Проблема невідповідності виробництва та споживанні енергії в світі

The objective of this study was to study whiplash injury outcome in front-seat occupants in rear-end impacts using double paired comparison technique. The combination of gender, seated position, and outcome was analyzed. Folksam, a Swedish insurance company, has a database of whiplash injuries. A questionnaire was used to collect study data. The response rate was 81%. The inclusion criteria included medical impairment one year after the impact, as judged by medical specialists. The study included rear-end impacts between 1990 and 1999 that resulted in at least one permanent neck injury impairment; in total, 430 impacts with 860 occupants and 444 impairments. Of those suffering impairment, 302 were female and 142 male; 235 were seated in the driver's seat and 209 in the front passenger seat. Relative risk estimates for impairing whiplash injury, by gender and seated position: 1.Driver male (DM)/passenger female (PF) relative risk = 0.5 n = 218 2.Driver male (DM)/passenger male (PM) relative risk = 1.4 n = 57 3.Driver female (DF)/passenger female (PF) relative risk = 2.5 n = 102 4.Driver female (DF)/passenger male (PM) relative risk = 4.6 n = 67. Females had a relative risk of medical impairment of 3.1 compared to men after adjustment for the average increased risk in the driver position. The driver position had a doubled relative risk compared to the front passenger position. As a conclusion it may be of value to take risk differences between male and female occupants and between driver and front passenger positions into account in future automotive car and seat construction.Originally mentioned in thesis as submitted to journal: Traffic injury prevention, ISSN 1538-9588.</p

INJURY EVENTS AMONG BUS AND COACH OCCUPANTS

A ten year complete data set from the health sector, comprising 284 injured bus and coach occupants from a well defined area, was analyzed. The annual injury incidence was 2 per 10,000 inhabitants, 3/4 were women. In non-crash incidents, 54% were injured; 2/3 while alighting from a bus or coach. In crashes, 46% were injured; 2/3 in collisions with other vehicles and 1/3 in single vehicle crashes. During October-March, 3/4 were injured. In two single vehicle mass casualty crashes in slippery road conditions, high built coaches were hit by so high cross wind forces that they were blown off the road. This crash mechanism has received little attention earlier. Of those injured in collisions with other vehicles, 78% were injured in collisions with other heavy vehicles. Slippery conditions contributed to half of the alighting injuries. The proportion of moderate or more serious injuries (MAIS 2+) was highest in single vehicle crashes (48%) and in alighting and boarding (43%) incidents, and was lowest (5%) in collisions. Every seventh injured was treated as an in-patient on average in five days. Non-crash victims consumed 57% of all in-patient days. Conclusions: The aerodynamic cross-wind factor merits more studies. Injury reducing measures against alighting injuries, addressing especially step height and slippery conditions, may have a great potential to reduce these injuries. Rear-end collisions by other heavy vehicles in urban areas, causing a high number of “whip-lash” injuries, also need to be further addressed. The newly introduced law on compulsory seat belt use in long distance coaches may have a potential to reduce single vehicle crash and some collision injuries

Flying roadside stones - a deadly risk in a crash

The crash of a coach with 58 occupants at 100 kmph revealed the danger of covering ditch areas with sharp stones 5–20 cm in size. Stones and dirt were sprayed into the coach compartment resulting in serious injuries and death. Road safety works need to address this factor in the future

PRE-HOSPITAL EMERGENCY CARE IN SWEDEN

Traffic injuries cause a heavy burden on society in most motorized countries. Pre-hospital and hospital trauma care may have a potential to reduce these losses. By tradition the pre-hospital ambulance care has not until the last decades been integrated in the medical sector organization in Sweden. Nowadays it is regarded as the extended arm of trauma care. Improved qualification level to Registered Nurse (R.N.) and structured education and training has improved the competence of the pre-hospital personnel. However, few objective studies of the effect are available. The National Board of Health and Welfare publish national guidelines for pre-hospital care and disaster management and support economically training in mass casualty and disaster command and control. Systemized training of rescue and ambulance teams in co-operation at a crash site may reduce the extrication time of entrapped car/truck crash victims by 40–50 per cent. This is a valuable time gain especially in a cold climate, which may add hypothermia problems to the injuries. In Sweden (9 million inhabitants), a sparsely populated country with sometimes long transportation distances to the nearest trauma hospital, 800 ambulances, 7 ambulance helicopters and 3–5 fixed wing ambulance aircraft are the available transport resources. In case of a mass casualty or disaster situation, inside or outside the country, a governmental project (Swedish National Medevac) aims to convert a passenger aircraft from Scandinavian Airlines System (SAS) to a qualified medical resource for long distance transport, with capacity to nurse six intensive care patients and an additional 6–20 lieing or seated patients during transport

