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  • 1.
    Ahlm, Kristin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Lindqvist, Per
    Division of Social and Forensic Psychiatry, Karolinska Institutet, Stockholm, Sweden; Dalarna University, Falun, Sweden.
    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.
    Suicidal drowning deaths in northern Sweden 1992-2009: the role of mental disorder and intoxication2015In: Journal of Forensic and Legal Medicine, ISSN 1752-928X, E-ISSN 1878-7487, Vol. 34, p. 168-172Article in journal (Refereed)
    Abstract [en]

    Suicides by drowning have received limited attention by researchers. A recent finding that almost onethird of all drowning deaths in Sweden were classified as suicide instigated this study. We identified 129 cases of suicide by drowning in Northern Sweden and analyzed the circumstances and the psychiatric history prior to the suicide. Information was obtained from autopsy, police and medical records, as well as from the National Inpatient Register. One-third of the suicide victims had previously attempted suicide and half of the victims had been hospitalized due to mental health problems. One-third of these had left the hospital less than one week before the suicide. Alcohol and psychoactive drugs were present in 16% and 62% of the cases, respectively. A history of mental disorder and previous suicide attempt (s), especially by drowning, is an ominous combination necessitating efficient clinical identification, treatment and follow-up if a complete suicide is to be prevented.

  • 2.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    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, Arctic Research Centre at Umeå University. Center for Disaster Medicine, Umeå University, Umeå, Sweden.
    Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients' temperatures in prehospital emergency care - an intervention study2015In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 74, article id 28878Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care.

    METHODS: A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures.

    RESULTS: Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes.

    CONCLUSIONS: The use of active heat from underneath increases the patients' thermal comfort and may prevent the negative consequences of cold stress.

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  • 3.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundin, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Joansson, Charlotta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Preparedness of Swedish EMS Personnel for Major Incidents in Underground Mines2017In: Journal of Health Science, E-ISSN 2328-7136, Vol. 5, p. 239-243Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to survey the EMS (emergency medical services) personnel preparedness for major incidents in the underground mining industry in Sweden. Every year, a high number of incidents, workplace accidents and fires are reported from the Swedish mining industry. Taking care of patients located in an underground mine represents a challenge to EMS personnel. Today, knowledge about EMS personnel preparedness for major incidents in the mining industry is limited. The study design was a cross-sectional survey. The questionnaires were distributed to EMS personnel working in ambulance stations geographically located near an underground mine. Thirteen ambulance stations were included and 137 of 258 personnel answered. Demographic data were analyzed using descriptive statistics. Differences among groups were analyzed with the Chi-Squared test, continuity correction and t-test. Results showed about half of the participants reported that they do not feel prepared to work in a major incident in an underground mine. The majority wished to receive educational training to enhance their preparedness. The most commonly requested type of education was practical drills on the scene, in an underground mine. The reported preparedness was significantly higher among the participants who had received some kind of education, or had authentic experience of a mission in an underground mine than those who did not. This study reveals shortcomings in the preparedness of EMS personnel. The perceived low preparedness of EMS personnel may affect their ability to work in a major incident in the mining industry. Study findings may be used in planning the future education, including practical drills, of EMS personnel.

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  • 4.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lämås, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    School Nurses' Attitudes toward Family Involvement in School Healthcare2020In: Health Behavior and Policy Review, ISSN 2326-4403, Vol. 7, no 1, p. 51-58Article in journal (Refereed)
    Abstract [en]

    Objective: We evaluated school nurses' attitudes towards family involvement in school healthcare when children exhibit signs of mental health problems.

    Methods: In a cross-sectional study, the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) instrument was used to measure school nurses' (N = 133) attitudes towards family involvement. Data were analyzed with the Mann-Whitney U-test.

    Results: School nurses (95%) encountered students with mental health problems every day or every week. Overall, school nurses were positive towards family involvement in school healthcare. Primary school nurses were more positive compared to secondary school nurses, seeing the family as a resource and a conversation partner. School nurses who felt that they had insufficient tools to work with children with mental health problems saw the family as a burden compared to school nurses who reported they have sufficient tools.

    Conclusion: School nurses' attitudes toward involving families as a resource are promising. However, when nurses perceive themselves as lacking sufficient tools to respond to children's mental health problems, they are more likely to experience the family as a burden than a resource. Cooperation between school nurses and families may be crucial. Therefore, we suggest a Family Health Conversations model to improve nurse-family collaboration

  • 5.
    Baetzner, Anke S.
    et al.
    Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany.
    Wespi, Rafael
    Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
    Hill, Yannick
    Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands; Institute of Brain and Behaviour Amsterdam, Amsterdam, Netherlands; Lyda Hill Institute for Human Resilience, Colorado Springs, United States.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sauter, Thomas C.
    Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Mohr, Stefan
    Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany.
    Regal, Georg
    Center for Technology Experience, AIT Austrian Institute of Technology, Vienna, Austria.
    Wrzus, Cornelia
    Psychological Institute and Network Aging Research, Heidelberg University, Heidelberg, Germany.
    Frenkel, Marie O.
    Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany.
    Preparing medical first responders for crises: a systematic literature review of disaster training programs and their effectiveness2022In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, no 1, article id 76Article, review/survey (Refereed)
    Abstract [en]

    Background: Adequate training and preparation of medical first responders (MFRs) are essential for an optimal performance in highly demanding situations like disasters (e.g., mass accidents, natural catastrophes). The training needs to be as effective as possible, because precise and effective behavior of MFRs under stress is central for ensuring patients’ survival and recovery. This systematic review offers an overview of scientifically evaluated training methods used to prepare MFRs for disasters. It identifies different effectiveness indicators and provides an additional analysis of how and to what extent the innovative training technologies virtual (VR) and mixed reality (MR) are included in disaster training research.

