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Background: Workplace-related serious injury events are a recognized problem in Europe, with construction sites bearing a higher risk compared to other workplaces. Sweden reports approximately 1,000 serious injury per year. Layperson involvement in workplace injury events can be stressful and may impact their ability to respond effectively. There is a knowledge gap concerning how workers in this context perceived their role.

Aim: To describe Swedish construction employees’ experiences of being involved as a layperson first aid provider in a serious workplace injury event.

Method: A total of nine construction employees were interviewed. Their ages ranged from 22 to 66 years, and varying experience in the construction industry, from 5 to 41 years. Eight had completed a first aid course at their workplace within the last three years. None of the participants had a background in areas such as rescue services, police, healthcare, or military. None of the construction sites had trained EMTs or company medical personnel on site. The transcribed text from the interviews was analyzed using qualitative content analysis.

Results: The study showed that construction employees experiences of being involved as a layperson first aid provider was linked to one main category: to try to reduce the consequences of limited knowledge through mutual understanding and support. There were three additional categories for reported experiences: suddenly trying to save lives after realizing the unexpected, the importance of collaboration in a chaotic situation, and the need for social support and following improvements with subcategories.

Conclusion: The results showed that with injury events in a complex environment, such as construction sites, there is a need for mutual understanding between dispatcher, ambulance services, rescue service, and laypersons. A level of understanding from professional organizations is required to support the layperson to be a valuable resource to the emergency personnel in serious workplace injury events.

Background: Hazardous chemicals are essential for modern society but the use and transportation of them bears the risk of major incidents. Past incidents have revealed the importance of preparation and training of emergency medical service (EMS) personnel when responding to these incidents. However, studies have shown the level of preparedness to be insufficient. There is a lack of knowledge as to how EMS personnel perceive their preparedness and response when facing chemical incidents.

Aim: The aim of this study was to qualitative investigate working procedures regarding chemical incidents among a cohort of EMS personnel.

Method: Seventeen ambulance nurses from rural and urban areas were individually interviewed using four different realistic scenarios (vignettes). The transcribed text from the interviews was analyzed using qualitative content analysis.

Result: The results were derived into two categories with underlying sub-categories: a struggle to organize the onsite work situation (insufficient managerial support, limited resources, trust in rescue services, difficult decision making, stressful responsibilities); and decontamination—a demanding and risky situation (risk management, work in protective gear, aggravating circumstances). Participants often lack real life experience in facing a chemical incident and training that improves preparedness and the ability to respond adequately.

Conclusion: Chemical incidents pose many challenges for EMS personnel, but with proper training efforts many of these challenges could be solved. This study has shown the need for more accessible chemical incident training targeting EMS personnel: especially focusing on risk assessment; managerial support; resource management; equipment; and decontamination, including stress management and decision-making. Research in the area of chemical incidents is sparse and there remains much to understand concerning work procedures during chemical incidents.

Background: The risk of high-energy trauma injuries on construction sites is relatively high. A delayed response time could affect outcomes after severe injury. This study assessed if an advanced first aid course for first aid response for laypersons (employees or apprentices) in the construction industry or real-time video communication and support with ambulance personnel, or neither, together with access to an advanced medical kit, would have an effect on immediate layperson vital responses in a severe injury scenario.

Method: This was a controlled simulation study. Employees or apprentices at a construction site were recruited and randomly allocated into a group with video support or not, and advanced first aid course or not, and where one group had both. The primary outcomes were correct behavior to recognize and manage an occluded airway and correct behavior to stop life-threatening bleeding from a lower extremity injury. Secondary outcomes included head-to-toe assessment performed, placement of a pelvic sling, and application of remote vital signs monitors.

Results: Ninety participants were included in 10 groups of 3 for each of 4 exposures. One group was tested first as a baseline group, and then later after having done the training course. Live video support was effective in controlling bleeding. A first aid course given beforehand did not seem to be as effective on controlling bleeding. Video support and the first aid course previously given improved the ability of bystanders to manage the airway, the combination of the two being no better than each of the interventions taken in isolation. Course exposure and video support together were not superior to the course by itself or video by itself, except regarding placing the biosensors on the injured after video support. Secondary results showed an association between video support and completing a head-to-toe assessment. Both interventions were associated with applying a pelvic sling.

