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Surviving a major bus crash: experiences from the crash and five years after
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.ORCID iD: 0000-0001-9387-3174
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Major road traffic crashes (RTCs) can have a significant impact on the survivors, their family, and their friends, as well as on emergency personnel, volunteers, and others involved. However, survivors’ perspectives are rare or missing in research on major RTCs in Sweden. A comprehensive understanding of the survivors and their experiences is also lacking. By studying what it is like to survive a major RTC, the care and support provided to survivors can be adapted and improved.

The overall aim is to broaden the understanding of the short- and long-term consequences and experiences of surviving a major bus crash.

Methods The contexts are two bus crashes that occurred in Sweden, in February 2007 and December 2014. In total, the participants are 110 out of the 112 survivors, and the data is collected through telephone interviews, official reports, and medical records at one month, three months, and five years after the crashes. Analysis methods include qualitative content analysis, descriptive statistics, thematic analysis, and mixed methods research analysis.

Results One month after the crash, most of the survivors were experiencing minor or major physical and/or psychological stress in their everyday lives (Study I). Four main findings were identified regarding their experiences of immediate care (Study II): prehospital discomfort, lack of compassionate care, dissatisfaction with crisis support, and satisfactory initial care and support. The importance of compassion and being close to others was also highlighted. Five years after the bus crash in Rasbo (Study III), survivors were still struggling with physical injuries and mental problems. Other long-term consequences were a lasting sense of connectedness among fellow passengers, a gratitude for life, as well as feelings of distress in traffic, especially in regard to buses. The main findings from study IV indicated that injury severity did not seem to affect mental health, and that social aspects were important to the recovery process. There was an interconnection among survivors in which they seemed to be linked to each other’s recovery.

Conclusion A strong need for short- and long-term social and psychological support in terms of compassion and community is evident in all the studies. The survivors ought to be acknowledged as capable and having the resources to contribute to their own and their fellow survivors’ recovery and health. There is a need for greater understanding of how different the survivors are, with each one of them having various physical, psychological, social, and existential needs. 

Abstract [sv]

Bakgrund Stora trafikskadehändelser kan ha en betydande inverkan på de överlevande och deras närståendes liv, likaså på sjukvårdspersonal, vittnen, och andra som är involverade. Trots detta så är de överlevandes perspektiv sällsynta eller saknas i forskning om stora trafikskadehändelser i Sverige. Det saknas även en helhetsförståelse av överlevande och deras erfarenheter. Genom att studera hur det är att överleva en busskrasch kan omhändertagande och stöd anpassas och förbättras.

Det övergripande syftet är att öka förståelsen av kort- och långsiktiga konsekvenser och erfarenheter av att överleva en stor busskrasch.

Metod Kontexten är två busskrascher som inträffade i februari 2007 och december 2014 i Sverige. Antal deltagare är 110 av 112 överlevande och data samlades in en månad, tre månader och fem år efter krascherna, via telefonintervjuer, officiella rapporter och medicinska journaler. Analysmetoder inkluderar kvalitativ innehållsanalys, deskriptiv statistik, tematisk analys och mixad metod.

Resultat En månad efter kraschen upplevde överlevande fysiskt obehag och/eller psykisk stress i varierande grad i sin vardag (Studie I). Gällande upplevelser av det initiala omhändertagandet (Studie II) identifierades fyra huvudresultat; obehag på skadeplats, brister i omhändertagande och bemötande, missnöje med krisstöd, och tillfredsställande initialt omhändertagande och stöd. Betydelsen av empati och medkänsla från personal och frivilliga samt samhörighet med medpassagerare lyftes fram av de överlevande. Fem år efter busskraschen i Rasbo (Studie III) fanns det överlevande som fortfarande kämpade med fysiska skador och psykiska problem. Andra tydliga långsiktiga konsekvenser var en bestående gemenskap mellan medpassagerare, en tacksamhet över livet, samt oro och rädsla i trafiken, speciellt vid bussåkande. Uppföljningen efter busskraschen i Tranemo (Studie IV) indikerade att sociala aspekter var betydelsefulla för återhämtningsprocessen hos överlevande och att skadornas svårighetsgrad inte var betydande för det psykiska välbefinnandet. En stark samhörighet upplevdes bland de närstående som reste tillsammans och de verkade följa varandras återhämtning.