Snowmobile, motorcycle and moose-car accidents : aspects on injury control

Injuries related to snowmobiles, motorcycles and moose-car collisions have increased. The aim of the present thesis was to analyse mechanisms and consequences in fatal and non-fatal accidents of these types, and to penetrate possible preventive measures. Snowmobiles The median age of the injured was 30 and of the killed 32, males pre­dominating. A majority of the accidents occurred during weekends, and especially the fatal accidents occurred after dark. The extremities were the most commonly injured parts of the body, however, drowning, crushed chest and cranial injuries caused most of the fatalities. Among the fatalities, four out of five were under the influence of alcohol. The present Swedish laws regarding snowmobiles seem well motivated. "Built-in" safety measures in the construction of the snowmobiles, pro­perly designed snowmobile tracks and functional search and rescue sys­tems could reduce the injuries. Motorcycles The median age was 19 years for both the traffic injured and the kil­led. Half of the traffic accidents were collisions with other motor ve­hicles. In the fatally injured group, also collisions with fixed road­side objects were common. Of the fatally injured, more than every fifth person died in an accident where alcohol was an influential factor. In the injured group, lower extremity injuries (especially in off-road riding) were common and among the fatalities most riders died from injuries to the head or chest. Out of one thousand motorcycle riders interviewed, 45% reported wobbling experiences (8% reported severe wobbling). Possible injury reducing measures include increasing the licensing age, more discriminating driving test, "built-in" restriction of the motorcycle's top speed, elimination of motorcycles prone to wobbling, and a more intensive traffic supervision (speeding, alco­hol). Moose-car collisitions The median age of the drivers was 38 years. Most collisions happened at dusk or when dark (3/4). The median collision speed was 70 km/h. The damage to the car was typical, the roof and the windshield pillars were deformed downwards and backwards. The broken windshield was often pressed into the passenger compartment. Most of the injured car occu­pants suffered cuts predominantly to the head and upper extremities. Nearly all the fatally injured died of head and neck injuries. The injuries may be reduced by strengthening the roof and the windshield pillars, and by introducing anti 1 acerati ve windshields.Diss. (sammanfattning) Umeå : Umeå universitet, 1985digitalisering@um

Vehicle-related injuries in and around a medium sized Swedish City - bicyclist injuries caused the heaviest burden on the medical sector

BACKGROUND: A data acquisition from the medical sector may give one important view of the burden on the society caused by vehicle related injuries. The official police-reported statistics may only reflect a part of all vehicle-related injured seeking medical attention. The aim is to provide a comprehensive picture of the burden of vehicle related injuries on the medical sector (2013), and to compare with official police-reported statistics and the development year 2000-2013. METHODS: The data set includes 1085 injured from the Injury Data Base at Umeå University Hospital's catchment area with 148,500 inhabitants in 2013. RESULTS: Bicyclists were the most frequently injured (54%). One-third had non-minor (MAIS2+) injuries, and bicyclists accounted for 58% of the 1071 hospital bed days for all vehicle-related injuries. Car occupants represented 23% of all injured, and only 9% had MAIS2+ injuries. They accounted for 17% of the hospital bed days. Motorized two wheel vehicle riders represented 11% of the injured and 39% had MAIS2+ injuries and they occupied 11% of the hospital bed days. Of the 1085 medically treated persons, 767 were injured in public traffic areas, and, therefore, should be included in the official police statistics; however, only a third (232) of them were reported by the police. The annual injury rate had not changed during 2000-2013 for bicyclists, motor-cycle riders, pedestrians or snowmobile riders. However, for passenger car occupants a decrease was observed after 2008, and for mopedists the injury rate was halved after 2009 when a licensing regulation was introduced. CONCLUSION: The Swedish traffic injury reducing strategy Vision Zero, may have contributed to the reduction of injured car occupants and moped riders. The official police-reported statistics was a biased data source for vehicle related injuries and the total number medically treated was in total five times higher. Bicyclists caused the heaviest burden on the medical sector; consequently, they need to be prioritized in future safety work, as recently declared in the Government plan Vision Zero 2.0

