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  • 1.
    Doohan, Isabelle
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Surviving a major bus crash: experiences from the crash and five years after2017Doctoral 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. 

  • 2.
    Doohan, Isabelle
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Östtlund, Ulrika
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study2017In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 2, p. 165-174Article in journal (Refereed)
    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.

  • 3.
    Doohan, Isabelle Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing. Affiliated to Arctic Research Centre, Umeå University, Umeå, Sweden.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing. Affiliated to Arctic Research Centre, Umeå University, Umeå, Sweden.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Affiliated to Arctic Research Centre, Umeå University, Umeå, Sweden.
    Survivors' experiences of consequences and recovery five years after a major bus crash2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 3, p. 1179-1187Article in journal (Refereed)
    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. 

  • 4.
    Doohan, Isabelle
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Research and Development in Disaster Medicine, Umeå University.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Impact on life after a major bus crash - a qualitative study of survivors' experiences2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 1, p. 155-163Article in journal (Refereed)
    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.

  • 5.
    Doohan, Isabelle
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Need for compassion in prehospital and emergency care: a qualitative study on bus crash survivors' experiences2015In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 2, p. 115-119Article in journal (Refereed)
    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.

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