Approximately 36,000 Swedish children seek medical care annually because of injuries during school time. The purpose of this field study is to investigate risky outdoor play at the school yard and to describe teachers’ perceptions of risk and safety in relation to learning and development. The study includes observations of children (6–12 years old) during outdoor activities as part of the school’s activities and includes focus-group interviews with teachers and children. Children were seen climbing high in play facilities, speeding down slides, or competing with sticks in the woods. Different views of risk and safety among the participants influence outdoor play activities. Teachers’ knowledge of risk seems to be derived from common sense and personal experiences rather than from a professional perspective. A joint approach of educational and medicine disciplines is desirable when it comes to children’s health and development.

Purpose: The purpose of this study was from a Swedish perspective to map experts' opinions on theoretical statements of essential collaboration activities for management of mining injury incidents.

Design/methodology/approach: A Delphi technique was performed, asking opinions from experts in iterative rounds to generate understanding and form consensus on group opinion around multi-agency management. The experts were personnel from emergency medical service, rescue service and mine industry, all with operative command positions.

Findings: Three iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important multi-agency collaboration activities to optimize victim's outcome from an injury incident in an underground mine. This resulted in 63 statements and additional three were added during the second round. The statements were divided into one trajectory and seventh time phases and comprised, e.g. early alarm routines, support of early life-saving interventions, relevant resources and equipment for the assignment and command and control center and functions with predefined action plans for response. It also comprised shared and communicated decisions about each agency's responsibility and safety. All statements reached consensus among the experts in Round 3.

Research limitations/implications: The experts included in this study seem to be adequate but there could be other experts and different statements that other researchers might consider.

Practical implications: These statements could be used to evaluate collaboration in major incidents exercises. The statements can also be quality indicators for reporting results from multi-agency management.

Originality/value: This paper contributes to the research field of collaboration and joint practices between and among personnel involved in rescue operations.

Mass casualty incidents (MCI) in tunnels can result in devastating consequences. Despite this, there is a knowledge gap in the perspectives and experiences of strategic stakeholders in relation to the emergency medical response to MCI in tunnels. This study aims to explore and describe this issue. The study includes 11 interview participants from the emergency services organisations and governmental and municipal organisations in Sweden. The results indicate that the medical perspective is inadequately represented at a strategic level due, among other, to limited input from emergency medical representatives during planning stages and a lack of social networks. The results implicate a need to create and improve networks among the stakeholders from the involved organisations. Emergency medical personnel should not only be acknowledged for their expertise but should also be included to a greater extent in the planning stages and exercises. Medical and rescue personnel need time to jointly discuss how they, in the best way, can save lives in tunnel MCIs.

Background: High demands are placed on the emergency medical services to handle rescue operations in challenging environments such as tunnels. In Oslo, Norway a specialised management function within the emergency medical services, the medical on-scene commander, in line with the command structure within the police and fire brigade, might support or take over command and control from the ambulance incident officer arriving as the first ambulance personnel on scene. The aim was to shed light on the emergency medical service experiences from real tunnel incidents described by the Oslo medical on-scene commanders.

Methods: Interviews were conducted with six of the seven medical on-scene commander in Oslo, Norway. Data were analysed using a qualitative content analysis.

Results: The overall theme was "A need for mutual understanding of a tunnel incident". The medical on-scene commander provided tactical support, using their special knowledge of risk objects and resources in the local area. They established operation plans with other emergency services (the police and fire brigade) in a structured and trustful way, thus creating a fluent and coordinated mission. Also, less time was spent arguing at the incident site. By socialising also outside ordinary working hours, a strong foundation of reliance was built between the different parties. A challenge in recent years has been the increasing ordinary workload, giving less opportunity for training and exchange of experiences between the three emergency services.

Conclusions: The enthusiastic pioneers within the three emergency services have created a sense of familiarity and trust. A specially trained medical on-scene commander at a tunnel incident is regarded to improve the medical management. To improve efficiency, this might be worth studying for other emergency medical services with similar conditions, i.e. tunnels in densely populated areas.

Venous blood specimen collection is an important practical task that results in an analysis response that often leads to a clinical decision. Errors due to inaccurate venous blood specimen collection are frequently reported and can jeopardize patient safety because inaccurate specimens may result in a delayed or incorrect diagnosis and treatment. However, few healthcare personnel have written an error report regarding venous blood specimen collection practices. The aim of this study is to describe the experiences of healthcare personnel with incident reporting of venous blood specimen collection practices in primary health care. Our study is based on 30 individual interviews with healthcare personnel from 10 primary health care centres. Data were analysed using qualitative content analyses. Personnel experiences of incident reporting were summarized in three categories; Uncertainties in the planning and organization, High workload and low priority and, A need for support and guidance. More specifically, barriers hinder personnel in reporting mistakes. An interpretation based on the results is that surrounding circumstances within the organization influence whether personnel report mistakes or not. The result indicates a need for parallel systems, to identify and report errors or near-misses to prevent mistakes. Processed incidents should be returned promptly to the personnel to use as a learning experience. Having a valid questionnaire and a key person to write an incident report, might reduce the burden on the health care staff and increase the numbers of incident reports and patient safety.

Purpose: The purpose of this paper is to examine emergency medical service (EMS) personnel’s perceptions and experiences of managing underground mining injury incidents.

Design/methodology/approach: In total, 13 EMS personnel were interviewed according to a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using qualitative content analysis.