Conclusion: These findings show that laypersons, here construction industry employees, can be supported to achieve good performance as first responders in a major injury scenario. Prior training, but especially live video support without prior training, improves layperson performance in this setting.

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.

Purpose: This study describes preparedness of emergency physicians and general practitioners following chemical, radiological and nuclear incidents.

Design/methodology/approach: Five emergency physicians and six general practitioners were interviewed individually, and data was analysed using qualitative content analysis.

Findings: The study results showed that physicians' preparedness for chemical, radiological and nuclear incidents is linked to one main category: to be an expert and to seek expertise and two categories: preparations before receiving CRN patients, and physical examination and treatment of CRN patients with subcategories.

Research limitations/implications: The results have implications for further research on the complexity of generalist vs specialist competence and knowledge when responding to chemical, radiological and nuclear incidents.

Originality/value: This study provides insights regarding chemical, radiological and nuclear preparedness among physicians at emergency departments and primary healthcare centres.

Postgraduate education programmes in health professions need to assess their students’ ability to practise in relation to the expected standards and to verify that students have met certain criteria upon programme completion (Ossenberg et al., 2015). Assessment of clinical practice must also correspond with the requirements for knowledge, skills, and professional judgements stipulated in national regulatory requirements. In this context, the importance of having valid and reliable assessment tools for the assessment process is clear (Shumway and Harden, 2003; McCarthy and Murphy, 2008; Wu et al., 2015). The present paper reports on a process to update and validate the tool Assessment of Clinical Education (AssCE-master) for use in clinical postgraduate nursing education.

The most common complication due to intubation isa high cuff pressure. A high cuff pressure can causepostanesthetic tracheal mucosal injuries in patientsundergoing surgery. The aim of this cross-sectionalstudy was to describe whether anesthetic nurses andanesthesiologists identified a very high cuff pressureby manual palpation of the external cuff balloon onan endotracheal tube. An airway device was intubatedwith an endotracheal tube cuffed to 95 cm H2O. Eachparticipant palpated the external cuff balloon and thenfilled out a questionnaire, including estimation of thecuff pressure and user frequency of the cuff pressuremanometer. The results showed that 89.1% estimatedthat the cuff pressure was high. Among the participantswho rated the cuff pressure as high, 44.8% ratedthe pressure as quite high and 60.6% rated the pressureas very high. There was no significant relationshipbetween profession and skill in identifying a veryhigh cuff pressure (P = .843) or between work experienceand skill in terms of identifying a very high cuffpressure (P = .816). These findings indicate that 10%of patients are at risk of tracheal erosion because of ahigh cuff pressure.

Background: During the last 20 years there have been different approaches to teaching nurse students cardiopulmonary resuscitation (CPR). Receiving CPR with compressions of adequate depth and frequency, and ventilations of adequate volume improves the chance of survival. The aim of this study was to evaluate effects of different types of feedback on CPR skills among nursing students.

Methods: A pilot study with an explorative approach including 30 nurse students. Students was randomized in three groups; 1) instructor-led training followed by self-training without feedback, 2) self-training with visual graphic feedback, and 3) self-training with voice advisory manikin (VAM). Outcomes were correct compression deep, frequency, hand position and release, and correct ventilation volume and flow. If performance was correct to 70%, students were considered to have reached approved level. The students also answered questions about theoretical knowledge about CPR.

Results: In technical skills, group 2 had significant higher level of correct ventilation volume compared with the other group. Both group 1 and 3 did not reach the level of 70% correct performance. Group 1 and 2 had significant higher level of correct deep of compressions compared with group 3 which did not reach the 70% level. There was no difference in performance between groups in other parameters.

Conclusion: This pilot study suggests that visual graphic feedback is promising and seemed to be more effective than self-training with voice advisory manikin and instructor-led training with followed self-training without feedback.

The aim of the study was to illuminate very old men’s experiences and reflections of purpose in life. The participants were 23 men who were interviewed and answered a specific question about purpose in life. The answers were analyzed according to qualitative content analysis, which revealed three content areas: the purpose of one’s life as a whole; purpose in everyday life; and reflections on purpose in life. Our findings showed that very old men experience purpose in life most strongly when remembering the past and when work is stressed as important. The analyzed text was dominated by positive experiences of PIL, although one man said that he had given up and that there was no purpose in his life at all.