    Methods: The systematic review was conducted according to the PRISMA guidelines and focused specifically on (quasi-)experimental studies published between January 2010 and September 2021. The literature search was conducted via Web of Science and PubMed and led to the inclusion of 55 articles. Results: The search identified several types of training, including traditional (e.g., lectures, real-life scenario training) and technology-based training (e.g., computer-based learning, educational videos). Most trainings consisted of more than one method. The effectiveness of the trainings was mainly assessed through pre-post comparisons of knowledge tests or self-reported measures although some studies also used behavioral performance measures (e.g., triage accuracy). While all methods demonstrated effectiveness, the literature indicates that technology-based methods often lead to similar or greater training outcomes than traditional trainings. Currently, few studies systematically evaluated immersive VR and MR training.

    Conclusion: To determine the success of a training, proper and scientifically sound evaluation is necessary. Of the effectiveness indicators found, performance assessments in simulated scenarios are closest to the target behavior during real disasters. For valid yet inexpensive evaluations, objectively assessible performance measures, such as accuracy, time, and order of actions could be used. However, performance assessments have not been applied often. Furthermore, we found that technology-based training methods represent a promising approach to train many MFRs repeatedly and efficiently. These technologies offer great potential to supplement or partially replace traditional training. Further research is needed on those methods that have been underrepresented, especially serious gaming, immersive VR, and MR.

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  • 6.
    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. 

  • 7.
    Doohan Stjerna, Isabelle
    et al.
    Umeå University, Faculty of Social Sciences, Police Education Unit at Umeå University. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Limited medical perspective at a strategic level in relation to mass casualty incidents in Swedish tunnels2019In: International Journal of Emergency Management, ISSN 1471-4825, E-ISSN 1741-5071, Vol. 15, no 4, p. 360-374Article in journal (Refereed)
    Abstract [en]

    Mass casualty incidents (MCI) in tunnels can result in devastating consequences. Despite this, there is a knowledge gap in the perspectives and experiences of strategic stakeholders in relation to the emergency medical response to MCI in tunnels. This study aims to explore and describe this issue. The study includes 11 interview participants from the emergency services organisations and governmental and municipal organisations in Sweden. The results indicate that the medical perspective is inadequately represented at a strategic level due, among other, to limited input from emergency medical representatives during planning stages and a lack of social networks. The results implicate a need to create and improve networks among the stakeholders from the involved organisations. Emergency medical personnel should not only be acknowledged for their expertise but should also be included to a greater extent in the planning stages and exercises. Medical and rescue personnel need time to jointly discuss how they, in the best way, can save lives in tunnel MCIs.

  • 8. Eklund, Annika
    et al.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Situational awareness during a full-scale exercise in an underground mine: A qualitative single-case study of the ambulance incident commander2021In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 54, article id 100950Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Underground environments present challenges for providing and managing effective emergency care. Situational awareness (SA) has been suggested as a critical process to the management of care.

    AIM: This study aims to explore the process of SA in the tasks of an ambulance incident commander (AIC) during a fullscale underground mine exercise.

    METHODS: Data consisted of video recordings, audiotapes and fieldnotes; these were subjected to content analysis based on the categories from the Busby Theory of Situational Awareness in Multi-casualty Incidents.

    RESULTS: The results show that the underground mining environment presented the AIC with specific challenges for the SA process with respect to aspects such as situational information about the scene and the victims, as well as with making decisions for ambulance personnel so they could perform their work safely, and having a structured manner to counteract information overload. Both technical and non-technical aspects influenced the process.

    CONCLUSION: The AIC's situational awareness was largely built through coordinated communications and actions with collaborating actors. The results of this study can be used for further exploration of how to train and support people in medical leadership roles on aspects of SA in emergency care, as well as on how to evaluate educational outcomes through exercises.

