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Background: Because health professionals can end up being first responders to a mass casualty incident, they must train to improve preparedness and increase the preconditions of victim outcomes. Training and learning on how to handle a mass casualty incident is traditionally based on reading, lectures, training through computer-based scenarios, or sometimes through live simulations. Professionals should practice in realistic environments to narrow the theory–practice gap, and the possibility of repeating the training is important for learning. Virtual reality is a promising tool for realistic and repeatable simulation training, but it needs further evaluation. This study aimed to describe the acceptability and applicability of using VR for training in mass casualty incidents.

Methods: A mixed-methods evaluation design was used, where the qualitative and quantitative findings were embedded into the discussion with a realist inquiry approach. A virtual reality simulation with mass casualty incident scenarios, named GoSaveThem (www.crash.nu), was used, and the participants were directed to perform triage. After the simulation, the participants filled in a questionnaire with open-ended questions and ratings on technical aspects, learning experiences, and improvement of preparedness. Eleven of the participants underwent interviews. The qualitative data was analyzed either summarily or with a conventional content analysis. Data were extracted from computer recordings of how long it took for each participant to triage the first 10 victims and to what extent the triage for the first 10 victims was correct. Descriptive statistical analyses were done, and a comparison was made to see if there were any differences between age, sex, educational background, and previous experiences that affected the outcome of triaging.

Results: Training with virtual reality enables repeatable and realistic simulation training of mass casualty incidents. The participants expressed motivation to repeat the training and experience expanded virtual reality scenarios. This study shows that the acceptability and applicability of using VR for training MCIs were high overall in all examined dimensions for most users, with some exceptions.

Background: Clinical education in Emergency services (EMS) is unique due to its dynamic environment, brief patient encounters, and unpredictable cases. EMS provides valuable learning opportunities for nursing students, fostering person-centered care approaches and a variation of clinical training and learning. Formative feedback is crucial to develop knowledge and skills. Multisource feedback (MSF) offers a comprehensive assessment by incorporating feedback from various individuals, promoting self-reflection and targeted learning. MSF has not, to our knowledge, been systematically evaluated in the context of EMS, and therefore, the aim of the study was to describe nursing students’ experiences with MSF during their clinical education in the EMS, using a digital instrument as a facilitating tool.

Methods: A qualitative design with an inductive approach was used. Data were collected in 2021, using focus group interviews (n = 4) with 31 final-semester nursing students in Stockholm, Sweden, who had conducted clinical education in the EMS and received MSF through a digital instrument. Data were analyzed using reflexive thematic analysis, guided by Braun and Clarke’s methodology.

Results: Three themes revealed: feedback from sources familiar with the student’s learning objectives, feedback from sources unfamiliar with the learning objectives, and general perceptions of MSF in the EMS. Students valued self-reflection and feedback from peers and supervisors for personal and professional growth. Patient feedback was challenging due to their limited contextual understanding and emotional states, while feedback from other healthcare professionals was appreciated but hindered by the healthcare professionals’ workload and timing constraints. Overall, students appreciated MSF’s diverse perspectives, enriching their learning, performance, and development.

Conclusion: This study underscores the value of MSF in nursing students’ clinical education within the EMS. Feedback from peers, supervisors, and self-reflection enhances self-awareness, professional growth, and mutual support. Despite challenges like stress and logistical barriers, structured support and a digital instrument improved accessibility and alignment with learning objectives for the students. Incorporating patient and healthcare professionals’ feedback enriches education by promoting patient-centred care and collaboration. MSF supported reflective practice, and team dynamics and highlights the need for refined feedback processes to optimize learning and professional development for nursing students during clinical education.

Political efforts in the Nordic countries aim to promote gender equality. However, an assumption is that patriarchal structures remain embedded in EMS organizations, often leading to a ‘glass ceiling’ effect for women. The Emergency Medical Services (EMS), generally positioned at the intersection of safety authorities and healthcare, operates within environments often shaped by masculine values and norms. Concurrently, the service also connects strongly to compassion, caring and nursing, which have been historically female-dominant professions and working environments. In recent decades, more females have entered the EMS. Despite the growing number of female paramedics, challenges persist, particularly in relation to gender inequality and workplace culture. Females in EMS field continue to face gender stereotypes, which may contribute to inequality. Gender stereotypes, combined with research describing sexual harassment and bias, underscore the need for further discussions and research on the impact of gender on paramedic work environments and career pathways for women working in the service.

Introduction: In mass-casualty incidents (MCIs), command centers often rely on oral or written reports, leading to communication gaps, misunderstandings, and inadequate logistics of available resources. In this study, a real-time communication and information system for Triage, Position, and Documentation (TriPoD) has been developed using action research in collaboration with end-users to ensure high usability. TriPoD integrates commercially available technology, utilizing a digital triage tag with a unique ID number that attaches to each injured person. Prehospital providers scan the electronic triage tag via a mobile app, instantly sending data to command centers through a web portal. The developed TriPoD enables a seamless transfer of patient information through the whole emergency care chain, from the scene of the MCI during transport, to and within hospitals.

