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Björnstig, Ulf
Publications (10 of 96) Show all publications
Thermaenius, F., Björnstig, U., Svensson, J. & Westman, A. (2023). Fatalities in Swedish fire-related car crashes from a toxicologic perspective. Traffic Injury Prevention, 24(1), 21-25
Open this publication in new window or tab >>Fatalities in Swedish fire-related car crashes from a toxicologic perspective
2023 (English)In: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 24, no 1, p. 21-25Article in journal (Refereed) Published
Abstract [en]

Objective: Vehicle materials developments raise concerns about new patterns of vehicle fire toxic gas emissions. This study aimed to describe toxicologic components in a recent material of fatal car crashes on Swedish roads in which the vehicle caught fire and compare the results to a previous material.

Methods: Retrospective registry study. All fatal car crashes with fire in Sweden 2009–2018 were extracted from the Swedish Transport Administration’s In-Depth Studies Database and compared with an earlier study of the time period 1998–2008.

Results: A total of 79 crashes and 94 fatalities were included. Carbon monoxide (COHb) blood levels >10% were found in 13 cases. Hydrogen cyanide (HCN) blood levels 0.1–1.7 µg/g were found in 10 cases. In 31 of the cases the person had a blood alcohol level (BAC) >0.2‰, which is the legal driving limit in Sweden. A total of 15 people died due to burn injuries and 2 individuals died due to toxic gas emissions without any other fatal traumatic injury. Total number of deaths in fire-related crashes halved from 181 (1998–2008) to 94 (2009–2018) but the percentage of fatalities in burning vehicles was unaltered (5% vs. 6%). The proportion of fatalities with HCN in the blood increased from 2% between 1998–2008 to 10% during 2009–2018 (p = 0.006). The age of the car involved in a crash increased by 0.26 years per calendar year (p = 0.001).

Conclusions: The proportion of fatalities with measured levels of HCN in the blood has increased. Eleven of the 15 burn injury fatalities had high levels of alcohol, HCN, or COHb, possibly contributing to an inability to leave a burning vehicle. Faster rescue brought by improved specific education and training of ambulance and rescue services personnel may be of future importance, as may on-scene antidote administration and revised regulations of vehicle flammability.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2023
Keywords
car crashes, carbon monoxide, hydrogen cyanide, Toxic gas emissions, vehicle fire
National Category
Vehicle Engineering Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-202004 (URN)10.1080/15389588.2022.2148831 (DOI)000894957000001 ()36480228 (PubMedID)2-s2.0-85144170224 (Scopus ID)
Funder
Swedish Civil Contingencies Agency, 2019-11351
Available from: 2022-12-29 Created: 2022-12-29 Last updated: 2023-09-26Bibliographically approved
Hylander, J., Saveman, B.-I., Björnstig, U., Gyllencreutz, L. & Westman, A. (2022). Time-efficiency factors in road tunnel rescue as perceived by Swedish operative personnel – an interview study. International Journal of Emergency Services, 11(2), 312-324
Open this publication in new window or tab >>Time-efficiency factors in road tunnel rescue as perceived by Swedish operative personnel – an interview study
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2022 (English)In: International Journal of Emergency Services, ISSN 2047-0894, E-ISSN 2047-0908, Vol. 11, no 2, p. 312-324Article in journal (Other academic) Published
Abstract [en]

Purpose: Major incidents in road tunnels remain a collaborative challenge for the emergency services (fire and rescue service, police and ambulance), emergency dispatch centres (EDCs) and infrastructure owners. The aim of this paper is to investigate how collaborative partners to the ambulance services perceive the rescue effort and to identify factors that may influence its efficiency.

Design/methodology/approach: Focus group and individual interviews were conducted with 19 participants who were infrastructure owners or had operational or tactical responsibilities with the emergency services or EDCs in two regions in Sweden with multiple road tunnels. The collected data were analysed using qualitative content analysis.

Findings: Three main categories described efficiency factors during and after an incident: (1) coordinating the initial information (using a shared terminology), (2) achieving situational awareness (identifying those persons in need) and (3) lessons (not) learnt (lack of joint tactical plans and exercises). The emerging theme was access, assess and evaluate.

Practical implications: The findings suggest that establishing national policies and collaborative forums might yield more efficiently managed rescue efforts in road tunnel incidents in Sweden and other countries with similar organisational structures.