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  • 9.
    Gyllencreutz, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Mårtensson, Sophia
    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.
    Medical incident commander leadership during a full-scale exercise in an underground mining environment: a qualitative single-case study2021In: International Journal of Emergency Management, ISSN 1471-4825, E-ISSN 1741-5071, Vol. 17, no 1, p. 90-103Article in journal (Refereed)
    Abstract [en]

    Swedish underground mines are constantly improving their safety. However, major incidents still occur, and the extreme environment poses challenges during rescue operations. The aim of this study was to evaluate prehospital medical management during a full-scale exercise in an underground mine in order to gain knowledge on the leadership and decision-making of the medical incident commander. We used a qualitative single-case study design following a full-scale exercise that included emergency medical services (EMSs), rescue services, and a mining company. The exercise was documented through on-site observation notes, audio recordings, and video recordings, all of which were written out as text and analysed using qualitative content analysis. The results showed that few decisions were made, and without all available medical information, and that they were made by others than the medical incident commander. This resulted in a delay in decision-making, in vital treatment, and in transport of patients from the site. Clearer leadership and more active decisions might have resulted in a different outcome for the injured parties.

  • 10.
    Gyllencreutz, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Pedersen, Ida
    Umeå University, Faculty of Medicine, Department of Nursing.
    Enarsson, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bölenius, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    The experience of healthcare staff of incident reporting with respect to venous blood specimen collection practices’2019In: Policy and Practice in Health and Safety, ISSN 1477-3996, E-ISSN 1477-4003, Vol. 17, no 2, p. 146-155Article in journal (Refereed)
    Abstract [en]

    Venous blood specimen collection is an important practical task that results in an analysis response that often leads to a clinical decision. Errors due to inaccurate venous blood specimen collection are frequently reported and can jeopardize patient safety because inaccurate specimens may result in a delayed or incorrect diagnosis and treatment. However, few healthcare personnel have written an error report regarding venous blood specimen collection practices. The aim of this study is to describe the experiences of healthcare personnel with incident reporting of venous blood specimen collection practices in primary health care. Our study is based on 30 individual interviews with healthcare personnel from 10 primary health care centres. Data were analysed using qualitative content analyses. Personnel experiences of incident reporting were summarized in three categories; Uncertainties in the planning and organization, High workload and low priority and, A need for support and guidance. More specifically, barriers hinder personnel in reporting mistakes. An interpretation based on the results is that surrounding circumstances within the organization influence whether personnel report mistakes or not. The result indicates a need for parallel systems, to identify and report errors or near-misses to prevent mistakes. Processed incidents should be returned promptly to the personnel to use as a learning experience. Having a valid questionnaire and a key person to write an incident report, might reduce the burden on the health care staff and increase the numbers of incident reports and patient safety.

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  • 11.
    Gyllencreutz, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rolfsman, Ewa
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Frånberg, Gun-Marie
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Injury risks during outdoor play among Swedish schoolchildren: teachers' perceptions and injury preventive practices2020In: Education 3-13, ISSN 0300-4279, E-ISSN 1475-7575, Vol. 48, no 1, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Approximately 36,000 Swedish children seek medical care annually because of injuries during school time. The purpose of this field study is to investigate risky outdoor play at the school yard and to describe teachers’ perceptions of risk and safety in relation to learning and development. The study includes observations of children (6–12 years old) during outdoor activities as part of the school’s activities and includes focus-group interviews with teachers and children. Children were seen climbing high in play facilities, speeding down slides, or competing with sticks in the woods. Different views of risk and safety among the participants influence outdoor play activities. Teachers’ knowledge of risk seems to be derived from common sense and personal experiences rather than from a professional perspective. A joint approach of educational and medicine disciplines is desirable when it comes to children’s health and development.

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  • 12.
    Gyllencreutz, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Rådestad, Monica
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Templates for handling multi-agency collaboration activities and priorities in mining injury incidents: a Delphi study2020In: International Journal of Emergency Services, ISSN 2047-0894, E-ISSN 2047-0908, Vol. 9, no 3, p. 257-271Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was from a Swedish perspective to map experts' opinions on theoretical statements of essential collaboration activities for management of mining injury incidents.

    Design/methodology/approach: A Delphi technique was performed, asking opinions from experts in iterative rounds to generate understanding and form consensus on group opinion around multi-agency management. The experts were personnel from emergency medical service, rescue service and mine industry, all with operative command positions.

    Findings: Three iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important multi-agency collaboration activities to optimize victim's outcome from an injury incident in an underground mine. This resulted in 63 statements and additional three were added during the second round. The statements were divided into one trajectory and seventh time phases and comprised, e.g. early alarm routines, support of early life-saving interventions, relevant resources and equipment for the assignment and command and control center and functions with predefined action plans for response. It also comprised shared and communicated decisions about each agency's responsibility and safety. All statements reached consensus among the experts in Round 3.

    Research limitations/implications: The experts included in this study seem to be adequate but there could be other experts and different statements that other researchers might consider.

    Practical implications: These statements could be used to evaluate collaboration in major incidents exercises. The statements can also be quality indicators for reporting results from multi-agency management.

    Originality/value: This paper contributes to the research field of collaboration and joint practices between and among personnel involved in rescue operations.

