Umeå University's logo

Background: Increasing mountain activity and decreasing participant preparedness, as well as climate change, suggest needs to tailor mountain rescue. In Sweden, previous medical research of these services are lacking. The aim of the study is to describe Swedish mountain rescue missions as a basis for future studies, public education, resource allocation, and rescuer training.

Methods: Retrospective analysis of all mission reports in the national Swedish Police Registry on Mountain Rescue 2018–2022 (n = 1543). Outcome measures were frequencies and characteristics of missions, casualties, fatalities, traumatic injuries, medical conditions, and incident mechanisms.

Results: Jämtland county had the highest proportion of missions (38%), followed by Norrbotten county (36%). 2% of missions involved ≥ 4 casualties, and 44% involved ≥ 4 mountain rescuers. Helicopter use was recorded in 59% of missions. Non-Swedish citizens were rescued in 12% of missions. 37% of casualties were females. 14% of casualties were ≥ 66 or ≤ 12 years of age. Of a total 39 fatalities, cardiac event (n = 14) was the most frequent cause of death, followed by trauma (n = 10) and drowning (n = 8). There was one avalanche fatality. 8 fatalities were related to snowmobiling, and of the total 1543 missions, 309 (20%) were addressing snowmobiling incidents. Of non-fatal casualties, 431 involved a medical condition, of which 90 (21%) suffered hypothermia and 73 (17%) cardiovascular illness.

Conclusions: These baseline data suggest snowmobiling, cardiac events, drownings, multi-casualty incidents, and backcountry internal medicine merit future study and intervention.

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.

The crash of a coach with 58 occupants at 100 kmph revealed the danger of covering ditch areas with sharp stones 5–20 cm in size. Stones and dirt were sprayed into the coach compartment resulting in serious injuries and death. Road safety works need to address this factor in the future.

Denna sammanfattning redovisar de viktigaste resultaten och slutsatserna i delrapport 1 och 2.

Dödsolyckor och allvarliga olyckor i arbetet har minskat kraftigt sedan 1950-talet i Sverige. I dag drabbas i genomsnitt 1 av 100 000 personer av en dödsolycka i arbetet och 1 av 500 personer av en allvarlig arbetsolycka.1 Nio av tio arbetsrelaterade dödsolyckor drabbar män. Dödsolyckor drabbar i högre grad äldre personer och mer än hälften av männen som omkom 2010-2014 var över 50 år. En delförklaring är att äldre får svårare skador än yngre om de utsätts för samma skadevåld och därmed ökar risken för en dödlig utgång.

Fordonsrelaterade olyckor utgör ca hälften av alla dödsolyckor. Hälften av dem sker i vägtrafikområden och hälften i andra miljöer. Fallolyckor är en annan viktig orsak till dödsolyckor och då främst fall från en höjd. Många sådana olyckor inträffar inom byggverksamhet, och vår analys tyder på att byggställningar kan vara ett område för förbättringar för att undvika tekniska brister. Dödliga elolyckor drabbar framför allt äldre elinstallatörer, som sannolikt har långvarig yrkeserfarenhet. Det talar för att också personer med lång erfarenhet kan behöva återkommande utbildningar. Trädfällning är en annan betydande orsak till dödsolyckor, framför allt inom jord- och skogsbruk.

En jämförelse av data ur registren för dödliga och allvarliga arbetsolyckor visar att det finns skillnader, bland annat när det gäller vem som drabbas och var skadan inträffar. Det innebär att register om allvarliga men icke dödliga skador ger begränsad information om vilka förebyggande åtgärder som är lämpliga mot dödsolyckor och var de ska sättas in.

Vi har även analyserat uppgifter från dödsorsaksregistret i kombination med yrkesregistret. Resultatet ger ingen ytterligare information utöver den man kan få ur Arbetsmiljöverkets register. Vi har också studerat data från registret över personer som vårdats i sluten vård på sjukhus och kombinerat detta med data från yrkesregistret. Resultatet ger ingen ytterligare information utöver den man kan få ur Arbetsmiljöverkets eller AFA Försäkrings register.