Findings: An underground mining environment was described as unfamiliar and unsafe and, with no guidelines for operational actions in an extreme environment, such as underground mines, the EMS personnel were uncertain of their role. They therefore became passive and relied on the rescue service and mining company during a major incident. However, the medical care was not considered to be different from any other prehospital care, although a mining environment would make the situation more difficult and it would take longer for the mine workers to be placed under definitive care.

Originality/value: This study complements earlier studies by examining the EMS personnel’s perceptions and experiences of major incidents.

Trauma care at an accident site is of great importance for patient survival. The purpose of the study was to observe the compliance of ambulance nurses with the Prehospital Trauma Life Support (PHTLS) concept of trauma care in a simulation situation. The material consisted of video recordings in trauma simulation and an observation protocol was designed to analyze the video material. The result showed weaknesses in systematic exam and an ineffective use of time at the scene of injury. Development of observation protocols in trauma simulation can ensure the quality of ambulance nurses' compliance with established concepts. Our pilot study shows that insufficiencies in systematic care lead to an ineffective treatment for trauma patients which in turn may increase the risk of complications and mortality.

Ett systematiskt traumaomhändertagande på olycksplats har stor betydelse för patienters överlevnad. Syftet med denna studie var att observera sjuksköters­kor i ambulanssjukvården och följsamhet till konceptet »prehospital trauma life support« vid traumaomhändertagande i en simuleringssituation. Ett observationsprotokoll utformades för att analysera videoinspelningar. Resultatet visar på brister i det systematiska omhändertagandet och ett ineffektivt omhändertagande på skadeplats. Användandet av observationsprotokoll i traumasimulering kan kvalitetssäkra sjuksköterskors följsamhet till vedertagna koncept.

Rationale: There is a lack of long-term follow-up studies focused on injured and uninjured survivors’ experiences of the recovery process after major traffic crashes.

Aim/objective: To explore survivors’ experiences of long-term physical and psychological consequences and recovery five years after a major bus crash.

Methodological design and justification: A qualitative design was used to explore experiences in a 5-year follow-up study.

Research methods: Participants were 54 survivors of a bus crash with 56 survivors and six fatalities. Telephone interviews were analyzed with qualitative content analysis.

Results: The theme overarching the categories is “visible and existential marks in everyday life” and it represents the range of the crash’s influence in the survivors’ lives. The first category, “health consequences in daily life,” has four subcategories covering quick recovery, suffering in daily life, distress in traffic situations, and long-term pain. Described reasons for quick recovery among survivors were previous crisis experiences, traveling alone, being uninjured, and not being exposed to traumatic impressions. For the other survivors, being reminded of the crash caused disturbing reactions, such as sweating, anxiety, and flashbacks. Survivors avoided going by bus if they could. A group of the injured survivors were still suffering from limiting and painful injuries. The second category, “oneself and social connection,” has three subcategories that include self-awareness, impact on relationships, and connectedness. Survivors developed a stronger bond to their significant other or separated from their partner within the first couple of years. Friendships and a sense of connectedness among survivors were sources of long-lasting comfort and support.

Conclusion: There is a need for more information about disruptive long-lasting consequences, such as travel anxiety, and available treatments. Initially, health-promoting connectedness can be facilitated by treating survivors as a group of people who belong together, from the day of the crash and throughout the recovery process. 

Objectives. To explore the perceptions and experiences of mining-, rescue service- (RS), and emergency medical service (EMS) personnel regarding how to handle incidents in an underground mine.

Methods. Six focus-group interviews and 10 individual interviews were carried out with groups of mining-, RS and EMS personnel, who served the underground mining industry located in small municipalities in a sparsely populated area of northern Sweden. The transcripts of the interviews were analysed using qualitative content analysis.

Results. The three groups mostly described experiences of minor incidents and announced a limited preparedness for handling major mining incidents. Collaboration was described as being difficult because of limited knowledge about the others’ responsibilities and capacities. Few non-mining personnel were trained, or prepared to fulfil their tasks in an underground environment, and some expressed that they would even refuse to go underground because of concerns for their own safety.

Conclusions. There is a need for more collaboration and joint practices between and among the groups involved in rescue operations. Collaboration between mine- and RS personnel exists, but the EMS personnel is largely excluded from this interaction. Therefore, the EMS personnel are insecure about how to handle underground mining incidents. A closer collaboration between all organizations in preparing for mining incidents is emphasized, and would have positive effects on the rescue operation. Some experiences may also be used under similar circumstances, such as incidents in railway and road tunnels.

In recent decades, prehospital emergency care has undergone extensive development. Today, prehospital emergency nurses (PENs) are well trained and provide advanced care to patients of all ages. Caring for pediatric trauma patients is considered to be particularly demanding. However, in Sweden and internationally, there is a lack of research regarding PENs' preparedness for caring for pediatric trauma patients.

Objective: The development and testing of a questionnaire on self-reported preparedness among PENs caring for pediatric trauma patients in a prehospital emergency setting.

Methods: Questionnaire development included face and content validity tests resulting in 38 questions. Eighteen of these questions were analyzed by test-retest. The content of the questionnaire was statistically analyzed.

Results: Fifteen questions were considered valid after reliability and validity tests. Three questions did not fulfill the stability criteria. The content analyses show a low degree of experience with pediatric trauma patients and half of the participants reported stress symptoms when responding to such alarms.

Conclusion: The questionnaire assessing PENs preparedness caring for pediatric trauma patients in Sweden is considered to be suitable for research and clinical practice to improve the care of pediatric trauma patients and the health of PENs, although further testing of the questionnaire is required.