  • 13.
    Holgersson, Annelie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eklund, Annika
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Psychology, Pedagogy and Sociology, Section for nursing, University West, Trollhättan, Sweden.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Emergency Medical Response in Mass Casualty Tunnel Incidents - with Emphasis on Prehospital Care2020In: Journal of Human Security, ISSN 1835-3800, E-ISSN 1835-3800, Vol. 16, no 1, p. 3-15Article in journal (Refereed)
    Abstract [en]

    Responding to mass casualty incidents in a tunnel environment is problematic not least from aprehospital emergency medical services (EMS) perspective. The aim of this review was to 1) categorizepreconditions for emergency response in tunnel environments based on Haddon’s matrix and 2) identify specificEMS knowledge of providing prehospital care. Twenty eight articles, reports and book chapters were selected forfurther analysis. Firstly, sorting the data from each included article was done according to Haddon’s matrix. Theresult covers human factors, technical factors, physical environmental factors and socioeconomic environmentalfactors all related to preconditions for emergency response. To describe the EMS’s knowledge the data wasalso sorted according to command and safety, communication, assessment, and triage treatment and transport,also known as CSCATT. Few studies, especially of high quality, actually provide detailed information regardingemergency response to tunnel incidents and those that do, often have a main focus on management by therescue service. While many incidents studied were caused by fires in tunnels, thus requiring rescue servicein action, the subsequent EMS response issues that have taken place appear to have been given limitedattention. To optimize the survival rates and health of the injured, as well as to provide a safe and effective workenvironment for the emergency services, there is a need to explore the event phase.

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  • 14.
    Hylander, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Disaster Medicine, Umeå University.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Disaster Medicine, Umeå University.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Disaster Medicine, Umeå University.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Disaster Medicine, Umeå University.
    Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway: an interview study2019In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 27, no 1, article id 78Article in journal (Refereed)
    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.

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  • 15.
    Hylander, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Senior ambulance officers in Swedish emergency medical services: a qualitative study of perceptions and experiences of a new management role in challenging incidents2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 12, article id e042072Article in journal (Refereed)
    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.

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  • 16.
    Hylander, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Westman, Anton
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Time-efficiency factors in road tunnel rescue as perceived by Swedish operative personnel – an interview study2022In: International Journal of Emergency Services, ISSN 2047-0894, E-ISSN 2047-0908, Vol. 11, no 2, p. 312-324Article in journal (Other academic)
    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.

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  • 17.
    Karlsson, Sofia
    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.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing.
    The medical perspective on mining incidents: Interviews with emergency medical service (EMS) personnel2019In: International Journal of Emergency Services, ISSN 2047-0894, E-ISSN 2047-0908, Vol. 8, no 3, p. 236-246Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to examine emergency medical service (EMS) personnel’s perceptions and experiences of managing underground mining injury incidents.

    Design/methodology/approach: In total, 13 EMS personnel were interviewed according to a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using qualitative content analysis.

    Findings: An underground mining environment was described as unfamiliar and unsafe and, with no guidelines for operational actions in an extreme environment, such as underground mines, the EMS personnel were uncertain of their role. They therefore became passive and relied on the rescue service and mining company during a major incident. However, the medical care was not considered to be different from any other prehospital care, although a mining environment would make the situation more difficult and it would take longer for the mine workers to be placed under definitive care.

    Originality/value: This study complements earlier studies by examining the EMS personnel’s perceptions and experiences of major incidents.

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  • 18.
    Karlsson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Preparedness for peer first response to mining emergencies resulting in injuries: a cross-sectional study2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, article id e036094Article in journal (Refereed)
    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.

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  • 19.
    Karlsson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Eklund, Annika
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Expansive Learning Process of Exercise Organizers: The Case of Major Fire Incident Exercises in Underground Mines2020In: Sustainability, E-ISSN 2071-1050, Vol. 12, no 14, article id 5790Article in journal (Refereed)
    Abstract [en]

    A major fire incident in a Swedish underground mine made the personnel from the mining company and the rescue service realize their limited preparedness. It was the beginning of a collaboration project that included the development of a new exercise model for a more effective joint rescue operation practice. The aim of this study was to explore the collaborative learning process of exercise organizers from the rescue service, mining companies, the emergency medical service, a training company, and academia. The analysis was performed through the application of the theory cycle of expansive learning to the material consisting of documents from 16 collaboration meetings and 11 full-scale exercises. The learning process started by the participants questioning the present practice of the rescue operation and analyzing it by creating a flow chart. An essential part of the process was to model new tools in order to increase the potential for collaboration. The tools were examined and tested during collaboration meetings and implemented during full-scale exercises. The exercise organizers reflected that the process led to organizational development and a better understanding of the other organizations’ perspectives. Consequently, a tentative model for developing the learning process of exercise organizers was developed.

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  • 20. Lukumay, Gift G.
    et al.
    Ndile, Menti L.
    Outwater, Anne H.
    Mkoka, Dickson A.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Backteman-Erlandsson, Susann
    Umeå University, Faculty of Medicine, Department of Nursing.
    Provision of post-crash first aid by traffic police in Dar es Salaam, Tanzania: a cross-sectional survey2018In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 18, article id 45Article in journal (Refereed)
    Abstract [en]

    Background: The availability of prehospital trauma care is an important means of reducing serious injuries and fatalities associated with road traffic injuries (RTIs). Lay responders such as traffic police play an important role in the provision of prehospital trauma care to RTI victims, especially where there is no established prehospital care system. Therefore, the objective of the present study was to investigate knowledge, self-reported practice, and attitudes toward post-crash first aid among traffic police officers in Tanzania.

