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  • 1. Englund, L
    et al.
    Forsberg, Rebecca
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Survivors´ experiences of media coverage after traumatic injury events2012Ingår i: International emergency nursing, ISSN 1755-599XArtikel i tidskrift (Refereegranskat)
  • 2. Englund, Liselotte
    et al.
    Forsberg, Rebecca
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Survivors' experiences of media coverage after traumatic injury events2014Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, nr 1, s. 25-30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Survivors' experiences of media at traumatic events, is still a limited research area. The aim of this study is to explore survivors' experiences of interacting with journalists and media coverage, including their experiences of being portrayed in the media, following two Swedish train crashes. Qualitative interviews were conducted with passengers from two train crashes in Sweden. A qualitative content analysis generated meaning units, subcategories, and categories. Survivors experienced interacting with journalists mainly in three ways: harmful, inconsequential, and helpful. Media content and personal media exposure was experienced in a similar way: uncomfortable, insignificant, and useful. Journalists and media coverage have a large impact on survivors' experiences following a traumatic event. It is important that emergency responders, such as ambulance nurses, are aware of how victims are affected by journalists' presence and the media coverage that follows so that negative outcomes can be reduced and the positive can be enhanced. The present study also shows that media coverage in the long term can become important pieces of information for the victim in order to understand and process the traumatic event. (C) 2013 Elsevier Ltd. All rights reserved.

  • 3.
    Forsberg, Rebecca
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Conditions affecting safety on the Swedish railway: Train drivers' experiences and perceptions2016Ingår i: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 85, s. 53-59Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Major changes have been implemented in recent years within the rail bound sector. There is, therefore, a need to consider if and how these large alterations affect rail safety. The aim of the study was to explore train drivers' experiences and perceptions of conditions affecting safety of the Swedish railway system. Narrative semi-structured interviews were performed with ten train drivers. Qualitative content analysis was used to analyze the interviews. The results were captured in two main categories: (1) Facing structural changes includes results unclarity in responsibility assignment, deteriorated tracks and insufficient safety culture and (2) facing technology development, covered safety systems such as ATC and ERTMS which were seen as high-quality safeguards with both benefits and challenges due to new technical devices. The new challenges that have entered the arena should be offset by increased coordination and by a party responsible for safety within the industry. Finally, restrictions and regulations regarding the use of the tablets and smart phones are desirable. 

  • 4.
    Forsberg, Rebecca
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Train crashes: consequences for passengers2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Globally, and in Sweden, passenger railway transport is steadily increasing. Sweden has been relatively free from severe train crashes in the last decades, but the railway infrastructure is alarmingly worn and overburdened, which may be one reason for an increasing number of reported mishaps. Worldwide, major train crashes/disasters are a frequent cause of mass casualty incidents. Several shortcomings, especially within the crash and post-crash phases cause severe consequences for the passengers.

    Aim: To investigate the consequences of train crashes on passengers, focusing on factors of importance in the crash and post-crash phases. The specific aims are: (I) to identify the historical development and magnitude of passenger train disasters globally on various continents and countries, (II, III) to identify injury panorama and injury objects in two train crashes, (IV) to explore survivor´s experiences from a train crash, and (V) to explore their experiences of journalists and media coverage.

    Methods: Study I is a register study based on 529 railway disasters worldwide, whereas studies II-V are case studies from the two latest severe train crashes in Sweden (Nosaby and Kimstad). These studies are based on 73 and 21 passengers respectively. Studies I-III is essentially quantitative where descriptive statistics (I, III), multivariate analysis (III), and content analysis (II, III) are used. Studies II and III are also supplemented by semi-structured interviews. Studies IV and V are qualitative and the interviews (n=14, n=30) have been analyzed with qualitative content analysis. Study IV is also supplemented with quantitative data.