The risk of whiplash-induced medical impairment in rear-end impacts for males and females in driver seat compared to front passenger seat

The objective of this study was to study whiplash injury outcome in front-seat occupants in rear-end impacts using double paired comparison technique. The combination of gender, seated position, and outcome was analyzed. Folksam, a Swedish insurance company, has a database of whiplash injuries. A questionnaire was used to collect study data. The response rate was 81%. The inclusion criteria included medical impairment one year after the impact, as judged by medical specialists. The study included rear-end impacts between 1990 and 1999 that resulted in at least one permanent neck injury impairment; in total, 430 impacts with 860 occupants and 444 impairments. Of those suffering impairment, 302 were female and 142 male; 235 were seated in the driver's seat and 209 in the front passenger seat. Relative risk estimates for impairing whiplash injury, by gender and seated position: 1.Driver male (DM)/passenger female (PF) relative risk = 0.5 n = 218 2.Driver male (DM)/passenger male (PM) relative risk = 1.4 n = 57 3.Driver female (DF)/passenger female (PF) relative risk = 2.5 n = 102 4.Driver female (DF)/passenger male (PM) relative risk = 4.6 n = 67. Females had a relative risk of medical impairment of 3.1 compared to men after adjustment for the average increased risk in the driver position. The driver position had a doubled relative risk compared to the front passenger position. As a conclusion it may be of value to take risk differences between male and female occupants and between driver and front passenger positions into account in future automotive car and seat construction.Originally mentioned in thesis as submitted to journal: Traffic injury prevention, ISSN 1538-9588.</p

The effect of active warming in prehospital trauma care during road and air ambulance transportation - a clinical randomized trial

Abstract Background Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientifical evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients. Methods Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored. Results Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C) to 36.0°C (95% CI; 35.7-36.3°C) (p Conclusions In mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response. Trial Registration ClinicalTrials.gov: NCT01400152</p

INJURY EVENTS AMONG BUS AND COACH OCCUPANTS – Non-crash Injuries as Important as Crash Injuries –

A ten year complete data set from the health sector, comprising 284 injured bus and coach occupants from a well defined area, was analyzed. The annual injury incidence was 2 per 10,000 inhabitants, 3/4 were women. In non-crash incidents, 54 % were injured; 2/3 while alighting from a bus or coach. In crashes, 46 % were injured; 2/3 in collisions with other vehicles and 1/3 in single vehicle crashes. During October-March, 3/4 were injured. In two single vehicle mass casualty crashes in slippery road conditions, high built coaches were hit by so high cross wind forces that they were blown off the road. This crash mechanism has received little attention earlier. Of those injured in collisions with other vehicles, 78 % were injured in collisions with other heavy vehicles. Slippery conditions contributed to half of the alighting injuries. The proportion of moderate or more serious injuries (MAIS 2+) was highest in single vehicle crashes (48%) and in alighting and boarding (43%) incidents, and was lowest (5%) in collisions. Every seventh injured was treated as an in-patient on average in five days. Non-crash victims consumed 57 % of all in-patient days. Conclusions: The aerodynamic cross-wind factor merits more studies. Injury reducing measures against alighting injuries, addressing especially step height and slippery conditions, may have a great potential to reduce these injuries. Rear-end collisions by other heavy vehicles in urban areas, causing a high number of “whip-lash ” injuries, also need to be further addressed. The newly introduced law on compulsory seat belt use i