    Method: A cross-sectional survey was conducted in Dar es Salaam, Tanzania between July-September 2017 to investigate knowledge, self-reported practice and attitude among traffic police officers during provision of post-crash care. We used simple random technique to recruit 340 traffic police officers, self -administered questionnaires were used to collect data. The researchers used descriptive statistics and Pearson's chi-square tests to analyze the data.

    Results: A total of 340 traffic police officers were surveyed. Nearly two thirds (65.3%) reported having had post-crash first aid on-the job training; a slightly larger proportion (70.9%) reported that they had cared for RTI victims in the previous year. The survey responses showed that, generally, traffic police officers' level of knowledge about post-crash first aid to RTI victims was low-about 3% of the surveyed officers possessed knowledge at a level considered good. Also, there was a statistically significant correlation between higher educational attainment and greater knowledgeability (p = 0.015). Almost all of the officers (96%) had a positive attitude toward providing post-crash first aid to RTI victims.

    Conclusions: Improved training of Tanzania traffic police officers, by means of an updated post-crash first aid curriculum and updated resources is recommended. Also, user-friendly post-crash first aid leaflets should be provided to traffic police for their reference.

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  • 21. Lukumay, Gift G.
    et al.
    Outwater, Anne H.
    Mkoka, Dickson A.
    Ndile, Menti L.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Traffic police officers' experience of post-crash care to road traffic injury victims: a qualitative study in Tanzania"2019In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 19, no 1, article id 51Article in journal (Refereed)
    Abstract [en]

    Background: Recently, road traffic injuries (RTIs) have become a major health problem affecting health systems in many low- and middle-income countries. Regardless of whether an ambulance is available for evacuation, police officers have been shown to arrive at the crash scene first, becoming, in effect, the first responders to RTI victims. Therefore, the study aimed to explore the experiences of traffic police officers in regard to the provision of care to RTI victims in the prehospital environment, including the role of traffic police upon arriving at the crash scene, the challenges they face, and their opinions about how to improve care to RTI victims.

    Method: The study used a qualitative approach in which data were obtained from 10 individual interviews and three focus group discussions. There were 41 participants, 27 of them were male and 14 were female. About half (48.7%) of the study participants were aged between 30 to 39 years. Qualitative content analysis was used to analyse all the materials.

    Results: Three themes emerged from the analysis. The theme "Maintain safety while saving injured victims' lives and facilitating access to a health facility" was comprised of safety, sorting, initial help, and assisting access to hospital care. "Overwhelmed working with limited resources and support" included limited care and transport resources, police fatigue, and little or no support. "Improving supportive system and empowering frontline personnel" included the need for an emergency care system, availability of resources and an emergency medical support system, and training for police and drivers regarding victims' first-aid care, and road safety.

    Conclusion: The study findings characterize an environment in which the police first responders have no knowledge or skills and no equipment and supplies to provide care to RTI victims at the scene before rushing them to definitive care. The results suggest a favorable climate for training and equipping officers so that they can deliver competent postcrash care at the scene while emergency medical services are yet to be established. However, more research will be needed to determine the efficacy of such training and its acceptability in the Tanzanian context.

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  • 22.
    Lundberg, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing, Åland University of Applied Sciences, Mariehamn, Åland, Finland.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Erika
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing, Åland University of Applied Sciences, Mariehamn, Åland, Finland.
    Characteristics of nursing encounters in primary healthcare in remote areas: a survey of nurses’ patient record documentation and self-report2021In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 41, no 2, p. 84-91Article in journal (Refereed)
    Abstract [en]

    To meet both current and future competence needs, improved and updated understanding of nurses’ scope of practice when working in remote communities is needed. The aim was to describe and analyze the characteristics of nursing encounters in primary healthcare in remote areas. The setting for the study was an island community in Finland. Nurses’ patient record documentation and self-reports on patient encounters were surveyed (n = 1062). Patients aged ≥65 years accounted for most encounters. Great variety in the encounters was seen, though some nursing tasks and patient conditions were overrepresented. For patient safety reasons, it is important to review how nurses maintain competence regarding those tasks and conditions encountered less often. Primary healthcare services should focus on the broader determinants of health. However, a more disease-oriented focus was seen. To ensure quality of care in primary healthcare in remote areas, there is a need for standardized routines for monitoring patients and documenting findings and performed interventions.

  • 23.
    Lundberg, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
    Santamäki-Fischer, Regina
    Department of Caring Science, Åbo Akademi University, Vasa, Finland.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
    Boman, Erika
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
    Standing alone on the frontline. The meaning of being a nurse in the archipelago: a phenomenological hermeneutical study2023In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, no 4, p. 1048-1056Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to illuminate the meaning of being a nurse in the archipelago.

    Methodological Design and Justification: A phenomenological hermeneutical design was applied, as there is a need to understand the lifeworld and the meaning of being a nurse in the archipelago.

