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Background: In significant events like chemical, biological, radiological, nuclear, and explosive (CBRNE) incidents, additional expertise in specific chemical substances becomes essential. Train-the-trainer programmes are used to increase knowledge and skills in a variety of fields and have been shown to be a cost-effective training method, eliminating the necessity of bringing in external experts or requiring participants to travel outside their region. Care in Hazardous Environments (CiHE) is one example of a course which comprises basic multi-disciplinary training together with personnel from rescue, police, and emergency medical services to prepare them to handle chemical and radioactive nuclear incidents. The train-the-trainer programme described in this study contains both theoretical and practical components, intended for instructors who will lead training on CiHE incidents. This study aimed to evaluate trainers’ level of knowledge before and after a train-the-trainer programme, as well as their thoughts about becoming an instructor i.e. the pedagogical competence for the Care in Hazardous Environments course.

Methods: A pre- and post-test, along with an evaluation of open-ended response options were employed to assess the effectiveness of the train-the-trainer programme for teaching the basic course (CiHE). A total of 49 participants were enrolled in the programme.

Results: Participants showed significant improvement in chemical, radiological and nuclear (CRN) response knowledge in two of the eight questions between the pre- and post-tests. The two questions that improved pertained to chemical substances and basic principles of radiation protection. Instructors trained in the train-the-trainer programme are intended to bring new knowledge, incorporate a rarely discussed topic into instruction regularly, and de-stigmatise CRN incidents by helping raise the minimum competency levels in their respective organisation.

Conclusion: An effective response to CBRNE events begins with readiness. First responders must be prepared and possess knowledge of both CRN components as well as protective gear to keep themselves and others safe at the incident scene. This study shows the importance of the train-the-trainer programme in continuing to educate police, and personnel from rescue and emergency medical services in CiHE, enable them to collaboratively prepare to handle CRN incidents.

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.

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.

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.

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.

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.

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.

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.

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.

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.