Originality/value: This study offers new insights on interoperability during responses to complex underground incidents.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2022
Keywords
Collaboration, Major incident, Incident management, Disaster medicine, Road tunnels
National Category
Other Health Sciences Nursing
Identifiers
urn:nbn:se:umu:diva-199232 (URN)10.1108/ijes-03-2021-0011 (DOI)000751943200001 ()2-s2.0-85124354073 (Scopus ID)
Funder
Swedish National Board of Health and WelfareSwedish Transport Administration
Available from: 2022-09-08 Created: 2022-09-08 Last updated: 2023-08-15Bibliographically approved
Björnstig, U. & Björnstig, J. (2021). Flying roadside stones - a deadly risk in a crash. Traffic Safety Research, 1, Article ID 000002.
Open this publication in new window or tab >>Flying roadside stones - a deadly risk in a crash
2021 (English)In: Traffic Safety Research, E-ISSN 2004-3082, Vol. 1, article id 000002Article in journal (Other academic) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Lund University, 2021
Keywords
stones, fatal, roadside hazard
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-193281 (URN)10.55329/tcfh3140 (DOI)2-s2.0-85137149714 (Scopus ID)
Available from: 2022-03-24 Created: 2022-03-24 Last updated: 2024-04-05Bibliographically approved
Westman, A., Saveman, B.-I., Björnstig, U., Hylander, J. & Gyllencreutz, L. (2021). Mobilisation of emergency services for chemical incidents in Sweden: a multi-agency focus group study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), Article ID 99.
Open this publication in new window or tab >>Mobilisation of emergency services for chemical incidents in Sweden: a multi-agency focus group study
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2021 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 29, no 1, article id 99Article in journal (Refereed) Published
Abstract [en]

Background: In chemical incidents, infrequent but potentially disastrous, the World Health Organization calls for inter-organizational coordination of actors involved. Multi-organizational studies of chemical response capacities are scarce. We aimed to describe chemical incident experiences and perceptions of Swedish fire and rescue services, emergency medical services, police services, and emergency dispatch services personnel.

Methods: Eight emergency service organizations in two distinct and dissimilar regions in Sweden participated in one organization-specific focus group interview each. The total number of respondents was 25 (7 females and 18 males). A qualitative inductive content analysis was performed.

Results: Three types of information processing were derived as emerging during acute-phase chemical incident mobilization: Unspecified (a caller communicating with an emergency medical dispatcher), specified (each emergency service obtaining organization-specific expert information), and aligned (continually updated information from the scene condensed and disseminated back to all parties at the scene). Improvable shortcomings were identified, e.g. randomness (unspecified information processing), inter-organizational reticence (specified information processing), and downprioritizing central information transmission while saving lives (aligned information processing).

Conclusions: The flow of information may be improved by automation, public education, revised dispatcher education, and use of technical resources in the field. Future studies should independently assess these mechanism’s degree of impact on mobilisation of emergency services in chemical incidents.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Accident and emergency medicine, Chemical incidents, Communication, Decision framework, Disasters, Emergency planning, Emergency response and management, Public health
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-186467 (URN)10.1186/s13049-021-00910-5 (DOI)000675401000001 ()34289881 (PubMedID)2-s2.0-85110987407 (Scopus ID)
Funder
Swedish National Board of Health and Welfare, 10.1-25244/2018
Available from: 2021-08-03 Created: 2021-08-03 Last updated: 2024-07-02Bibliographically approved
Otxoterena, P., Björnstig, U. & Lindquist, M. (2020). Post-collision fires in road vehicles between 2002 and 2015. Fire and Materials, 44(6)
Open this publication in new window or tab >>Post-collision fires in road vehicles between 2002 and 2015
2020 (English)In: Fire and Materials, ISSN 0308-0501, E-ISSN 1099-1018, Vol. 44, no 6Article in journal (Refereed) Published
Abstract [en]

