Hvilke faktorer påvirker reservedelslogistikkløsningen til Fridtjof Nansen-klassen fregattene? Er det indikasjoner på at forsyningskjeden ikke er optimal?

God tilgjengelighet på reservedeler er en grunnleggende forutsetning for at Fridtjof Nansen-klassen fregattene skal kunne være teknisk og operativt tilgjengelige, og slik evne å trygge Norges suverenitet til havs. Etter å ha jobbet flere år med Marinens organiske logistikk, blant annet med distribuering av reservedeler til fregattene, har motivasjonen økt for å få finne ut mer om hvordan forsyningskjeden for reservedeler til fartøyene er bygget opp. I tillegg har en hensikt med oppgaven vært å se på hvorvidt det er mulig å gjennomføre endringer i forsyningskjeden for å øke den operative tilgjengeligheten til fregattene. For å finne ut av forsyningskjedenes oppbygging og virkning er følgende problemstilling definert: Hvilke faktorer påvirker reservedelslogistikkløsningen til Fridtjof Nansen-klassen fregattene? Er det indikasjoner på at forsyningskjeden ikke er optimal? Fremgangsmåten som ble benyttet for å samle informasjon var en gjennomgang av rapporter fra NATO-operasjoner som fregattene har deltatt i de siste fire årene, samt gjennomgang av styrende logistikkdirektiver og doktriner. Denne informasjonen ble stilt opp mot svarene fra individuelle semistrukturerte intervjuer med sentrale personer i anskaffelsesprosessene i logistikkjeden, og knyttet opp mot teoriens beskrivelse av hensiktsmessig fremgangsmåte. Teoriene som ble benyttet for å definere hensiktsmessig fremgangsmåte er hentet fra logistikkdomenet og forsyningskjedelogistikk. I tillegg har det i drøftingen blitt sett på dannelsen av subkulturer i en organisasjon samt hvordan disse kan påvirke de nevnte logistikkprosessene. Resultatet av dette forskningsarbeidet viser til at logistikksystemet er komplekst og har noen grunnleggende forutsetninger som må på plass for å kunne nå sitt fulle potensiale. Disse forutsetningene er ikke nødvendigvis til stede slik situasjonen er i dag. Noen av de viktigste momentene dette forskningsarbeidet fremhever er for det første at det mangler én helhetlig styring av logistikkprosessene. Deretter fremkommer det at det foreligger store mangler i innføring av masterdata i ERP systemene, noe som medfører kraftige forsinkelser i forsyningskjeden gjennom fregattenes levetid. Det siste store momenter er at det, på grunn av forsinkelsene over tid, har dannet seg sterke subkulturer som, med motivasjonen om å forbedre prosessene, i økende grad motarbeider logistikksystemet slik det er organisert i dag. Diskusjonen i oppgaven dreier seg om alle de forskjellige identifiserte faktorene som påvirker forsyningskjeden negativt. Videre tar den for seg konsekvensene som vil følge av en manglende utbedring av disse momentene, samt hvilke fordeler en kan oppnå i form av operativ tilgjengelighet på fregattene, dersom en utbedrer de identifiserte grunnleggende manglene.Good availability of spare parts is a basic prerequisite for the Fridtjof Nansen-class frigates to be technically and operationally available – and therefore secure Norway's sovereignty at sea. I have worked for several years within the navy's internal logistics departments, including the distribution of spare parts to the frigates. During this time, I have developed a strong desire to better understand how the full supply chain for spare parts is structured. Further, it is my intention to look at whether it is possible to make changes to the supply chain, in order to increase the operational availability of the frigates. To determine the structure and effectiveness of the supply chain, the following questions are posed: What factors affect the spare parts logistics solution for the Fridtjof Nansen-class frigates? Are there indications that the supply chain is not optimal? The methodology applied, was to gather information through reviewing reports from NATO operations that the frigates have participated in over the past four years, as well as reviewing governing logistics directives and doctrines. This information was then compared to the responses gained from interviews with key persons in the procurement processes, the logistics chain, and those linked to the theoretical descriptions of appropriate procedures. The theories used to define appropriate methods are taken from the logistics and the supply chain logistics domain. In addition, the discussion has looked at the formation of subcultures in an organization and how these can affect the aforementioned logistics processes. The results of this research work suggest that the logistics system is complex and requires the implementation of some basic elements in order to reach its full potential. Not all of these elements are in place today. The most important findings of this research work are: There is a lack of coordinated leadership in the logistics process. Secondly there are major deficiencies in the uploading of master data into the ERP systems. This leads to significant delays in the supply chain throughout the life of the frigates. Thirdly, due to these delays, over time, strong subcultures have formed. These subcultures are increasingly compromising the logistics system and undermining the effort to improve processes. The discussion in the assignment addresses the different factors that affect the supply chain negatively. Furthermore, it identifies the consequences that will result from a failure to rectify these elements. It also highlights the potential benefits that can be obtained, in terms of operational availability of the frigates, if the identified deficiencies are rectified

Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital survey

<p>Abstract</p> <p>Background</p> <p>Formalized trauma systems have shown beneficial effects on patient survival and have harvested great recognition among health care professionals. In spite of this, the implementation of trauma systems is challenging and often met with resistance.</p> <p>Recommendations for a national trauma system in Norway were published in 2007. We wanted to assess the level of implementation of these recommendations.</p> <p>Methods</p> <p>A survey of all acute care hospitals that receive severely injured patients in the south-eastern health region of Norway was conducted. A structured questionnaire based on the 2007 national recommendations was used in a telephone interview of hospital trauma personnel between January 17 and 21, 2011. Seventeen trauma system criteria were identified from the recommendations.</p> <p>Results</p> <p>Nineteen hospitals were included in the study and these received more than 2000 trauma patients annually via their trauma teams. Out of the 17 criteria that had been identified, the hospitals fulfilled a median of 12 criteria. Neither the size of the hospitals nor the distance between the hospitals and the regional trauma centre affected the level of trauma resources available. The hospitals scored lowest on the criteria for transfer of patients to higher level of care and on the training requirements for members of the trauma teams.</p> <p>Conclusion</p> <p>Our study identifies a major shortcoming in the efforts of regionalizing trauma in our region. The findings indicate that training of personnel and protocols for inter-hospital transfer are the major deficiencies from the national trauma system recommendations. Resources for training of personnel partaking in trauma teams and development of inter-hospital transfer agreements should receive immediate attention.</p

Pediatric Emergencies in Helicopter Emergency Medical Services:A National Population-Based Cohort Study From Denmark

Study objective: To examine the diagnostic pattern, level of severity of illness or injuries, and mortality among children for whom a physician-staffed helicopter emergency medical service (HEMS) was dispatched. Methods: Population-based cohort study including patients aged less than 16 years treated by the Danish national HEMS from October 1, 2014, to September 30, 2018. Diagnoses were retrieved from inhospital medical records, and the severity of illness or injuries was assessed by a severity score on scene, administration of advanced out-of-hospital care, need for intensive care in a hospital, and mortality. Results: In total, 651 HEMS missions included pediatric patients aged less than 1 year (9.2%), 1 to 2 years (29.0%), 3 to 7 years (28.3%), and 8 to 15 years (33.5%). A third of the patients had critical emergencies (29.6%), and for 20.1% of the patients, 1 or more out-of-hospital interventions were performed: intubation, mechanical chest compressions, intraosseous vascular access, blood transfusion, chest tube insertion, and/or ultrasound examination. Among the 525 patients with hospital follow-up, the most frequent hospital diagnoses were injuries (32.2%), burns (11.2%), and respiratory diseases (7.8%). Within 24 hours of the mission, 18.1% of patients required intensive care. Twenty-nine patients (5.1%, 95% confidence interval [CI] 3.6 to 7.3) died either on or within 1 day of the mission, and the cumulative 30-day mortality was 35 of 565 (6.2%, 95% CI 4.5 to 8.5) (N¼565 first-time missions). Conclusion: On Danish physician-staffed HEMS missions, 1 in 5 pediatric patients required advanced out-of-hospital care. Among hospitalized patients, nearly one-fifth of the patients required immediate intensive care and 6.2% died within 30 days of the mission.publishedVersio

Patients Referred to a Norwegian Trauma Centre: effect of transfer distance on injury patterns, use of resources and outcomes