    Results: The number of railway disasters, fatalities, and non-fatally injured passengers has increased throughout the last hundred years - particularly during the last four decades (1970–2009) when 88% of all disasters occurred (I). Passengers in the first overturned carriage suffered most severe and lethal injuries (III). Internal structures such as tables, chairs, internal walls, as well as luggage, other passengers (II, III), glass (II), and wood pellets (III) induced many of the injuries. Those who traveled facing forward with a table in front of them, in carriages that did not overturn, were more likely to sustain injuries to their abdomen/pelvis than those without a table (III). Passengers who traveled rear facing had higher rates of whiplash injuries. Surviving a train crash was experienced as "living in a mode of existential threat". The long term consequences however were diverse for different persons (IV). All experienced that they had cheated death, but some became "shackled by history", whereas others overcame the "haunting of unforgettable memories." The centrality of others and the importance of reconstructing the turn of events were important when "dealing with the unthinkable". The media coverage were experienced as positive in the recovery process and the journalists were also perceived as helpful (V). By some the journalist’s nevertheless were also perceived as harmful or negligible, and the subsequent media coverage as either uncomfortable or insignificant.

    Conclusion: Despite extensive crash avoidance systems severe railway crashes still occur. Improved interior safety, as has been implemented in the automobile and aviation industries, would have an important reduction in injuries and facilitate evacuation. Being surrounded by family, friends, fellow passengers and participating in crash investigations, and experiencing descriptive media coverage were some crucial factors when dealing with the traumatic event and should be promoted.

  • 5.
    Forsberg, Rebecca
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    One hundred years of railway disasters and recent trends2011Ingår i: Prehospital and disaster medicine, ISSN 1049-023X, Vol. 26, nr 5, s. 367-373Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Globally, railway transport is increasing steadily. Despite the adoption of diverse safety systems, major railway incidents continue to occur. Higher speeds and increased passenger traffic are factors that influence the risk of mass-casualty incidents and make railway crashes a reality that merits extensive planning and training.

    METHODS: Data on railway disasters were obtained from the Centre for Research on the Epidemiology of Disasters (CRED), which maintains the Emergency Events Database (EM-DAT). This descriptive study consists of 529 railway disasters (≥10 killed and/or ≥100 non- fatally injured) from 1910 through 2009.

    RESULTS: The number of railway disasters, people killed, and non-fatally injured, has increased throughout the last hundred years-particularly during the last four decades (1970-2009), when 88% of all disasters occurred. In the mid-20th century, a shift occurred, resulting in more people being non-fatally injured than fatally injured. During 1970-2009, 74% of all railway disasters occurred in Asia, Africa, and South and Central America, combined. The remaining 26% occurred in Europe, North America, and Oceania, combined. Since 1980, railway disasters have increased, especially in Asia and Africa, while Europe has had a decrease in railway disasters. The number killed per disaster (1970-2009) was highest in Africa (n = 55), followed by South and Central America (n = 47), and Asia (n = 44). The rate was lowest in North America (n = 10) and Europe (n = 29). On average, the number of non-fatal injuries per disaster was two to three times the number of fatalities, however, in the African countries (except South Africa) the relation was closer to 1:1, which correlates to the relation found in more developed countries during the mid-20th century. The total losses (non-fatally and fatally injured) per disaster has shown a slight decreasing trend.

    CONCLUSIONS: Despite extensive crash avoidance and injury reduction safety systems, railway crashes occur on all continents, indicating that this type of incident must be accounted for in disaster planning and training. Better developed safety, crashworthiness, and rescue resources in North America and Europe may be factors explaining why the number of crashes and losses has stabilized and why the average number of people killed per disaster is lowest on these continents.

  • 6.
    Forsberg, Rebecca
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Holgersson, Annelie
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Bodén, Ida
    Passengers' Perceptions of Railway Safety2017Ingår i: International Journal of Transportation, ISSN 2287-7940, Vol. 5, nr 2, s. 47-54Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the study was to identify the passengers' perceptions of railway safety, with emphasis on the internal safety and potential safety improvements. Train passengers (n=243) in Sweden were surveyed and data were analyzed with descriptive and bi-variate statistics. Results showed that only 40% judged the internal train safety as safe. Closed luggage racks and more space for luggage were the most acceptable changes. Both regarding internal safety and acceptable safety changes there were significant differences between high-and low-frequency travelers, with more seasoned travelers less worried about safety and less excepting of additional safety features and costs. The conclusion was that high-frequency and low-frequency travelers differ in their perceptions of safety and that acceptability of safety features followed the perceived effects on comfort.