The loss of human lives and body injuries due to post-crash fires, either by smoke inhalation or due to burn injuries, are unfortunately not uncommon. The literature indicates that fire events related to crashes are still a significant problem. The increased combustible load in newer vehicles is an important factor to be taken into account for the fire safety, as well as their potential to release toxic fumes while burning. Trends indicate that the survivable collision energy will continue to increase, and, at the same time, the probability of post-crash fires rises with the collision energy. This means that the occupants of a vehicle may probably survive a high-energy collision but might sustain severe injuries or death due to a post-collision fire. This work reports a literature and interview study about post-crash fires including statistics on the causes and dynamics of post-crash fires in road vehicles based on the literature, crash and incident reports, as well as on interviews with medicine specialists. Results from this study indicate that fires in vehicles which originated by a collision event are a problem that remains to be solved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
fires in vehicles, post-collision fires, survivability
National Category
Public Health, Global Health, Social Medicine and Epidemiology Vehicle Engineering
Identifiers
urn:nbn:se:umu:diva-173457 (URN)10.1002/fam.2862 (DOI)000541230900001 ()2-s2.0-85087209262 (Scopus ID)
Available from: 2020-07-10 Created: 2020-07-10 Last updated: 2023-03-24Bibliographically approved
Karlsson, S., Saveman, B.-I., Hultin, M., Björnstig, U. & Gyllencreutz, L. (2020). Preparedness for peer first response to mining emergencies resulting in injuries: a cross-sectional study. BMJ Open, 10, Article ID e036094.
Open this publication in new window or tab >>Preparedness for peer first response to mining emergencies resulting in injuries: a cross-sectional study
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2020 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 10, article id e036094Article in journal (Refereed) Published
Abstract [en]

Objective: Identify factors of preparedness for peer first response to underground mining emergencies with injured victims.

Design: Cross-sectional questionnaire study of Swedish underground mineworkers.

Setting: Seven out of nine Swedish underground mines.

Participants: A total of 741 mineworkers out of 1022 (73%) participated in this study.

Interventions: None.

Outcome measures: Level of preparedness for emergencies with injuries in underground mines.

Results: Three factors influenced the preparedness of mineworkers for a peer first response: (1) familiarity with rescue procedures during emergencies with injuries; (2) risk perception of emergencies with injuries and (3) experience of using self-protective and first aid equipment. Mineworkers who believed that they knew how to handle emergencies with injuries (OR 1.30, 95% CI 1.22 to 1.38) and those who were trained in the use of self-protective and first aid equipment (OR 1.19, 95% CI 1.07 to 1.32) considered themselves to be better prepared for a peer first response than those who were unfamiliar with the rescue procedures or who had not used self-protective and first aid equipment. However, mineworkers who rated the risk for emergencies with injuries as high considered themselves to be less prepared than those who rated the risk as low (OR 0.95, 95% CI 0.91 to 0.98).

Conclusion: This study identified three factors that were important for the peer-support preparedness of underground mineworkers. More research is needed to adapt and contextualise first aid courses to the needs of underground peer responders.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
National Category
Surgery Anesthesiology and Intensive Care Nursing
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-174286 (URN)10.1136/bmjopen-2019-036094 (DOI)000595708200020 ()2-s2.0-85096082067 (Scopus ID)
Funder
Swedish National Board of Health and WelfareEuropean Regional Development Fund (ERDF)
Available from: 2020-08-20 Created: 2020-08-20 Last updated: 2023-09-05Bibliographically approved
Hylander, J., Saveman, B.-I., Björnstig, U. & Gyllencreutz, L. (2020). Senior ambulance officers in Swedish emergency medical services: a qualitative study of perceptions and experiences of a new management role in challenging incidents. BMJ Open, 10(12), Article ID e042072.
Open this publication in new window or tab >>Senior ambulance officers in Swedish emergency medical services: a qualitative study of perceptions and experiences of a new management role in challenging incidents
2020 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 12, article id e042072Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Increased demands are placed on emergency services and their role and ability to act in incidents in challenging environments, for example, road tunnels. Collaboration between officers from emergency services (fire brigade, police and ambulance services) is important for an effective rescue effort. In Gothenburg, Sweden, a position as a senior ambulance officer (SAO) within the emergency medical services (EMS) has been introduced to support the regular force during major incidents. The aim of this paper was to explore the perceptions and experiences of the SAO's new management role in challenging incidents, such as those occurring in road tunnels.

DESIGN: A qualitative interview study.

SETTING: The study was carried out from February to June 2019 in Gothenburg, Sweden, which is a municipality with several road tunnels and a population of approximately 580 000 people. SAOs collaborate with the corresponding function within the police and fire brigade, both having senior officers at major incident sites.

PARTICIPANTS: Twelve SAOs.

METHODS: The study used semistructured interviews. The collected data were analysed using qualitative content analysis.

RESULTS: According to SAOs' experience, prehospital medical management included not only leadership, but also planning, training and indepth knowledge of, for example, tunnel environments. Furthermore, SAOs adopted an encouraging and teaching role for their colleagues. SAOs' responsibilities also included proactive planning together with the fire brigade and police, which was regarded as enhancing interorganisational collaboration. An overall theme emerged which the SAOs described as 'A new holistic approach to EMS leadership and management'.