    Ethical Issues and Approval: Approval was granted by the Regional Ethical Committee and local management team. All participants provided consent to participate.

    Research Method: Individual interviews were conducted with 11 nurses (Registered Nurses or primary health nurses). The interviews were transcribed, and the text was analysed by means of phenomenological hermeneutical method.

    Results: The analyses ended in one main theme: Standing alone on the frontline, and three themes: 1. Combating sea, weather and the clock with the sub-themes: Fighting to give care to patients despite harsh conditions and Fighting against time; 2. Standing firm but wavering with the sub-themes: Embracing the unexpected and Calling out for support; and 3. Being a lifeline throughout the entire lifespan with the sub-themes: Having responsibility for the islanders and Having an intertwined private and work life.

    Study Limitations: The interviews may be considered few, but the textual data were rich and assessed suitable for the analysis. The text may be interpreted differently, but we deemed our interpretation as more probable than others.

    Conclusion: Being a nurse in the archipelago means standing alone on the frontline. Nurses, other health professionals and managers need knowledge and insight about working alone and the moral responsibilities thereof. There is a need to support the nurses in their lonely work. Traditional means of consultations and support could preferably be supplemented by modern digital technology.

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  • 24.
    Lämås, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jacobsson, Catrine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Östlund, Ulrika
    Possibilities for evaluating cost-effectiveness of family system nursing: an example based on Family Health Conversations with families in which a middle-aged family member had suffered stroke2016In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 38, no 2, p. 74-81Article in journal (Refereed)
    Abstract [en]

    Family Health Conversations (FamHC) increase health and well-being, but knowledge about their cost-effectiveness, and how to best calculate this, is lacking. In this feasibility study we evaluated the cost-effectiveness of using FamHC with families in which a middle-aged family member had suffered stroke. Seven families participated in a FamHC intervention and seven families received ordinary care. Health-related quality of life (HRQoL) was estimated with SF-6D and EQ-5D over a six-month period. The costeffectiveness of the intervention was calculated. Families receiving FamHC intervention had significantly increased HRQoL at follow up. Cost per quality adjusted life year differed depending on the instrument and analysis method used in the calculation. However, all calculations showed that FamHC were cost-effective. We conclude that FamHC significantly increase HRQoL and suggest that they are cost-effective. Both instruments seemed to be able to capture changes. Considering the participants’ experience of answering the two instruments, we advocate the use of EQ-5D.

  • 25.
    Ndile, Menti L.
    et al.
    Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Outwater, Anne H.
    Department of Community Nursing, MUHAS, Dar es Salaam, Tanzania.
    Mkoka, Dickson A.
    Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
    Backteman-Erlandson, Susanne
    Umeå University, Faculty of Medicine, Department of Nursing.
    Implementing a layperson post-crash first aid training programme in Tanzania: a qualitative study of stakeholder perspectives2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 750Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In low and middle-income countries (LMICs), laypersons play a significant role in providing initial care to injured victims of traffic accidents. Post-crash first aid (PFA) training programmes for laypersons have become an important response to addressing knowledge and skills gaps in pre-hospital care. However, little is known about factors influencing effective implementation of such programmes from stakeholders' point of view. Therefore, this study aimed to explore views of stakeholders on potential factors that may facilitate or hinder successful implementation of a PFA training programme for lay persons.

    METHODS: Twelve semi-structured qualitative interviews with leaders at a traffic police department and leaders of an association of city bus drivers, taxi drivers and motorcycle taxis in Tanzania were conducted. Interviews were audio-recorded and transcribed verbatim. A thematic analysis approach was used to identify themes and sub-themes.

    RESULTS: Three themes pertaining to implementation of a PFA training programme were identified: Motivation for engaging in training, Constrains for engaging in training and Training processes. They consisted of a total of six sub-themes: "perceived benefits of first aid training" and "availability of incentives" were considered as facilitators to PFA training. "Availability of time to attend training" and "accessibility of training" were reported as a potential barriers to successful training. Finally, they felt that "methods of training delivery" and "availability of first aid training materials and equipment" could either facilitate or impede delivery of PFA training.

    CONCLUSION: This study highlights potential facilitators and barriers to implementing a PFA training programme for lay persons from the perspectives of leaders from police department and associations of city bus drivers, taxi drivers, and motorcycle taxis. This may be useful information for other stakeholders, and may enable government-level leaders and persons higher up in the health service hierarchy to take action to meet WHO recommendations for emergency pre-hospital care.

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  • 26.
    Ndile, Menti
    et al.
    Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
    Lukumay, Gift G.
    Bölenius, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Outwater, Anne H.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Backteman-Erlandson, Susanne
    Umeå University, Faculty of Medicine, Department of Nursing.
    Impact of a postcrash first aid educational program on knowledge, perceived skills confidence, and skills utilization among traffic police officers: a single-arm before-after intervention study2020In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 20, article id 21Article in journal (Refereed)
    Abstract [en]

    Background: An overwhelming proportion of road traffic deaths and injuries in low- and middle-income countries(LMICs) occur in prehospital environments. Lay first responders such as police officers play an important role inproviding initial assistance to victims of road traffic injuries either alone or in collaboration with others. The presentstudy evaluated a postcrash first aid (PFA) educational program developed for police officers in Tanzania.

