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  • 1.
    Forsberg, Rebecca
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holgersson, Annelie
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Bodén, Ida
    Passengers' Perceptions of Railway Safety2017In: International Journal of Transportation, ISSN 2287-7940, Vol. 5, no 2, p. 47-54Article in journal (Refereed)
    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.

  • 2.
    Forsberg, Rebecca
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holgersson, Annelie
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Bodén, Ida
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    A study of a mass casualty train crash, focusing on the cause of injuries2014In: Journal of Transportation Safety & Security, ISSN 1943-9962, Vol. 6, no 2, p. 152-166Article in journal (Refereed)
    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.

  • 3.
    Holgersson, Annelie
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Preparedness for mass-casualty attacks on public transportation2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Public transportation constitutes a vulnerable sector in modern day society with a high probability of generating mass casualties if attacked. By preparing for mass-casualty attacks (MCAs), response can become more effective and public transportation can become a less rewarding target. However, preparedness for attacks, much like response, implies resource constraints, and this dissertation pinpoints some major dilemmas that inhibit achieving preparedness for MCAs on public transportation in Sweden.

    Aim: The aim of this dissertation was to investigate preparedness for mass-casualty attacks on public transportation. This allowed for identification of major challenges for preparedness and response with a particular focus on the Swedish context.

    Methods: Study I included 477 MCAs identified through searches of the Global Terrorism Database, journals, newspapers and websites, which were examined with descriptive statistics. Study II thematically analyzed 105 articles attained by systematic searches of the PubMed and Scopus databases. Study III and IV statistically analyzed data from 864 responses to a purposive-designed questionnaire, from operational personnel of the Swedish emergency organizations. Study V entailed validation of a finite element (FE) simulation model of a bombing in a train carriage compared to the bombings in Madrid 2004.

    Results: International trends of MCAs (≥ 10 fatally injured and/or ≥ 100 non-fatally injured) on public transportation, during the years 1970-2009 (I) showed that the average number of injured increased considerably, despite a quite stable incidence rate since the 1980s. High numbers of injured people were connected to attacks on terminal buildings, multiple targets and complex tactical approaches. Few MCAs occurred in Europe, but the average number of fatalities per incident and injured per incident were the second highest among regions. The literature study (II) of previous on-scene management showed that commonly encountered challenges during unintentional incidents were added to during MCAs, implying specific issues for safety, assessment, triage and treatment, which require collaborative planning and specific training. The study regarding the Swedish emergency organizations’ perceptions of terrorist attacks (III) showed significant differences on perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence in knowledge of tasks to be performed on scene. The police respondents stood out; e.g., fewer police personnel had high estimates of their organizations’ management capability and knowledge of tasks on-scene compared to the other organizations. The study of factors that influence responders’ perceptions of preparedness for terrorism (IV) showed that these were influenced by the responders’ sex, work experience, organizational affiliation, various training arrangements and access to personal protective equipment (PPE). Investing in amenable factors, such as terrorism-related management training and provision of PPE, could improve responders’ perceptions of preparedness for terrorism. A finite-element (FE) model of an explosion in a train carriage (V) was developed and showed that FE modeling techniques could effectively model damage and injuries for explosions with applicability for preparedness and injury mitigation efforts, but, also, there was room for improvement of the model in terms of injuries.

    Conclusion: Achieving preparedness for MCAs on public transportation is a multiple choice balancing act between ostensible dilemmas regarding investments, disaster plans, training, response strategies, collaboration and inventions.

