunteers, and others involved. However, survivors’ perspectives are rare or missing in research on major RTCs in Sweden. A comprehensive understanding of the survivors and their experiences is also lacking. By studying what it is like to survive a major RTC, the care and support provided to survivors can be adapted and improved.The overall aim is to broaden the understanding of the short- and long-term consequences and experiences of surviving a major bus crash.Methods The contexts are two bus crashes that occurred in Sweden, in February 2007 and December 2014. In total, the participants are 110 out of the 112 survivors, and the data is collected through telephone interviews, official reports, and medical records at one month, three months, and five years after the crashes. Analysis methods include qualitative content analysis, descriptive statistics, thematic analysis, and mixed methods research analysis.Results One month after the crash, most of the survivors were experiencing minor or major physical and/or psychological stress in their everyday lives (Study I). Four main findings were identified regarding their experiences of immediate care (Study II): prehospital discomfort, lack of compassionate care, dissatisfaction with crisis support, and satisfactory initial care and support. The importance of compassion and being close to others was also highlighted. Five years after the bus crash in Rasbo (Study III), survivors were still struggling with physical injuries and mental problems. Other long-term consequences were a lasting sense of connectedness among fellow passengers, a gratitude for life, as well as feelings of distress in traffic, especially in regard to buses. The main findings from study IV indicated that injury severity did not seem to affect mental health, and that social aspects were important to the recovery process. There was an interconnection among survivors in which they seemed to be linked to each other’s recovery.Conclusion A strong need for short- and long-term social and psychological support in terms of compassion and community is evident in all the studies. The survivors ought to be acknowledged as capable and having the resources to contribute to their own and their fellow survivors’ recovery and health. There is a need for greater understanding of how different the survivors are, with each one of them having various physical, psychological, social, and existential needs.
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- Holgersson, Annelie, 1985-
(författare)
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Preparedness for mass-casualty attacks on public transportation
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Public transportation constitutes a vulnerable sector in modern day society with a high probability of generating mass casualties if attacked. By preparing for mass-casualty attacks (MCAs), response can become more effective and public transportation can become a less rewarding target. However, preparedness for attacks, much like response, implies resource constraints, and this dissertation pinpoints some major dilemmas that inhibit achieving preparedness for MCAs on public transportation in Sweden.Aim: The aim of this dissertation was to investigate preparedness for mass-casualty attacks on public transportation. This allowed for identification of major challenges for preparedness and response with a particular focus on the Swedish context.Methods: Study I included 477 MCAs identified through searches of the Global Terrorism Database, journals, newspapers and websites, which were examined with descriptive statistics. Study II thematically analyzed 105 articles attained by systematic searches of the PubMed and Scopus databases. Study III and IV statistically analyzed data from 864 responses to a purposive-designed questionnaire, from operational personnel of the Swedish emergency organizations. Study V entailed validation of a finite element (FE) simulation model of a bombing in a train carriage compared to the bombings in Madrid 2004.Results: International trends of MCAs (≥ 10 fatally injured and/or ≥ 100 non-fatally injured) on public transportation, during the years 1970-2009 (I) showed that the average number of injured increased considerably, despite a quite stable incidence rate since the 1980s. High numbers of injured people were connected to attacks on terminal buildings, multiple targets and complex tactical approaches. Few MCAs occurred in Europe, but the average number of fatalities per incident and injured per incident were the second highest among regions. The literature study (II) of previous on-scene management showed that commonly encountered challenges during unintentional incidents were added to during MCAs, implying specific issues for safety, assessment, triage and treatment, which require collaborative planning and specific training. The study regarding the Swedish emergency organizations’ perceptions of terrorist attacks (III) showed significant differences on perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence in knowledge of tasks to be performed on scene. The police respondents stood out; e.g., fewer police personnel had high estimates of their organizations’ management capability and knowledge of tasks on-scene compared to the other organizations. The study of factors that influence responders’ perceptions of preparedness for terrorism (IV) showed that these were influenced by the responders’ sex, work experience, organizational affiliation, various training arrangements and access to personal protective equipment (PPE). Investing in amenable factors, such as terrorism-related management training and provision of PPE, could improve responders’ perceptions of preparedness for terrorism. A finite-element (FE) model of an explosion in a train carriage (V) was developed and showed that FE modeling techniques could effectively model damage and injuries for explosions with applicability for preparedness and injury mitigation efforts, but, also, there was room for improvement of the model in terms of injuries.Conclusion: Achieving preparedness for MCAs on public transportation is a multiple choice balancing act between ostensible dilemmas regarding investments, disaster plans, training, response strategies, collaboration and inventions.
