Emergency Medical Response in Mass Casualty Tunnel Incidents—with Emphasis on Prehospital Care

Responding to mass casualty incidents in a tunnel environment is problematic not least from a prehospital emergency medical services (EMS) perspective. The aim of this review was to 1) categorize preconditions for emergency response in tunnel environments based on Haddon’s matrix and 2) identify specific EMS knowledge of providing prehospital care. Twenty eight articles, reports and book chapters were selected for further analysis. Firstly, sorting the data from each included article was done according to Haddon’s matrix. The result covers human factors, technical factors, physical environmental factors and socioeconomic environmental factors all related to preconditions for emergency response. To describe the EMS’s knowledge the data was also sorted according to command and safety, communication, assessment, and triage treatment and transport, also known as CSCATT. Few studies, especially of high quality, actually provide detailed information regarding emergency response to tunnel incidents and those that do, often have a main focus on management by the rescue service. While many incidents studied were caused by fires in tunnels, thus requiring rescue service in action, the subsequent EMS response issues that have taken place appear to have been given limited attention. To optimize the survival rates and health of the injured, as well as to provide a safe and effective work environment for the emergency services, there is a need to explore the event phase

Preparing medical first responders for crises: a systematic literature review of disaster training programs and their effectiveness.

BACKGROUND Adequate training and preparation of medical first responders (MFRs) are essential for an optimal performance in highly demanding situations like disasters (e.g., mass accidents, natural catastrophes). The training needs to be as effective as possible, because precise and effective behavior of MFRs under stress is central for ensuring patients' survival and recovery. This systematic review offers an overview of scientifically evaluated training methods used to prepare MFRs for disasters. It identifies different effectiveness indicators and provides an additional analysis of how and to what extent the innovative training technologies virtual (VR) and mixed reality (MR) are included in disaster training research. METHODS The systematic review was conducted according to the PRISMA guidelines and focused specifically on (quasi-)experimental studies published between January 2010 and September 2021. The literature search was conducted via Web of Science and PubMed and led to the inclusion of 55 articles. RESULTS The search identified several types of training, including traditional (e.g., lectures, real-life scenario training) and technology-based training (e.g., computer-based learning, educational videos). Most trainings consisted of more than one method. The effectiveness of the trainings was mainly assessed through pre-post comparisons of knowledge tests or self-reported measures although some studies also used behavioral performance measures (e.g., triage accuracy). While all methods demonstrated effectiveness, the literature indicates that technology-based methods often lead to similar or greater training outcomes than traditional trainings. Currently, few studies systematically evaluated immersive VR and MR training. CONCLUSION To determine the success of a training, proper and scientifically sound evaluation is necessary. Of the effectiveness indicators found, performance assessments in simulated scenarios are closest to the target behavior during real disasters. For valid yet inexpensive evaluations, objectively assessible performance measures, such as accuracy, time, and order of actions could be used. However, performance assessments have not been applied often. Furthermore, we found that technology-based training methods represent a promising approach to train many MFRs repeatedly and efficiently. These technologies offer great potential to supplement or partially replace traditional training. Further research is needed on those methods that have been underrepresented, especially serious gaming, immersive VR, and MR

Patients' experiences of illness, operation and outcome with reference to gastro-oesophageal reflux disease.

Background. Describing the illness-story from a patient perspective could increase understanding of living with a chronic disease for health professionals and others, facilitate decision-making about treatment and enhance information about the outcome from a patient perspective. Aim. To illuminate patients' illness experiences of having a gastro-oesophageal reflux disease (GORD), going through surgery and the outcome. Methods. Twelve patients were interviewed 5 years after having had the operation; six patients had had fundoplication via laparoscopy and six via open surgery. Each patient was asked to talk openly about their experiences, thoughts, feelings and consequences of living with the illness, going through surgery and the period from surgery to the day of interview. A qualitative content analysis was performed concerning the context of the data and its meaning. Findings. Three central categories were identified and nine subcategories: living with GORD- symptoms of the disease affecting daily living, taking medicines, work, family and social life; concerns related to surgery- decision-making about the operation, influence by physicians; life after the operation- outcomes and consequences, side-effects and complications of the operation, sick leave, information and sharing experiences with future patients. All patients were free from symptoms of the illness after surgery independent of type of surgery, but side-effects from surgical treatment varied individually. Interviewees would have liked information concerning side-effects after surgery from previous patients. Conclusions. This study contributes to knowledge about patients' long-term suffering, their control of symptoms and how they have tried to cure themselves, but also about their concerns about surgery and the importance of surgical treatment to their quality of life. They wanted information about treatment, outcome and consequences, not only from a health care perspective but also from previous patients having had the same treatment

Formal carers in health care and the social services witnessing abuse of the elderly in their homes