  • 4.
    Holgersson, Annelie
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Review of on-scene management of mass-casualty attacksManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The scene of a mass-casualty attack (MCA) entails a crime scene, a hazardous space, and a great number of people needing medical assistance. Public transportation has been the target of such attacks and involves a high probability of generating mass casualties. The review aimed to investigate challenges for on-scene responses to MCAs and suggestions made to counter these challenges, with special attention given to attacks on public transportation and associated terminals. Methods: Articles were found through PubMed and Scopus, “relevant articles” as defined by the databases, and a manual search of references. Inclusion criteria were that the article referred to attack(s) and/or a public transportation-related incident and issues concerning formal on-scene response. An appraisal of the articles’ scientific quality was conducted based on an evidence hierarchy model developed for the study. Results: One hundred and five articles were reviewed. Challenges for command and coordination on scene included establishing leadership, inter-agency collaboration, multiple incident sites, and logistics. Safety issues entailed knowledge and use of personal protective equipment, risk awareness and expectations, cordons, dynamic risk assessment, defensive versus offensive approaches, and joining forces. Communication concerns were equipment shortfalls, dialoguing, and providing information. Assessment problems were scene layout and interpreting environmental indicators as well as understanding setting-driven needs for specialist skills and resources. Triage and treatment difficulties included differing triagesystems, directing casualties, uncommon injuries, field hospitals, level of care, providing psychological and pediatric care. Transportation hardships included scene access, distance to hospitals, and distribution of casualties. Conclusion: Commonly encountered challenges during unintentional incidents were added to during MCAs, implying specific issues for safety, assessment, triage, and treatment, which require collaborative planning and specific training.

  • 5.
    Holgersson, Annelie
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Mass-casualty attacks on public transportation2014In: Journal of Transportation Security, ISSN 1938-7741, E-ISSN 1938-775X, Vol. 7, p. 1-16Article in journal (Refereed)
    Abstract [en]

    The 21st century has provided many examples of the devastating effects attacks can have when public transportation has been targeted or used as weapons. Four hundred and seventy seven mass-casualty attacks (≥10 fatally injured and/or ≥100 non-fatally injured) against public transportation and terminal buildings during the years 1970–2009 were studied with data from the Global Terrorism Database in addition to open media sources, scientific journals, and books. Asia was the most frequently targeted region, followed by the Middle East & North African region and Sub Saharan Africa. Airplanes were the most frequently attacked mode of transport during the 1970s, but were surpassed by buses in the mid-80s. There was also an alarming increase in attacks against terminal buildings during 2000–2009. The two most common types of attacks were bombings and armed assault. Complex tactical approaches so as to achieve as much carnage as possible were apparent—e.g., maximizing the number of exposed people, enhancing weapon effects, approaching victims one-by-one, combining several attack types, and targeting rescue personnel. These approaches were more predominant during the last two decades and attacks against rescue personnel were exclusive to the 21st century. The average number of injured increased considerably, despite a quite stable incidence rate since the 1980s. High numbers of non-fatally injured people were connected to attacks on terminal buildings, multiple targets and complex tactical approaches. These incidents, with more and more non-fatally injured, challenge our societal response structures and thus require more research.

  • 6.
    Holgersson, Annelie
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Forsberg, Rebecca
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Inre säkerheten i tåg eftersatt: fallstudie efter tågkraschen i Kimstad2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 1-2, p. 24-26Article in journal (Refereed)
    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.

  • 7.
    Holgersson, Annelie
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sahovic, Dzenan
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Factors influencing responders' perceptions of preparedness for terrorism2016In: Disaster Prevention and Management, ISSN 0965-3562, E-ISSN 1758-6100, Vol. 25, no 4, p. 520-533Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to analyse factors influencing perceptions of preparedness in the response to terrorist attacks of operational personnel in Swedish emergency organizations. Design/methodology/approach: Data were collected using a questionnaire distributed to operational personnel from the police, rescue and ambulance services in eight Swedish counties; 864 responses were received and analysed. Findings: Three aspects of the perception of preparedness for terrorist attacks among Swedish emergency responders were studied: willingness to respond; level of confidence with tasks; and estimated management capability. Factors which positively influenced these perceptions were male sex, training in first aid and dealing with mass casualty incidents, terrorism-related management training (MT), table-top simulations, participation in functional exercises, and access to personal protective equipment (PPE); work experience was inversely related. Occupation in police or rescue services was positively associated with willingness to respond whereas occupation within the emergency medical services was positively associated with estimated management capability. Practical implications: These findings show that terrorism-related MT and access to PPE increase the perceptions of preparedness for terrorism among the emergency services, aiding judgements about investments in preparedness by crisis management planners. Originality/value: Limited research in disaster management and hazard preparedness has been conducted in a European context, especially regarding terrorism. Little is known about aspects of preparedness for terrorism in Sweden, particularly from the perspective of the emergency responders.

