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- Hylander, Johan, 1986-
(author)
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Prehospital medical management in Swedish road tunnel incidents
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Background: The complexity of modern road tunnel systems may delay an efficient rescue effort. Capable decision-making is needed to limit time to care. The Swedish ambulance commander, responsible for the on-scene ambulance personnel, may lack education and experience from managing road tunnel incidents. Their competence is sometimes questioned by fellow emergency services commanders. Such marginalization may obscure the medical focus and give the ambulance commander a subservient role. The ambulance commander’s role and lack of knowledge need to be explored and addressed to potentially improve their competence in managing road tunnel incidents.Aim: The overall aim of this thesis was to explore the possibilities of strengthening the decision-making ability of ambulance commanders to create more efficient rescue efforts in road tunnel incidents.Methods: In studies I and II, interviews were conducted with ambulance commanders (n=18) in Norway and Sweden concerning their experience in managing real and simulated road tunnel incidents. In study III, interviews were conducted with participants (n=19) from organizations that collaborates with the Swedish ambulance services in road tunnel incidents, about their opinions on how the ambulance commanders can improve their incident management. In study IV, an e- learning course was created based on the findings of studies I–III. The course influence on the ambulance commander’s ability to make decisions in road tunnel incidents was tested through an intervention study (n=20) which contained two simulations of major road tunnel incidents.Results: In study I, the requirement of familiarity with the tunnel system and involved organizations tasks were highlighted as important for the Norwegian ambulance commanders in their leadership role. In study II, the Swedish ambulance commanders described their leadership role as greater than that at the incident site, e.g., caring for their colleagues and being proactive, although having limited time allocated for these tasks. Findings from study III highlighted the importance of risk management and a shared terminology when responding to road tunnel incidents to avoid time-consuming misunderstandings. In study IV, the main finding was that none of the participants entered the dual- tube road tunnel correctly at the early stage of an incident. Secondly, theiiie-learning course did not significantly impact the ambulance commanders decision-making capabilities.Conclusion: The resilience of ambulance services to road tunnel incidents requires a knowledgeable and decisive ambulance commander. Inter- and intraorganizational obstacles limit the ambulance commander to become familiar with the tunnel environment, generating ambiguous decision-making. Tailored assessment methods and educational material may improve the ambulance commander situational awareness. Findings also indicate that the ambulance services command structure may be less than optimal in its current form. A senior ambulance commander, hierarchically equal to corresponding emergency services command structures, could possibly strengthen prehospital medical management in unfamiliar and complex settings such as the currently studied.
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| 2. |
- Ndile, Menti, 1975-
(author)
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Improving initial care of road traffic injured people in Tanzania : Evaluation of a traffic police first aid education programme
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Background: An overwhelming proportion of road traffic deaths and injuries in low- and middle-income countries occurs in prehospital environments. Lay responders such as traffic police officers play an important role in providing initial assistance to victims of road crashes, either alone or in collaboration with others. However, published and unpublished reports indicate that traffic police officers lack appropriate first aid education and therefore competencies to care for road crash victims.Aim: The overall aim of this thesis was to evaluate the impact of a post-crash educational programme on traffic police officers’ first aid competencies and application at the workplace.Methods: Four interrelated studies were conducted in Dar es Salaam, Tanzania. In Study I, questionnaires (n = 340) assessing the current knowledge, attitudes, and practice regarding initial post-crash care among traffic police officers were analyzed using descriptive statistics. In Study II, individual interviews with leaders of traffic police unit and drivers’ associations (n = 12) exploring factors potentially influencing the implementation of a post-crash first aid (PFA) educational programme were analyzed using qualitative thematic analysis. In Study III, before–after questionnaires (n = 135) evaluating the impact of a PFA educational programme on knowledge, perceived skills confidence, and skills utilization among traffic police officers were analyzed using descriptive and inferential statistics. In Study IV, focus group discussions with traffic police officers (n = 34) exploring factors influencing the use of first aid skills at the workplace were analyzed inductively using qualitative content analysis.Results: Although nearly all traffic police officers believed that it was part of their responsibilities to provide first aid to crash victims, their knowledge and practice of critical first aid procedures such as airway management and victim positioning were generally very poor (Study I). Study II showed that, among other things, methods of delivering training and the availability of incentives among participants could affect implementation of a PFA educational programme. Study III showed that following implementation of a post-crash educational programme, the mean knowledge score for first aid increased from about 45% before training to about 73% six months after training (p < .001, n = 102). The mean perceived skills confidence scores for providing first aid (measured on a five-point Likert scale), when rounded, increased from low (i.e., two points) before training to high (i.e., four points) six months after training (p < .001, n = 102). However, of traffic police officers who witnessed a serious crash event (n = 92), fewer than half reported having used their trained first aid skills. Study IV showed that contextual issues related to physical, social, resource, and work situations influenced the opportunity of police officers to apply their trained first aid skills at the workplace.Conclusion: A PFA educational programme has been shown to improve traffic police officers’ knowledge and perceived skills confidence regarding provision of first aid when adult learning principles are incorporated into the implementation of training. However, the increase in knowledge and perceived skills confidence did not translate into increased use of trained first aid skills in caring for crash victims. To enhance the use of skills, there is a need to improve the working conditions of traffic police officers, including equipping them with essential resources for the provision of post-crash care.
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