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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.

Purpose: Major incidents in tunnel environment will pose several challenges for the emergency service organisations in terms of heat, visibility and lack of experiences from working in confined environments. These aspects, in turn, could pose challenges to establish collaboration. This study aims to contribute to the field of collaborative tunnel responses by exploring how “common knowledge” (Edwards, 2011) is built by the emergency services organisations, that is, what the organisations consider important while working on a potentially common problem, and their motives for the interpretations and actions if a major tunnel incident occurs.

Design/methodology/approach: Participants from the road traffic control centre, emergency dispatch centre, emergency medical service, rescue service and police were included in the study. Data from four focus group sessions was analysed using thematic analysis.

Findings: The study revealed that the tunnel environment presents specific aspects of how common knowledge was produced related to lifesaving and safety. The themes structuring mechanisms to reduce uncertainty, managing information for initial priorities, aligning responsibilities without hampering each other's work and adjusting actions to manage distance, illustrated how common knowledge was produced as crucial aspects to a collaborative response. Organising management sites, grasping and communicating risks, accessing the injury victims, was challenged by the confined environment, physical distances and imbalance in access to information and preparedness activities in tunnel environments.

Originality/value: This study offers new insights of common knowledge, by illustrating a motive perspective on collaborative responses in tunnel incidents. Creating interoperability calls not just for readiness for action and tunnel safety, but also training activities acknowledging different interpretations and motives to further develop tunnel responses.

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.

Objectives: If a chemical incident occurs, the emergency response centre (ERC) personnel are the first that are notified. They need to quickly attain situation awareness, based on the information from the caller, in order to dispatch the correct emergency units. The aim of this study is to examine the situation awareness of the personnel working at ERCs-how they perceive, comprehend, project and act during chemical incidents.

Methods: Semi-structured individual interviews with 12 participants from the Swedish ERCs were performed. The interviews were analysed with qualitative content analysis.

Results: Three categories of responses were identified. Responses focused on the complexity of identifying chemical incidents, the importance of ensuring the safety of citizens and personnel of emergency organisations and the situation-based dispatch of organisations.

Conclusions: The correct identification of the chemical incident and the involved chemical by the ERC personnel are necessary in order to notify, inform and dispatch the correct units, as well as to ensure the safety of citizens and emergency personnel. More research is needed about the dichotomies of the ERC personnel needing as much information as possible for everyone's safety versus their responsibility for the safety of the caller as well as between using emergency dispatch index interview guides and trusting their gut feeling.

Introduction: Leadership during major incidents has been described as challenging and dependent on the non-technical skills of leaders. The complex tunnel environment contributes to an even more challenging incident response. Hence, this study aims to identify elements of non-technical skills when leading collaborative road-tunnel incident responses.

Methods: The study was conducted using four focus group discussions with tactical leaders from the rescue services, emergency medical services, police, and collaborative organizations from the emergency dispatch center and road-traffic control center. The data was analyzed using a non-technical skills taxonomy.

Results: Twelve non-technical skill elements emerged. Abilities to gather, sort, and proactively share relevant information and dispatch the correct resources were described. Additionally, abilities to prioritize actions and cooperate to establish a shared operational picture were found. Abilities to adjust leadership to the tunnel environment and conditions and assess the severity of the incident to make decisions were also described.

Conclusion: When managing a road-tunnel incident response, tactical leaders utilizes a range of non-technical skills. The elements of these skills were found to be specific both to the tunnel environment and the collaborative nature of the response. Further studies into and development of these skills are needed to facilitate a timely response and minimize potential risks to personnel or evacuees in future tunnel incident responses.

Colorectal cancer (CRC) remains one of the most common cancers worldwide. Metastatic disease is ultimately fatal when incurable. Cancer research has evolved to take the importance of the tumour microenvironment (TME) into account. The extracellular matrix (ECM) has been viewed merely as a structural scaffold, but it is now evident that the ECM is a highly active part of the TME and affects tumour cell behaviour and metastatic capability. The ECM context and composition are linked to patient outcome and the response to surgical and oncological therapy in CRC patients and may be an area for developing novel biomarkers and targeted therapy. In this review we focus on the components of the ECM in human primary and metastatic CRC. We discuss future aspects of the ECM for targeted therapy, as a source of novel biomarkers, current knowledge of the area and important considerations when studying the ECM in human CRC.

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.

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.