Slutsatser Ett starkt behov av kort- och långsiktigt socialt och psykologiskt stöd i form av gemenskap och empati är tydligt i samtliga studier. De överlevande bör uppmärksammas som aktörer med kapacitet och resurser till att bidra till sin egen och medpassagerares återhämtning och hälsa. Det behövs en ökad förståelse för hur olika de överlevande är, med varierande fysiska, psykologiska, sociala, och existentiella behov. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2017. , 67 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1915
Keyword [en]
bus crash, major road traffic crash, survivors, injuries, consequences, experiences, recovery, social support, emergency care, compassionate care, long-term recovery
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-140198ISBN: 978-91-7601-763-0 (print)OAI: oai:DiVA.org:umu-140198DiVA: diva2:1146577
Public defence
2017-10-27, Hörsal B, 9 tr, Norrlands universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2017-10-06 Created: 2017-10-03 Last updated: 2017-10-06Bibliographically approved
List of papers
1. Impact on life after a major bus crash - a qualitative study of survivors' experiences
Open this publication in new window or tab >>Impact on life after a major bus crash - a qualitative study of survivors' experiences
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 1, 155-163 p.Article in journal (Refereed) Published
Abstract [en]

Background Crashes occur regularly throughout the world and can result in multiple fatalities and many injuries. Research into how survivors experience a crash is very limited. AimTo describe and analyse the nonphysical consequences of a multifatality bus crash in Sweden and the subsequent effect on the surviving passengers' lives. MethodThe participants were all (n=56) of the survivors of a major bus crash. The passengers were interviewed approximately one month after the bus crash. The interviews were analysed using a qualitative content analysis. ResultsPrior to the arrival of rescue personnel at the crash site, helpfulness emerged among the passengers. Further, the crash generated an impact on the surviving passengers' lives from a short-term perspective. The passengers displayed a diverse need for crisis support; informal support from family and friends was essential for the early healing process. Sleep difficulties and a change in travel routines were the most common consequences. Lastly, passengers sought closure in order to move on with their lives. ConclusionThe passengers' reactions to and behaviour following a crash offer an insight into the, relatively unexplored, interaction between people experiencing a major road traffic crash. It is necessary to have a flexible crisis support system, and the vital role of family support ought to be upgraded.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keyword
bus crash, consequences, experiences, interviews, qualitative content analysis
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-86327 (URN)10.1111/scs.12040 (DOI)000329925600018 ()
Available from: 2014-02-25 Created: 2014-02-24 Last updated: 2017-10-04Bibliographically approved
2. Need for compassion in prehospital and emergency care: a qualitative study on bus crash survivors' experiences
Open this publication in new window or tab >>Need for compassion in prehospital and emergency care: a qualitative study on bus crash survivors' experiences
2015 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 2, 115-119 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To explore the survivors' experiences after a major bus crash. Background: Survivors' experiences of emergency care after transportation related major incidents are relatively unexplored, with research involving survivors mainly focused on pathological aspects or effects of crisis support. Methods: Semi-structured telephone interviews were conducted with 54 out of 56 surviving passengers 5 years after a bus crash in Sweden. Interviews were analyzed using qualitative content analysis. Results: Prehospital discomfort, lack of compassionate care, dissatisfaction with crisis support and satisfactory initial care and support are the categories. Lack of compassion in emergency departments was identified as a main finding. Lack of compassion caused distress among survivors and various needs for support were not met. Survivors' desire to be with their fellow survivors the day of the crash was not facilitated after arriving at emergency departments. Conclusions: Connectedness among survivors ought to be promoted upon arrival at emergency departments. There is a need for emergency department professionals to be sufficiently educated in compassionate care.

Keyword
Compassionate care, Emergency medical services, Emergency nursing, Experiences, Interview, Qualitative research, Social support
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-106372 (URN)10.1016/j.ienj.2014.08.008 (DOI)000354139000015 ()25257225 (PubMedID)
Available from: 2015-07-15 Created: 2015-07-14 Last updated: 2017-12-04Bibliographically approved
3. Survivors' experiences of consequences and recovery five years after a major bus crash
Open this publication in new window or tab >>Survivors' experiences of consequences and recovery five years after a major bus crash
(English)Manuscript (preprint) (Other academic)
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. 

Keyword
Busskrasch, överlevande, upplevelser, erfarenheter, trafikskadehändelser, återhämtning, långtidsuppföljning
National Category
Other Medical Sciences not elsewhere specified Nursing
Research subject
Caring Sciences; hälso- och sjukvårdsforskning
Identifiers
urn:nbn:se:umu:diva-140190 (URN)
Available from: 2017-10-03 Created: 2017-10-03 Last updated: 2017-10-04
4. Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study
Open this publication in new window or tab >>Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study
2017 (English)In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 2, 165-174 p.Article in journal (Refereed) Published
Abstract [en]

Objective The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery. Methods The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis. Results Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors' recoveries. The integrated findings are in the form of four core cases of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash. Conclusion The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery.

Place, publisher, year, edition, pages
CAMBRIDGE UNIV PRESS, 2017
Keyword
Emergency Medical Services, injuries, mass-casualty incident, survivors
National Category
Other Medical Sciences not elsewhere specified Nursing
Identifiers
urn:nbn:se:umu:diva-134251 (URN)10.1017/S1049023X16001485 (DOI)000398228600007 ()28132665 (PubMedID)
Available from: 2017-05-23 Created: 2017-05-23 Last updated: 2017-10-03Bibliographically approved

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