Aim: The study aimed to evaluate TriPoD’s effectiveness and usability during a simulated MCI with figurants.

Methods: Using a qualitative observational design, nonparticipant observers were stationed at the incident site, at a regional command center, and a hospital command center. Observers systematically compared TriPoD with standard procedures and management.

Results: Results revealed that command centers received real-time updates on the patient count, triage status, and locations faster than traditional methods. Data transmitted through the web portal was updated each time a new patient was scanned, allowing for continuous real-time monitoring and decisions. Both prehospital providers and command center users observed TriPoD’s effectiveness and usability, with minor delays when prehospital emergency care providers did not consistently scan injured individuals.

Conclusion: The study demonstrates that seamless information transfer from MCI scenes enhances reliable communication and management efforts. Although TriPoD shows strong potential for improving MCI response and management, further development and testing with intended users are essential. 

Background: Intrusive memories of psychologically traumatic events bring distress both sub-clinically and clinically. This parallel-group, two-arm randomised controlled trial evaluated the effect of a brief behavioural intervention on reducing intrusive memories in frontline healthcare workers exposed to traumatic events during the COVID-19 pandemic.

Methods: Participants with at least two intrusive memories of work-related trauma in the week before recruitment were randomised 1:1 to an imagery-competing task intervention (n = 73) or attention-based control task (n = 71). The number of intrusive memories was assessed at baseline and 5 weeks after the guided session (primary endpoint).

Results: The intervention significantly reduced intrusive memory frequency compared with control [intervention Mdn = 1.0 (IQR = 0–3), control Mdn = 5.0 (IQR = 1–17); p < 0.0001, IRR = 0.30; 95% CI = 0.17–0.53] and led to fewer post-traumatic stress-related symptoms at 1, 3 and 6 month follow-ups (secondary endpoints). Participants and statisticians were blinded to allocation. Adverse events data were acquired throughout the trial, demonstrating safety. There was high adherence and low attrition.

Conclusions: This brief, single-symptom, repeatable digital intervention for subclinical-to-clinical samples after trauma allows scalability, taking a preventing-to-treating approach after trauma.

Trial registration: 2020–07-06, ClinicalTrials.gov identifier: NCT04460014.

Introduction Health professionals traditionally train and learn how to handle a mass casualty incident (MCI) based on reading and/or training through computer-based scenarios, or sometimes through live simulations with actors. Professionals should practice in realistic environments, and the possibility of repeating the training is important for learning [1]. High-fidelity virtual reality is a promising tool for realistic and repeatable simulation training but needs further evaluation [2]. 

Aim: This study aims to assess the acceptability and applicability of virtual reality (VR) for training mass casualty incidents. 

Methods: We used a mixed-methods evaluation design. Both quantitative and qualitative data were used to answer the study aim. To assess the acceptability, participants (n=82) filled out a questionnaire with four open-ended questions after doing the VR simulation, and eleven also agreed to undertake individual interviews. The applicability was assessed by how the participants (n=82) rated the technical aspects, usability, learning experiences, and improvement of preparedness.

Preliminary results: Training with virtual reality enables repeatable and realistic simulation training of mass casualty incidents. Training with virtual reality is exciting and the participants express motivation to repeat the training and experience expanded virtual reality scenarios. Virtual reality offers a cost-effective and safe learning environment. The acceptability and applicability of virtual reality training in mass casualty incidents depend on the level of immersion/realism, the technology being error-free, not getting motion sickness, and the ease of use. 

Background: Assessment of undergraduate students using assessment instruments in the clinical setting is known to be complex. The aim of this study was therefore to examine whether two different assessment instruments, containing learning objectives (LO`s) with similar content, results in similar assessments by the clinical supervisors and to explore clinical supervisors’ experiences of assessment regarding the two different assessment instruments.

Method: A mixed-methods approach was used. Four simulated care encounter scenarios were evaluated by 50 supervisors using two different assessment instruments. 28 follow-up interviews were conducted. Descriptive statistics and logistic binary regression were used for quantitative data analysis, along with qualitative thematic analysis of interview data.

Result: While significant differences were observed within the assessment instruments, the differences were consistent between the two instruments, indicating that the quality of the assessment instruments were considered equivalent. Supervisors noted that the relationship between the students and supervisors could introduce subjectivity in the assessments and that working in groups of supervisors could be advantageous. In terms of formative assessments, the Likert scale was considered a useful tool for evaluating learning objectives. However, supervisors had different views on grading scales and the need for clear definitions. The supervisors concluded that a complicated assessment instrument led to limited very-day usage and did not facilitate formative feedback. Furthermore, supervisors discussed how their experiences influenced the use of the assessment instruments, which resulted in different descriptions of the experience. These differences led to a discussion of the need of supervisor teams to enhance the validity of assessments.