    Method: A 16-h PFA educational program was conducted in Dar es Salaam, Tanzania, for 135 police officers. Participantscompleted training surveys before, immediately and 6months after the training (before, N = 135; immediately after, N=135;after 6 months, N=102). The primary outcome measures were PFA knowledge, perceived skills confidence, and skillsutilization. Parametric and nonparametric tests were used to analyse changes in outcome.

    Results: The mean PFA knowledge score increased from 44.73% before training (SD = 20.70) to 72.92% 6months aftertraining (SD = 18.12), p < .001, N = 102. The mean PFA perceived skills confidence score (measured on a 1–5 Likert scale)increased from 1.96 before training (SD = 0.74) to 3.78 6months after training (SD=0.70), p < .001, N = 102. Followingtraining, application of the recovery position skill (n = 42, 46%) and application of the bleeding control skill (n = 45, 49%) werereported by nearly half of the responding officers. Less than a quarter of officers reported applying head and neckimmobilization skills (n = 20, 22%) following training.

    Conclusion: A PFA educational program has shown to improve police officers’ knowledge and perceived skills confidenceon provision of first aid. However qualitative research need to be conducted to shed more light regarding reasons for lowutilization of trained first aid skills during follow-up.

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  • 27.
    Ndile, Menti
    et al.
    Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lukumay, Gift G.
    Mkoka, Dickson A.
    Outwater, Anne H.
    Backteman-Erlandson, Susanne
    Umeå University, Faculty of Medicine, Department of Nursing.
    Traffic police officers' use of first aid skills at work: a qualitative content analysis of focus group discussions in Dar Es Salaam, Tanzania2020In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 20, no 1, article id 72Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organisation (WHO) recommends involving lay people in prehospital care. Several training programmes have been implemented to build lay responder first aid skills. Findings show that most programmes significantly improved participants' first aid skills. However, there is a gap in knowledge of what factors influence the use of these skills in real situations. The current study aimed to describe police officers' views on and experiences of factors that facilitate or hinder their use of trained first aid skills at work.

    Methods: Thirty-four police officers participated in five focus group discussions. A structured interview guide was used to collect data. Interviews were audio-recorded and transcribed verbatim. Data were analysed using qualitative content analysis.

    Results: We identified five categories of facilitators or hindrances. Training exposure was considered a facilitator; work situation and hospital atmosphere were considered hindrances; and the physical and social environments and the resources available for providing first aid could be either facilitators or hindrances.

    Conclusion: Practical exposure during training is perceived to improve police officers' confidence in applying their first aid skills at work. However, contextual factors related to the working environment need to be addressed to promote this transfer of skills.

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  • 28.
    Pusa, Susanna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Family systems nursing conversations: influences on families with stroke2022In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 21, no 1, article id 108Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Since a family member's stroke affects the entire family, family systems nursing conversations (FSNCs) may be an appropriate intervention to support the family as a whole. The purpose of our study was to illuminate family members' experiences within their family situations 6 months after participating in FSNCs when a family member under 65 years of age had suffered a stroke.

    METHODS: Fourteen semi-structured follow-up interviews were conducted with family members 6 months after they had completed a series of 3 FSNCs. The interview transcripts were subjected to qualitative content analysis.

    RESULTS: Family members experienced that the FSNCs had contributed to greater understanding of each other and greater closeness in the family. The FSNCs had also facilitated a mutual understanding of the family's situation, which they could better manage and move forward with together.

    CONCLUSIONS: FSNCs can support relational aspects and healthy transitions within families. However, long-term follow-up research is needed to generate sound evidence and inform education about FSNCs, as well as to facilitate their implementation. As a result, families may become better able to prevent the negative outcomes of illness in the family.

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  • 29.
    Stenberg, Maud
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Family experiences up to seven years after a severe traumatic brain injury-family interviews2022In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, no 4, p. 608-616Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore the experiences of being a family with one member suffering from severe traumatic brain injury (STBI) up to 7 years earlier through narrative family interviews.

    Methods: There are few studies where a family as a unit, including persons with STBI, are interviewed together. This study used a family systems research approach following a qualitative interpretative design. Therefore, 21 families with a total of 47 family members were interviewed. Qualitative content analysis was used to reveal categories with sub-categories and a theme.

    Results: "From surviving STBI towards stability, through the unknown, into a new everyday life and a new future as a family" characterized the implicit message. The results revealed two categories both with three subcategories. The first category characterized the rapid change from a normal everyday life to one of uncertainty and finally to one of stability, and the second category described how it is to adapt as a family after STBI.

    Conclusions: Long-term experiences of STBI show the importance for the whole family of belonging to a context, having a job, and having something to belong to as a way to achieve stability. Families' feelings of loneliness and lack of treatment and support are challenges for professionals when trying to involve families in care and rehabilitation.