  • 8.
    Holgersson, Annelie
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kunskapsöversikt - passagerarsäkerhet i tåg2011Report (Refereed)
  • 9.
    Holgersson, Annelie
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strandh, Veronica
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Emergency organizations’ diverging perceptions of terrorist attacksManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: To analyse how the police, the rescue services and the emergency medical services (EMS) perceive the threat of terrorism and preparedness for a terrorist-induced crisis. It also aims to unravel differences among the emergency organizations and to discuss their potential implications for emergency preparedness. Methodology: Data were collected using a questionnaire distributed to operational personnel from the emergency services in eight Swedish counties; 864 responses were received and analysed. Findings: There were significant differences between the police, rescue and ambulance services regarding perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence with tasks to be performed on scene. Perceived likelihood of events appeared affected by institutional logic; events within their respective domain of responsibility were perceived as more likely. The police stood out in many aspects, with more personnel with experience of violence on duty and a high grading of the probability of terrorist attacks compared to the other organizations. Fewer police had high estimates of their organizations’ management capability and knowledge of tasks on-scene. Practical implications: Differences in perspectives of terrorism preparedness and response among the emergency services were shown, highlighting the importance of enabling inter-organizational insights on safety culture, with risk awareness and management strategies, as well as knowledge of the other organizations’ institutional logics and main tasks, so as to achieve an effective, collaborative response to terrorism-induced crises. Originality: Little research has been conducted comparatively with regard to the emergency services and their perceptions of terrorism-specific threats and preparedness, particularly in the Swedish context. 

  • 10.
    Holgersson, Annelie
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strandh, Veronica
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Emergency organizations' diverging perceptions of terrorist attacks2016In: International Journal of Emergency Services, ISSN 2047-0894, E-ISSN 2047-0908, Vol. 5, no 1, p. 82-94Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to analyse how the police, the rescue services and the emergency medical services perceive the threat of terrorism and preparedness for a terrorist-induced crisis. It also aims to unravel differences among the emergency organizations and to discuss their potential implications for emergency preparedness.

    Design/methodology/approach – Data were collected using a questionnaire distributed to operational personnel from the emergency services in eight Swedish counties; 864 responses were received and analysed.

    Findings – There were significant differences between the police, rescue and ambulance services regarding perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence with tasks to be performed on-scene. Perceived likelihood of events appeared affected by institutional logic; events within their respective domain of responsibility were perceived as more likely. The police stood out in many aspects, with more personnel with experience of violence on duty and a high grading of the probability of terrorist attacks compared to the other organizations. Fewer police had high estimates of their organizations’ management capability and knowledge of tasks on-scene.

    Practical implications – Differences in perspectives of terrorism preparedness and response among the emergency services were shown, highlighting the importance of enabling inter-organizational insights on safety culture, with risk awareness and management strategies, as well as knowledge of the other organizations’ institutional logics and main tasks, so as to achieve an effective, collaborative response to terrorism-induced crises.

    Originality/value – Little research has been conducted comparatively with regard to the emergency services and their perceptions of terrorism-specific threats and preparedness, particularly in the Swedish context.

     

  • 11. Larcher, Martin
    et al.
    Forsberg, Rebecca
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holgersson, Annelie
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Solomos, George
    Effectiveness of finite-element modelling of damage and injuries for explosions inside trains2016In: Journal of Transportation Safety and Security, ISSN 1943-9962, Vol. 8, p. 83-100Article in journal (Refereed)
    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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