CONCLUSIONS: The participants considered that the new SAO role not only seems to improve the prehospital medical management, but also makes the EMS command structure during challenging incidents symmetrical with the fire brigade and police command structure. The implementation of national guidelines is desirable and is requested by the SAOs.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
Keywords
accident & emergency medicine, organisational development, qualitative research
National Category
Other Clinical Medicine Nursing
Identifiers
urn:nbn:se:umu:diva-177812 (URN)10.1136/bmjopen-2020-042072 (DOI)000600203000016 ()33293325 (PubMedID)2-s2.0-85097515015 (Scopus ID)
Available from: 2020-12-18 Created: 2020-12-18 Last updated: 2023-09-05Bibliographically approved
Hylander, J., Saveman, B.-I., Björnstig, U. & Gyllencreutz, L. (2019). Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway: an interview study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), Article ID 78.
Open this publication in new window or tab >>Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway: an interview study
2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 27, no 1, article id 78Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
Medical on-scene commander, Prehospital emergency care, Tunnel incidents
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-163681 (URN)10.1186/s13049-019-0649-8 (DOI)000483063100001 ()31429788 (PubMedID)2-s2.0-85071262204 (Scopus ID)
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2024-01-17Bibliographically approved
Engström, K. G., Angrén, J., Björnstig, U. & Saveman, B.-I. (2018). Mass casualty incidents in the underground mining industry: applying the Haddon Matrix on an integrative literature review. Disaster Medicine and Public Health Preparedness, 12(1), 138-146
Open this publication in new window or tab >>Mass casualty incidents in the underground mining industry: applying the Haddon Matrix on an integrative literature review
2018 (English)In: Disaster Medicine and Public Health Preparedness, ISSN 1935-7893, E-ISSN 1938-744X, Vol. 12, no 1, p. 138-146Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Underground mining is associated with obvious risks that can lead to mass casualty incidents. Information about such incidents was analyzed in an integrated literature review.

METHODS: A literature search (1980-2015) identified 564 modern-era underground mining reports from countries sharing similar occupational health legislation. These reports were condensed to 31 reports after consideration of quality grading and appropriateness to the aim. The Haddon matrix was used for structure, separating human factors from technical and environmental details, and timing.

RESULTS: Most of the reports were descriptive regarding injury-creating technical and environmental factors. The influence of rock characteristics was an important pre-event environmental factor. The organic nature of coal adds risks not shared in hard-rock mines. A sequence of mechanisms is commonly described, often initiated by a human factor in interaction with technology and step-wise escalation to involve environmental circumstances. Socioeconomic factors introduce heterogeneity. In the Haddon matrix, emergency medical services are mainly a post-event environmental issue, which were not well described in the available literature. The US Quecreek Coal Mine incident of 2002 stands out as a well-planned rescue mission.

CONCLUSION: Evaluation of the preparedness to handle underground mining incidents deserves further scientific attention. Preparedness must include the medical aspects of rescue operations.

Place, publisher, year, edition, pages
Cambridge University Press, 2018
Keywords
mass casualty incident, medical emergency, preparedness, rescue, underground mining
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-137579 (URN)10.1017/dmp.2017.31 (DOI)000428215300023 ()28592339 (PubMedID)2-s2.0-85020658188 (Scopus ID)
Available from: 2017-07-05 Created: 2017-07-05 Last updated: 2023-03-24Bibliographically approved
Doohan, I. M., Gyllencreutz, L., Björnstig, U. & Saveman, B.-I. (2018). Survivors' experiences of consequences and recovery five years after a major bus crash. Scandinavian Journal of Caring Sciences, 32(3), 1179-1187
Open this publication in new window or tab >>Survivors' experiences of consequences and recovery five years after a major bus crash
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 3, p. 1179-1187Article in journal (Refereed) Published
Abstract [en]

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. 

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
Busskrasch, överlevande, upplevelser, erfarenheter, trafikskadehändelser, återhämtning, långtidsuppföljning
National Category
Other Medical Sciences not elsewhere specified Nursing
Research subject
Caring Sciences; health services research
Identifiers
urn:nbn:se:umu:diva-140190 (URN)10.1111/scs.12563 (DOI)000445450800020 ()29436007 (PubMedID)2-s2.0-85041857628 (Scopus ID)
Available from: 2017-10-03 Created: 2017-10-03 Last updated: 2023-03-23Bibliographically approved
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