The purpose was to elucidate the reactions of formal carers as witnesses and helpers in situations of elder abuse, to illuminate abusive situations and to reflect on the findings from an ethical point of view. Twenty-one district nurses from one county council were interviewed (I, II, III, IV). They described the problems they had when dealing with cases of elder abuse, the uncertainty they felt when they approached the family, identified the abuse and intervened (I). They used no distinct definition of elder abuse but described it as ’overstepping the boundaries of a person’s integrity/autonomy’ (II). In the 44 cases narrated the elderly people were mostly physically and/or psychologically impaired, the person abused could either be the impaired elderly person, the informal carer or both. Abuse was related to the inability of one party to meet the demands made on him/herself, the other person, or to a history of violence (III). The cases narrated were analysed for reliability and were considered reliable (IV). Questionnaires submitted to 163 district nurses revealed 33 cases of elder abuse (V) and to home service assistants 97 cases (VI). The abused elderly people were often very old women, mostly healthy or unhealthy in equal proportions. The perpetrators were mostly close relatives, responsible or not responsible for the caring. The abusive acts often involved a combination of psychological, physical, and financial abuse and neglect. Mental disturbance and alcohol abuse, as well as financial reasons were reported as contributing to the abuse (V, VI). The attitudes of general practitioners, district nurses and home service assistants towards elder abuse and the interventions suggested in hypothetical cases of elder abuse were investigated (VII). All groups were uncertain about their attitudes towards elder abuse. Their suggested interventions were amalgamated into three groups; sparse and of the social type, more specific and of the health care and voluntary type, or overall types of intervention. The situation, profession and organization seemed to result in different interventions (VII). The findings were reflected on using Lögstrup’s ethic as a framework, and the conclusion was that in order to be able to intervene successfully formal carers need to find solutions on a meta-level. Conventions and norms must be developed and public responsibility is needed.S. 1-82: sammanfattning, s. 85-199: 7 uppsatserdigitalisering@um

Survivors' experiences from a train crash

Rarely described are people's lived experiences from severe injury events such as train crashes. The number of train crashes named disasters with ≥10 killed and/or ≥100 nonfatally injured grows globally and the trend shows that more people survive these disasters today than did so in the past. This results in an increased number of survivors needing care. The aim of the study was to explore survivors' experiences from a train crash. Narrative interviews were performed with 14 passengers 4 years after a train crash event. Qualitative content analysis was used to analyse the interviews. Experiences were captured in three main themes: (1) Living in the mode of existential threat describes how the survivors first lost control, then were thrown into a state of unimaginable chaos as they faced death. (2) Dealing with the unthinkable described how survivors restored control, the central role of others, and the importance of reconstructing the event to move forward in their processing. (3) Having cheated death shows how some became shackled by their history, whereas others overcame the haunting of unforgettable memories. Furthermore, the result shows how all experienced a second chance in life. Experiencing a train crash meant that the passengers experienced severe vulnerability and a threat to life and interdependence turned out to play a crucial role. Focusing on helping other passengers on site was one way to regain the loss of control and kept the chaos at bay. Family, friends, and fellow passengers turned out to be extremely important during the recovery process why such closeness should be promoted and facilitated

Interactions between family members and staff in intensive care units-An observation and interview study.

Background: Research about interactions between family members and staff are sparse, although family members’ needs and experiences in intensive care units are well researched areas. Aim: The aim was to describe and interpret interactions between family members and staff in intensive care units. Methods: Interviews (n=24) with family members and repeated observations of interactions of family members and staff in intensive care units were performed and analysed together by means of content analysis. Results: The initial interactions between staff and family members had a substantial effect on family members and influenced their further interactions with the staff. Two kinds of interactions were revealed; mutual understanding and mutual misunderstanding. Family members, who understood the explicit information and the implicit messages were open in communication with the staff, adjusted well to the system, were acknowledged by the staff and sometimes consoled. Family members, who had difficulties understanding information and implicit messages drew back from communication with staff, did not adjust to the system and were sometimes insulted by the staff. Conclusions: Unambiguous information from the staff is important for developing interactions of mutual understanding. The results may be a starting point for intensive care unit staff to reflect on how all family members are initially met and further informed and treated. Further research of family members’ experiences of interactions with staff in a longitudinal perspective and the influence of critical illness on families are needed

Everyday outdoor mobility in old age : focus group interviews with active senior citizens

Background: Senior citizens are over-represented in injury statistics, and fall-related injuries are globally recognized as a major threat to their health and wellbeing. Outdoor falls are likely to occur among those who are active and healthy when walking or cycling. The objective of this study was to explore active senior citizens’ experiences and perceptions of how their safety could be increased and their risk reduced in outdoor environments. Methods: Six focus-group interviews with 31 healthy and active senior citizens were conducted in northern Sweden. Data were analyzed via a qualitative content analysis method. Results: Participants adjusted to age-related changes in order to stay safe during outdoor mobility. Outdoor activities were facilitated by having confidence of safety within the environment, and by using safety devices. Fear of, for example, falling and dangerous environments, such as uneven surfaces, as well as the shortcomings of safety devices, were constraining elements for outdoor activity. Conclusions: It is of great importance to raise awareness of healthy aging and to illuminate directions for environmental changes. Asking old people about their experiences allows the researcher to identify with their perspective, and may give a more comprehensive understanding of the most appropriate recommendations for health and safety improvements

Health and Well-Being of Persons of Working Age up to Seven Years after Severe Traumatic Brain Injury in Northern Sweden : A Mixed Method Study

Purpose: To explore the health and well-being of persons seven years after severe traumatic brain injury (STBI). Material and methods: Follow-up of 21 persons 1 and 7 years after STBI using surveys for functional outcome, anxiety/depression, health and mental fatigue. Interviews were conducted and analysed using qualitative content analysis. Convergent parallel mixed method then merged and analysed the results into an overall interpretation. Results: Good recovery, high functional outcome and overall good health were relatively unchanged between 1 and 7 years. Well-being was a result of adaptation to a recovered or changed life situation. Persons with good recovery had moved on in life. Persons with moderate disability self-estimated their health as good recovery but reported poorer well-being. For persons with severe disability, adaptation was an ongoing process and health and well-being were low. Only a few persons reported anxiety and depression. They had poorer health but nevertheless reported well-being. Persons with moderate and severe mental fatigue had low functional outcomes and overall health and none of them reported well-being. Conclusions: The life of a person who has suffered STBI is still affected to a lesser or greater degree several years after injury due to acceptance of a recovered or changed life situation. Further studies are needed on how health and well-being can be improved after STBI in the long-term perspective