    IMPLICATIONS FOR REHABILITATIONA

    • sense of belonging, having a purpose and a social network are important within families.
    • Professionals can provide information and can help to eliminate misunderstandings for individuals with severe traumatic brain injury and their families.
    • It is important for rehabilitation professionals to undertake a thorough family assessment.
    • This assessment will support families become involved in the process of rehabilitation.
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  • 30.
    Stenberg, Maud
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Family Illness Trajectory During Seven Years After A Severe Traumatic Brain Injury-Family Interviews2019In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, p. 147-147Article in journal (Other academic)
  • 31.
    Stenberg, Maud
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Health and Well-Being of Persons of Working Age up to Seven Years after Severe Traumatic Brain Injury in Northern Sweden: A Mixed Method Study2022In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 11, no 5, article id 1306Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore the health and well-being of persons seven years after severe traumatic brain injury (STBI).

    Material and methods: Follow-up of 21 persons 1 and 7 years after STBI using surveys for functional outcome, anxiety/depression, health and mental fatigue. Interviews were conducted and analysed using qualitative content analysis. Convergent parallel mixed method then merged and analysed the results into an overall interpretation.

    Results: Good recovery, high functional outcome and overall good health were relatively unchanged between 1 and 7 years. Well-being was a result of adaptation to a recovered or changed life situation. Persons with good recovery had moved on in life. Persons with moderate disability self-estimated their health as good recovery but reported poorer well-being. For persons with severe disability, adaptation was an ongoing process and health and well-being were low. Only a few persons reported anxiety and depression. They had poorer health but nevertheless reported well-being. Persons with moderate and severe mental fatigue had low functional outcomes and overall health and none of them reported well-being.

    Conclusions: The life of a person who has suffered STBI is still affected to a lesser or greater degree several years after injury due to acceptance of a recovered or changed life situation. Further studies are needed on how health and well-being can be improved after STBI in the long-term perspective.

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  • 32.
    Stenberg, Maud
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Long-Term Follow-Up Observation Study 7 Years after Severe Traumatic Brain Injury in Northern Sweden2019In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, p. 161-161Article in journal (Other academic)
  • 33.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stenberg, Maud
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Long-Term Follow-Up of Disability, Cognitive, and Emotional Impairments after Severe Traumatic Brain Injury2019In: Behavioural Neurology, ISSN 0953-4180, E-ISSN 1875-8584, Vol. 2019, article id 9216931Article in journal (Refereed)
    Abstract [en]

    Aim. To assess the clinical course of disability, cognitive, and emotional impairments in patients with severe TBI (s-TBI) from 3 months to up to 7 years post trauma. Methods. A prospective cohort study of s-TBI in northern Sweden was conducted. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Glasgow Outcome Scale Extended (GOSE), the Hospital Anxiety and Depression Scale (HADS), and the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) at 3 months, 1 year, and 7 years after the injury. Results. The scores on both GOSE and BNIS improved significantly from 3 months (GOSE mean: 4.4 +/- 2.3, BNIS mean: 31.5 +/- 7.0) to 1 year (GOSE mean: 5.5 +/- 2.7, p=0.003, BNIS mean: 33.2 +/- 6.3, p=0.04), but no significant improvement was found from 1 year to 7 years (GOSE mean: 4.7 +/- 2.8, p=0.13, BNIS mean: 33.5 +/- 3.9, p=0.424) after the injury. The BNIS subscale "speech/language" at 1 year was significantly associated with favourable outcomes on the GOSE at 7 years (OR=2.115, CI: 1.004-4.456, p=0.049). Conclusions. These findings indicate that disability and cognition seem to improve over time after s-TBI and appear to be relatively stable from 1 year to 7 years. Since cognitive function on some of the BNIS subscales was associated with outcome on the GOSE, these results indicate that both screening and follow-up of cognitive function could be of importance for the rehabilitation of persons with s-TBI.

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  • 34.
    Westman, Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital, Huddinge, Sweden.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. 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.
    Hylander, Johan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Mobilisation of emergency services for chemical incidents in Sweden: a multi-agency focus group study2021In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 29, no 1, article id 99Article in journal (Refereed)
    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.

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  • 35. Östlund, Ulrika
    et al.
    Bäckström, Britt
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    A Family Systems Nursing Approach for Families Following a Stroke: Family Health Conversations2016In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 22, no 2, p. 148-171Article in journal (Refereed)
    Abstract [en]

    Stroke in midlife is a life altering, challenging experience for the whole family thereby necessitating a family approach to intervention. The aim of this study was to describe the experiences of 17 family members living in Sweden, including seven adult stroke patients (six males; one female) under the age of 65 who participated in a series of three nurse-led family conversations that were offered in each family's home. These Family Health Conversations (FamHC) were guided by the conceptual lens of Family System Nursing. Individual, semi-structured, evaluative interviews conducted with each participant one month after the FamHC were analyzed by qualitative content analysis. The FamHC were described by family members as a unique conversation that they had not previously experienced in health care contexts. Family members described possibilities for relational sharing and meaningful conversations as well as changes in family functioning that support the suitability of FamHC for family stroke care.

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