Background Triage and interhospital transfer are central to trauma systems. Few studies have addressed transferred trauma patients. This study investigated transfers of variable distances to OUH (Oslo University Hospital, Ullevål), one of the largest trauma centres in Europe. Methods Patients included in the OUH trauma registry from 2001 to 2008 were included in the study. Demographic, injury, management and outcome data were abstracted. Patients were grouped according to transfer distance: ≤20 km, 21-100 km and > 100 km. Results Of the 7.353 included patients, 5.803 were admitted directly, and 1.550 were transferred. The number of transfers per year increased, and there was no reduction in injury severity during the study period. Seventy-six per cent of the transferred patients were severely injured. With greater transfer distances, injury severity increased, and there were larger proportions of traffic injuries, polytrauma and hypotensive patients. With shorter distances, patients were older, and head injuries and injuries after falls were more common. The shorter transfers less often activated the trauma team: ≤20 km -34%; 21-100 km -51%; > 100 km -61%, compared to 92% of all directly admitted patients. The mortality for all transferred patients was 11%, but was unequally distributed according to transfer distance. Conclusion This study shows heterogeneous characteristics and high injury severity among interhospital transfers. The rate of trauma team assessment was low and should be further examined. The mortality differences should be interpreted with caution as patients were in different phases of management. The descriptive characteristics outlined may be employed in the development of triage protocols and transfer guidelines

A concept for major incident triage: full-scaled simulation feasibility study

<p>Abstract</p> <p>Background</p> <p>Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents.</p> <p>Methods</p> <p>The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7).</p> <p>Results</p> <p>Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001.</p> <p>Conclusions</p> <p>Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage.</p

Hvilke faktorer påvirker reservedelslogistikkløsningen til Fridtjof Nansen-klassen fregattene? Er det indikasjoner på at forsyningskjeden ikke er optimal?

God tilgjengelighet på reservedeler er en grunnleggende forutsetning for at Fridtjof Nansen-klassen fregattene skal kunne være teknisk og operativt tilgjengelige, og slik evne å trygge Norges suverenitet til havs. Etter å ha jobbet flere år med Marinens organiske logistikk, blant annet med distribuering av reservedeler til fregattene, har motivasjonen økt for å få finne ut mer om hvordan forsyningskjeden for reservedeler til fartøyene er bygget opp. I tillegg har en hensikt med oppgaven vært å se på hvorvidt det er mulig å gjennomføre endringer i forsyningskjeden for å øke den operative tilgjengeligheten til fregattene. For å finne ut av forsyningskjedenes oppbygging og virkning er følgende problemstilling definert: Hvilke faktorer påvirker reservedelslogistikkløsningen til Fridtjof Nansen-klassen fregattene? Er det indikasjoner på at forsyningskjeden ikke er optimal? Fremgangsmåten som ble benyttet for å samle informasjon var en gjennomgang av rapporter fra NATO-operasjoner som fregattene har deltatt i de siste fire årene, samt gjennomgang av styrende logistikkdirektiver og doktriner. Denne informasjonen ble stilt opp mot svarene fra individuelle semistrukturerte intervjuer med sentrale personer i anskaffelsesprosessene i logistikkjeden, og knyttet opp mot teoriens beskrivelse av hensiktsmessig fremgangsmåte. Teoriene som ble benyttet for å definere hensiktsmessig fremgangsmåte er hentet fra logistikkdomenet og forsyningskjedelogistikk. I tillegg har det i drøftingen blitt sett på dannelsen av subkulturer i en organisasjon samt hvordan disse kan påvirke de nevnte logistikkprosessene. Resultatet av dette forskningsarbeidet viser til at logistikksystemet er komplekst og har noen grunnleggende forutsetninger som må på plass for å kunne nå sitt fulle potensiale. Disse forutsetningene er ikke nødvendigvis til stede slik situasjonen er i dag. Noen av de viktigste momentene dette forskningsarbeidet fremhever er for det første at det mangler én helhetlig styring av logistikkprosessene. Deretter fremkommer det at det foreligger store mangler i innføring av masterdata i ERP systemene, noe som medfører kraftige forsinkelser i forsyningskjeden gjennom fregattenes levetid. Det siste store momenter er at det, på grunn av forsinkelsene over tid, har dannet seg sterke subkulturer som, med motivasjonen om å forbedre prosessene, i økende grad motarbeider logistikksystemet slik det er organisert i dag. Diskusjonen i oppgaven dreier seg om alle de forskjellige identifiserte faktorene som påvirker forsyningskjeden negativt. Videre tar den for seg konsekvensene som vil følge av en manglende utbedring av disse momentene, samt hvilke fordeler en kan oppnå i form av operativ tilgjengelighet på fregattene, dersom en utbedrer de identifiserte grunnleggende manglene