1 En olycka som kräver mer än 14 dagars sjukskrivning.10

Våra viktigaste slutsatser är:

• Dödsolyckor och allvarliga olyckor är sällsynta händelser och händelseförloppet varierar mycket. Därför är det svårt för företag, organisationer och grupper av individer (arbetskamrater, den drabbade etcetera) att lära sig något av en olycka. Därmed bedömer vi att personliga erfarenheter och allmän information om olycksrisker har begränsat värde för att minska antalet dödsolyckor och allvarliga olyckor. I stället anser vi att det förebyggande arbetet bör inriktas mot att prioritera tekniska lösningar som minskar risker samt att införa strikta organisatoriska rutiner för till exempel skyddsutrustning och handhavande där det finns risk för dödsolyckor. Så sker redan idag i mycket riskmedvetna organisationer som till exempel flyget.
• Strategierna för att förebygga dödsolyckor respektive allvarliga olyckor bör delvis ha olika fokus. Det går alltså inte att prioritera åtgärder mot dödsolyckor i arbetslivet enbart utifrån var och hur allvarliga skadefall inträffar.
• Vissa typer av dödsolyckor är vanligare än andra och ca två tredjedelar av alla dödsolyckor gäller fordonsolyckor och fallolyckor från höjd. För att minska förekomsten mer påtagligt måste man inrikta åtgärder mot dem.
• Vissa grupper är också mer utsatta än andra, till exempel personer som arbetar med eller vid fordon och på hög höjd. Många sådana arbeten är på tillfälliga arbetsplatser, vilket ofta ställer särskilda krav på att individen själv förebygger risker. Därför krävs särskild och fortlöpande utbildning. Dödsolyckor bland elektriker drabbar främst äldre personer, liksom dödsolyckor i samband med trädfällning. Därför är det viktigt att upprätthålla kunskap och medvetenhet om risker även hos personer med långvarig yrkeserfarenhet. Vidare kan det behövas särskilt anpassade åtgärder för små företag eller egenföretagare.
• Utredningarna av dödsolyckor och allvarliga olyckor kan utvecklas för att få ett ännu tydligare fokus på det förebyggande arbetet.

Fatal and serious occupational accidents have decreased in Sweden since the 1950s. Today, there is on average, about 1 fatal outcome of occupational accidents per 100 000 persons, and 1 serious accident per 500 persons.2 Nine of ten occupational accidents with fatal outcome 2010-2014 happened to men. Fatal accidents are more common among elderly people and more than half of the male victims were over the age of 50. Older people often suffer more severe injuries than younger people for the same trauma, which may have contributed to the observed higher death rate among mature and elderly persons.

Accidents related to vehicles represented about half of all fatalities. Half of these happened on public roads in ordinary road traffic, and the other half happened in other places and under other circumstances than vehicle crashes. Falls, especially from higher level, were another significant cause of fatal accidents. Many such accidents occurred in the construction industry, and our analysis indicates that e.g. improvement of scaffolding could decrease the risk. Half of fatally injured electricians were older than 58 years with long occupational experience. This indicates that persons with long experience may also need repeated training and education. Cutting down trees was another important cause of fatalities, especially among older persons working within forestry and agriculture.

Comparative data from registers of fatal and serious occupational accidents indicates differences in who had the accident and where the accident occurred. This means that a register of non-fatal accidents gives limited information about possible strategies for the prevention of accidents with fatal outcome.

2 A serious accident is an accident with at least 14 days sick absenteeism.12

Important conclusions are

• Fatal and serious occupational accidents are rare events with different causes. It is therefore difficult for organizations and working groups to learn from incidents in their own organization. Personal experience and general information about risks have thus limited potential to prevent fatal and serious accidents within a single organization if not compiled or aggregated in e.g. a wider national perspective. We think that injury mitigation work should focus on technical measures and support strict organizational procedures, e.g. for the use of protective equipment especially where there is risk for fatal accidents. Today that is routine procedure in organizations with high awareness of risks, such as the aviation industry.
• The strategy for prevention of fatal and serious occupational injuries may partly have different focus as their epidemiology is different.
• Two of three fatal accidents are related to vehicles, or to falls from higher level, which are the two most important areas to address in the injury reducing work of fatalities.
• Many of the most risky activities above happened at temporary workplaces, which often require that the worker themselves prevent risks. This requires special training and education.
• Fatal accidents due to electricity or cutting of trees often happened to mature and elderly persons. It may indicate that continuous training and education could be of value also in experienced persons as well as in small enterprises and among the self-employed.
• Investigation of fatal and serious occupational accidents could be developed to have an even stronger focus on injury mitigation and prevention.