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- Gyllencreutz, Lina, 1979-
(författare)
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To prevent without over-protecting : children and senior citizens injured during outdoor activities
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Injuries are a common public health problem. Non-fatal injuries may result in pain and disabilities. Falls are a common causes of non-fatal injuries and many of these injuries occur during some physical activity. Children and senior citizens are two groups of special interest as their body constitution makes them more vulnerable to injuries than the general population. Outdoor environments influence the risk of injury as people are generally physically active when outdoor. Despite a higher risk for injury, physical activity is a common recommendation for a healthy lifestyle. Children and senior citizens should be able to safely participate in outdoor activities and gain health benefits. There is a need to highlight the complexity of balancing injury risk and the healthy benefits of outdoor activities among these two groups.Aim: The overall aim of this thesis was to investigate injuries among children and senior citizens sustained during outdoor activities and explore experiences and perceptions on risk and possibilities to increase safety in the outdoor environment.Methods: The studies were performed in northern Sweden. Theparticipants were children through the age of 12 (Studies I & II) and senior citizens aged 65 and older (Studies III & IV). In Studies I and III, a crosssectional retrospective study design was used. The data were collected from an Injury Data Base (IDB) at a hospital with a catchment area of 60 kilometres in a well-defined population. Data in Study III was complemented with a study-specific questionnaire. Injury data were analysed descriptively. Study II was a field-study that included 14 days of observations, six focus-group interviews with children, and four focus-group interviews with teachers. The three data sources were taken together and analysed using qualitative content analysis. Study IV was a focus-group interview study with 31 senior citizens divided into six focus-groups. Data in Study IV was analysed with qualitative content analysis.Results: In Study I, 795 children attended the emergency department from 2007 through 2009 and were registered in the IDB with non-minor injuries, such as fractures. The most commonly reported activities contributing to injuries were play, sport, and transport. Other factors contributing to the incident were often related to the ground surface. Contributing products were, for example, trampolines, climbing frames, bicycles, and downhill skis. In the field study (Study II), children at schoolyards were seen climbing high in trees, speeding down slides, or fighting with sticks in the woods. Different perspectives on risk and safety influenced or restricted the children’s outdoor play activities. In Study III, 300 senior citizens were registered in the IDB after injuries from pedestrian falls from January 2009 through April 2011. Women were overrepresented. Sixty percent suffered non-minor injuries. Fracture was the most common injury type. Environmental factors, especially ice, snow, and irregularities on the ground surface were the most commonly described causes to the injury incidents. As the incidents happened in public transport areas, the respondents indicated that they hold the local authorities responsible for poor sidewalk and road maintenance. However, they admitted their own responsibility in preventing similar incidents by changing their behaviour and using safety products. The senior citizens in the focus-group interview study (Study IV) described how they needed to adjust to age-related changes when outdoors, for example, by taking responsibility and using common sense. Facilitating possibilities for outdoor mobility increased with the feelings of safety within the outdoor environment and when using safety devices. To the contrary, fear of falling, shortcomings of safety devices, and dangerous elements such as ice, snow, and interactions with bicyclists constrained outdoor mobility.Conclusion: Non-minor injuries such as fractures among children and senior citizens that are sustained during outdoor activities must be a focus of injury prevention. Different perspectives on risk and safety influence children’s outdoor play at the schoolyard and senior citizens’ outdoor mobility. There is a need for balance between teachers’ common sense knowledge and the knowledge base of injury prevention. In the same manner, there is a need for balance between healthy activities and an acceptable injury risk for participating in outdoor activities. Nurses are well suited to work with this complexity and to optimize these efforts both at schools and in other public settings.
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