Conclusion: The findings showed that there were no significant differences in pass/fail gradings using the two different assessment instruments. The quantitative data suggests that supervisors struggled with subjectivity, phrasing, and definitions of the LO´s and the scales used in both instruments. This resulted in arbitrary assessments that were time-consuming and resulted in limited usage in the day-to-day assessment. To mitigate the subjectivity, supervisors suggested working in teams and conducting multiple assessments over time to increase assessment validity.

Early identification of stroke symptoms is essential. The rate of stroke identification by call-takers at emergency medical communication centres (EMCCs) varies, and patients who are found in a lying down position are often not identified as having an ongoing stroke.

Objectives: this study aimed to explore signs and symptoms of stroke in patients who had fallen or were found in a lying position.

Design: a retrospective exploratory qualitative study design was used.

Method: a total of 29 emergency calls to EMCCs regarding patients discharged with a stroke diagnosis from a large teaching hospital in Stockholm, Sweden, in January–June 2011, were analysed using qualitative content analysis.

Results: during the emergency calls, the callers described a sudden change in the patient’s health status including signs such as the patient’s loss of bodily control, the patient’s perception of a change in sensory perception, and the callers’ inability to communicate with the patient.

Conclusions: The callers’ descriptions of stroke in a person found in a lying position are not always as described in assessment protocols describing the onset of a stroke. Instead, the symptom descriptions are much vaguer. Therefore, to increase identification of stroke during emergency calls, there is a need for an increased understanding of how callers describe stroke symptoms and communicate with the call-takers.

Background: Registered nurses working on the frontline during the COVID-19 pandemic encountered significant challenges, including exposure to critical incidents. Critical incidents refer to sudden unexpected clinical events that surpass an individual's ability to cope, leading to considerable psychological distress, which could potentially result in the development of post-traumatic stress disorder symptoms. Research has shown a high prevalence of post-traumatic stress disorder symptoms among healthcare workers, particularly those in close contact with COVID-19 patients.

Objective: To assess the levels of post-traumatic stress symptoms among registered nurses in relation to exposure to working conditions during the COVID-19 pandemic, such as how much their work was affected by the pandemic, re-deployment, working hours hindering sufficient recovery between shifts and critical incidents.

Design: Cross sectional study.

Setting(s): The registered nurses working in multiple health care services covering all 21 geographic regions in Sweden.

Participants: A total of 1,923 registered nurses, who are part of a Swedish national cohort and have been followed since their nursing education, were invited to participate in a survey in late September 2021 (15 to 19 years post graduation).

Methods: The data were analyzed using descriptive statistics, unpaired t-tests, and one-way analysis of variance. Cohen's d was employed to quantify differences in mean levels between subgroups.

Results: The response rate were 56.5 %. Over 50 % of experienced registered nurses reported significant disruptions to their work environments. In total, 85 % of registered nurses were exposed to at least one critical incident in their work during the pandemic, with 60 % facing organisational changes and nearly 50 % experiencing emotionally distressing situations. The exposure to work situations involving critical incidents consistently demonstrated strong associations with higher levels of post-traumatic stress disorder symptoms compared to those not exposed, with effect sizes ranging from moderate to high.

Conclusions: This study underscores the profound impact that working conditions, such as redeployment and exposure to critical incidents, have on the mental health of registered nurses. We offer valuable insights into registered nurses’ pandemic-related challenges, highlighting the need for support and interventions to prevent and manage critical incidents, ultimately promoting their well-being. We also highlight the significance of thorough workforce readiness planning for future pandemics and other challenging health care scenarios, such as staff shortage.

Background: How ambulance clinicians (ACs) handle a mass casualty incident (MCI) is essential for the suffered, but the training and learning for the ACs are sparse and they don’t have the possibility to learn without realistic simulation training. In addition, it is unclear what type of dilemmas ACs process in their clinical reasoning during an MCI. With virtual reality (VR) simulation, the ACs clinical reasoning can be explored in a systematic way. Therefore, the objective was to explore ambulance clinicians’ clinical reasoning when simulating a mass casualty incident using virtual reality.

Methods: This study was conducted as an explorative interview study design using chart- stimulated recall technique for data collection. A qualitative content analysis was done, using the clinical reasoning cycle as a deductive matrix. A high-fidelity VR simulation with MCI scenarios was used and participants eligible for inclusion were 11 senior ACs.

Results/conclusion: All phases of the clinical reasoning cycle were found to be reflected upon by the participants during the interviews, however with a varying richness of analytic reflectivity. Non-analytic reasoning predominated when work tasks followed specific clinical guidelines, but analytical reasoning appeared when the guidelines were unclear or non-existent. Using VR simulation led to training and reflection on action in a safe and systematic way and increased self-awareness amongst the ACs regarding their preparedness for MCIs. This study increases knowledge both regarding ACs clinical reasoning in MCIs, and insights regarding the use of VR for simulation training.