BACKGROUND: A data acquisition from the medical sector may give one important view of the burden on the society caused by vehicle related injuries. The official police-reported statistics may only reflect a part of all vehicle-related injured seeking medical attention. The aim is to provide a comprehensive picture of the burden of vehicle related injuries on the medical sector (2013), and to compare with official police-reported statistics and the development year 2000-2013.

METHODS: The data set includes 1085 injured from the Injury Data Base at Umeå University Hospital's catchment area with 148,500 inhabitants in 2013.

RESULTS: Bicyclists were the most frequently injured (54%). One-third had non-minor (MAIS2+) injuries, and bicyclists accounted for 58% of the 1071 hospital bed days for all vehicle-related injuries. Car occupants represented 23% of all injured, and only 9% had MAIS2+ injuries. They accounted for 17% of the hospital bed days. Motorized two wheel vehicle riders represented 11% of the injured and 39% had MAIS2+ injuries and they occupied 11% of the hospital bed days. Of the 1085 medically treated persons, 767 were injured in public traffic areas, and, therefore, should be included in the official police statistics; however, only a third (232) of them were reported by the police. The annual injury rate had not changed during 2000-2013 for bicyclists, motor-cycle riders, pedestrians or snowmobile riders. However, for passenger car occupants a decrease was observed after 2008, and for mopedists the injury rate was halved after 2009 when a licensing regulation was introduced.

CONCLUSION: The Swedish traffic injury reducing strategy Vision Zero, may have contributed to the reduction of injured car occupants and moped riders. The official police-reported statistics was a biased data source for vehicle related injuries and the total number medically treated was in total five times higher. Bicyclists caused the heaviest burden on the medical sector; consequently, they need to be prioritized in future safety work, as recently declared in the Government plan Vision Zero 2.0.

Nio av tio arbetsrelaterade dödsolyckor drabbar män. Utifrån vår analys verkar det som att kvinnor och män har liknande risk att drabbas av en dödsolycka om förhållandena i arbetsmiljön är likartade.

Dödsolyckor drabbar också i högre grad äldre personer än yngre, och mer än hälften av männen som omkom var över 50 år. En viktig delförklaring är att äldre får svårare skador och har högre risk för dödlig utgång än yngre om de utsätts för samma skadevåld.

Fordonsrelaterade olyckor utgör ca hälften av alla dödsolyckor, och hälften av dem sker i vägtrafikområden. Det finns dock redan många aktörer som arbetar för att förebygga olyckor i trafiken, så aktörer inom arbetsmiljöområdet bör prioritera förebyggande åtgärder i andra miljöer. Olyckor i sådana andra miljöer utgör ca en fjärdedel av alla dödsolyckor.

Fallolyckor är en viktig orsak till dödsolyckor och då främst fall från höjd. Många sådana olyckor inträffar inom byggverksamhet, och vår analys tyder på att tekniska brister i byggställningar kan vara ett område för förbättringar. Dessutom bör åtgärder riktas mot gruppen äldre elinstallatörer eftersom de förhållandevis ofta drabbas av dödliga elolyckor.

Trädfällning är en annan betydande orsak till dödsolyckor, framför allt inom jord- och skogsbruk.

En jämförelse mellan data ur registren för dödliga och svåra men icke-dödliga arbetsolyckor visar på stora skillnader ibland annat vem som drabbas och var skadan inträffar. Det innebär att register om svåra men icke-dödliga skador ger begränsad information om vilka förebyggande åtgärder som är lämpliga mot dödsolyckor och var de ska sättas in.

Sammantaget visar vår analys att statistik över allvarliga arbetsrelaterade olyckor, baserat på sjukskrivningstid, har begränsat värde när det gäller att prioritera åtgärder för att förebygga arbetsrelaterade dödsolyckor. I registren finns fritextsvar som beskriver händelseförloppet för varje anmäld olycka. En textanalys av dessa beskrivningar kan ge värdefull kunskap, men det är något som behöver studeras ytterligare.