  • 7.
    Forsberg, Rebecca
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Holgersson, Annelie
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Bodén, Ida
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    A study of a mass casualty train crash, focusing on the cause of injuries2014Ingår i: Journal of Transportation Safety & Security, ISSN 1943-9962, Vol. 6, nr 2, s. 152-166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This case study includes 73 fatally and nonfatally injured passengers from a level-crossing train crash in Nosaby, Sweden, in 2004. The aim was to identify the injury panorama and the injury objects and to determine the injury-inducing variables. Data were analyzed with descriptive statistics, quantitative content analysis, and multivariate data analysis. The first carriage overturned, and its occupants were the ones who suffered the most severe and lethal injuries. Injury type and injury location for these passengers also differed significantly from the passengers on the other two carriages. Tables significantly influenced injury type and injury location in all carriages, whereas the injured persons’ seating position had significant effect only in the second and third carriage. Those who had travelled facing forward with a table in front of them in Carriages 2 and 3 were more likely to have sustained injuries to their abdomen or pelvis. Other injury-inducing objects were seats, interior structures, wood pellets from the truck, and other passengers. Neck sprains were significantly more prevalent among those who had travelled facing backward. Improved train crashworthiness also needs to include interior safety, which would have a potential to reduce crash injuries.

  • 8.
    Forsberg, Rebecca
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Iglesias Vazquez, Jose Antonio
    A Case Study of the High-speed Train Crash Outside Santiago de Compostela, Galicia, Spain2016Ingår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, nr 2, s. 163-168Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The worldwide use of rail transport has increased, and the train speeds are escalating. Concurrently, the number of train disasters has been amplified globally. Consequently, railway safety has become an important issue for the future. High-velocity crashes increase the risk for injuries and mortality; nevertheless, there are relatively few studies on high-speed train crashes and the influencing factors on travelers' injuries occurring in the crash phase. The aim of this study was to investigate the fatal and non-fatal injuries and the main interacting factors that contributed to the injury process in the crash phase of the 2013 high-velocity train crash that occurred at Angrois, outside Santiago de Compostela, Spain. Methods: Hospital records (n = 157) of all the injured who were admitted to the six hospitals in the region were reviewed and compiled by descriptive statistics. The instant fatalities (n = 63) were collected on site. Influencing crash factors were observed on the crash site, by carriage inspections, and by reviewing official reports concerning the approximated train speed. Results: The main interacting factors that contributed in the injury process in the crash phase were, among other things, the train speed, the design of the concrete structure of the curve, the robustness of the carriage exterior, and the interior environment of the carriages. Of the 222 people on board (218 passengers and four crew), 99% (n = 220) were fatally or non-fatally injured in the crash. Thirty-three percent (n = 72) suffered fatal injuries, of which 88% (n = 63) died at the crash site and 13% (n = 9) at the hospital. Twenty-one percent (n = 32) of those admitted to hospital suffered multi-trauma (ie, extensive, severe, and/or critical injuries). The head, face, and neck sustained 42% (n = 123) of the injuries followed by the trunk (chest, abdomen, and pelvis; n = 92; 32%). Fractures were the most frequent (n = 200; 69%) injury. Conclusion: A mass-casualty incident with an extensive amount of fatal, severe, and critical injuries is most probable with a high-velocity train; this presents prehospital challenges. This finding draws attention to the importance of more robust carriage exteriors and injury minimizing designs of both railway carriages and the surrounding environment to reduce injuries and fatalities in future high-speed crashes.