Senior citizens get around, to a large extent, as pedestrians, and safe walking is desirable for senior citizens allowing them to stay mobile, independent and healthy in old age. Senior citizens are over-represented in injury statistics, and fall-related injuries are common. The aim of this study was to investigate fall-related injuries including healthcare costs among senior citizen pedestrians injured when walking in public outdoor environments and to describe their self-reported causes and suggested preventive strategies. The data were based on a combination of information from injury data and a questionnaire. Three hundred senior citizens attended one emergency department after sustaining injuries from pedestrian falls; 60% suffered nonminor injuries, mostly fractures. One-fifth of the pedestrians were hospitalised for an average of 8 days with an indirect hospital cost of 6.2 million EUR (55 million SEK). Environmental factors such as ice were the most commonly described cause of the injury incident. Forty per cent of the respondents indicated that the municipality was responsible for the cause of the injury incident. Fewer respondents mentioned their own responsibility as a preventive strategy. Thirty per cent described a combination of improvements such as better road maintenance, changes in human behaviour and use of safety products as preventive strategies. It is of great importance to highlight general safety, products and preventive strategies to minimise injury risks, so that pedestrians can safely realise the known health benefits of walking and thereby limit healthcare costs.

Objective: To study the epidemiology and causes of death in fatal car crashes on Swedish roads in which the victim's vehicle caught fire. Methods: The data set is from the Swedish Transport Administrations in-depth studies of fatal crashes 1998-2008. Autopsies from all cases provided data on injuries, toxicological analyses, and cause of death. Results: In total, 181 people died in 133 burning cars, accounting for 5 percent of all deaths in passenger cars, sport utility vehicles, vans, and minibuses during 1998 to 2008. The cause of death for a third of the victims was fire related, as burns and/or smoke inhalation injuries, with no fatal trauma injuries. Twenty-five of these 55 deaths were persons 19 years or younger and included 15 of 18 rear seat deaths. Over half of the 181 deaths were in vehicles that had collided with another vehicle and, of these cases, half were killed in collisions with heavy vehicles. The percentage of drivers with illegal blood alcohol concentrations (27%) and suicides (5.5%) were not higher than in other fatal crashes on Swedish roads. The ignition point of the fire was indicated in only half of the cases and, of those, half started in the engine compartment and one fourth started around the fuel tank or lines. Conclusions: Car fires are a deadly postcrash problem. Reducing this risk would be primarily a responsibility for the automotive industry. A multifactor approach could be considered as follows: risk-reducing design, insulation, reduced flammability in motor compartment fluids and plastics, and automatic fire extinguishing equipment. Inspiration could be found in how, for example, the auto racing and aviation industries handle this problem.

Between 1995 and 2004, 293 passenger car occupants died in collisions with other vehicles in northern Sweden (annual incidence: 3.3 per 100,000 inhabitants, 6.9 per 100,000 cars, or 4.8 per 109 km driven); half of these deaths involved heavy vehicles. The annual number of passenger car occupant death per 100,000 cars in var-truck/bus collisions has remained unchanged since the 1980s, , but in car-car collisions it has decreased to one third of its former level. As crash objects, trucks and buses killed five times as many car occupants per truck/bus kilometer driven as did cars.

The collisions were characterized by crashes in the oncoming vehicle´s lane, under icy, snowy, or wet conditions; crashes into heavy vehicles generally occurred in daylight, on workdays, in winter, and on 90 and 70 km/h two-lane roads. Head and chest injuries accouted for most of the fatal injuries. multiple fatal injuries and critical and deadly head injuries characterized the deaths in collisions with heavy vehicles.

An indication of suicide was present in 4% of the deaths; for thos who crashed into trucks, this percentage was doubled. Among the driver victims, 4% had blood alcohol levels above the legal limit of 0.2 g/L.

Frontal collision risks might be reduced by a mid-barrier, by building less injurious fronts on trucks and buses, by efficient skid prevention, and by use of flexible speed limits varying with road and light conditions.