  • 9.
    Forsberg, Rebecca
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Survivors' experiences from a train crash2011Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, nr 4, s. 8401-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rarely described are people's lived experiences from severe injury events such as train crashes. The number of train crashes named disasters with ≥10 killed and/or ≥100 nonfatally injured grows globally and the trend shows that more people survive these disasters today than did so in the past. This results in an increased number of survivors needing care. The aim of the study was to explore survivors' experiences from a train crash. Narrative interviews were performed with 14 passengers 4 years after a train crash event. Qualitative content analysis was used to analyse the interviews. Experiences were captured in three main themes: (1) Living in the mode of existential threat describes how the survivors first lost control, then were thrown into a state of unimaginable chaos as they faced death. (2) Dealing with the unthinkable described how survivors restored control, the central role of others, and the importance of reconstructing the event to move forward in their processing. (3) Having cheated death shows how some became shackled by their history, whereas others overcame the haunting of unforgettable memories. Furthermore, the result shows how all experienced a second chance in life. Experiencing a train crash meant that the passengers experienced severe vulnerability and a threat to life and interdependence turned out to play a crucial role. Focusing on helping other passengers on site was one way to regain the loss of control and kept the chaos at bay. Family, friends, and fellow passengers turned out to be extremely important during the recovery process why such closeness should be promoted and facilitated.

  • 10.
    Forsberg, Rebecca
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Strandberg, Veronica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Goede, Patrick
    Liuski, Petra
    Sahovic, Dzenan
    [New threats raise new disaster planning requirements]2010Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 9, s. 603-604Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [sv]

    En rad attentat mot den spårbundna trafiken har visat hur sårbar sektorn är för attacker. Ett väl utvecklat och anpassat katastrofmedicinskt omhändertagande behövs för att öka förmågan att hantera följderna av eventuella attentat.

  • 11.
    Holgersson, Annelie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Forsberg, Rebecca
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Inre säkerheten i tåg eftersatt: fallstudie efter tågkraschen i Kimstad2012Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, nr 1-2, s. 24-26Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Delar av tågnätet i Sverige är i dag överbelastat, vilket försvårar möjligheterna till underhåll samtidigt som slitaget ökar. Tåghastigheten ökar, liksom antalet skadehändelser och deras allvarlighetsgrad, medan säkerhetsarbetet halkar efter. Inredning, glas och bagage hade stor inverkan på skadebilden vid tågkraschen i Kimstad år 2010. Avståndet till banvallen utgjorde sekundär skaderisk vid evakueringen. Inredningen orsakade allvarligast skador, bagaget moderata skador och glas många, men lindriga skador. Energiabsorberande ytor, luckor för bagageförvaring samt antilacerativa fönster kan reducera antalet skador vid en tågkrasch. Evakueringen kan underlättas av tillgång till utfällbara stegar.

  • 12. Larcher, Martin
    et al.
    Forsberg, Rebecca
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Holgersson, Annelie
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Solomos, George
    Effectiveness of finite-element modelling of damage and injuries for explosions inside trains2016Ingår i: Journal of Transportation Safety and Security, ISSN 1943-9962, Vol. 8, s. 83-100Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The rail-bound sector has become a preferred target of terrorist attacks because of its vulnerability, and the most frequent way to carry out these attacks has been the use of explosive devices.The aim of this study is to investigate the effectiveness of modelling detonation effects inside train carriages using explicit finite element techniques. The numerical simulations consider fluid-structure interaction phenomena and several parametric studies are conducted. Carriage damage and injuries to the passengers are examined. Displacements in the model of the carriage structure do not vary greatly for small changes of the charge size, its location, or by open doors. Changing charge size, the location of the detonation, and door setting however had significant impact on the risk of eardrum rupture and fatality. Comparison of the simulation and real life data demonstrate a good agreement between the real and calculated displacements of the carriage, whereas the risk of death and eardrum rupture is slightly higher in the calculations. The model presented can reproduce a reliable actual situation if more parameters that influence injuries of blast waves were considered.

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