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Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway: an interview study
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Disaster Medicine, Umeå University.ORCID iD: 0000-0003-1346-7200
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Disaster Medicine, Umeå University.ORCID iD: 0000-0003-3716-6445
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Disaster Medicine, Umeå University.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Disaster Medicine, Umeå University.ORCID iD: 0000-0002-1848-060x
2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 27, no 1, article id 78Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
2019. Vol. 27, no 1, article id 78
Keywords [en]
Medical on-scene commander, Prehospital emergency care, Tunnel incidents
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-163681DOI: 10.1186/s13049-019-0649-8ISI: 000483063100001PubMedID: 31429788Scopus ID: 2-s2.0-85071262204OAI: oai:DiVA.org:umu-163681DiVA, id: diva2:1362814
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2024-01-17Bibliographically approved
In thesis
1. Prehospital medical management in Swedish road tunnel incidents
Open this publication in new window or tab >>Prehospital medical management in Swedish road tunnel incidents
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Prehospital sjukvårdsledning vid skadehändelser i svenska vägtunnlar
Abstract [en]

Background: The complexity of modern road tunnel systems may delay an efficient rescue effort. Capable decision-making is needed to limit time to care. The Swedish ambulance commander, responsible for the on-scene ambulance personnel, may lack education and experience from managing road tunnel incidents. Their competence is sometimes questioned by fellow emergency services commanders. Such marginalization may obscure the medical focus and give the ambulance commander a subservient role. The ambulance commander’s role and lack of knowledge need to be explored and addressed to potentially improve their competence in managing road tunnel incidents.

Aim: The overall aim of this thesis was to explore the possibilities of strengthening the decision-making ability of ambulance commanders to create more efficient rescue efforts in road tunnel incidents.

Methods: In studies I and II, interviews were conducted with ambulance commanders (n=18) in Norway and Sweden concerning their experience in managing real and simulated road tunnel incidents. In study III, interviews were conducted with participants (n=19) from organizations that collaborates with the Swedish ambulance services in road tunnel incidents, about their opinions on how the ambulance commanders can improve their incident management. In study IV, an e- learning course was created based on the findings of studies I–III. The course influence on the ambulance commander’s ability to make decisions in road tunnel incidents was tested through an intervention study (n=20) which contained two simulations of major road tunnel incidents.

Results: In study I, the requirement of familiarity with the tunnel system and involved organizations tasks were highlighted as important for the Norwegian ambulance commanders in their leadership role. In study II, the Swedish ambulance commanders described their leadership role as greater than that at the incident site, e.g., caring for their colleagues and being proactive, although having limited time allocated for these tasks. Findings from study III highlighted the importance of risk management and a shared terminology when responding to road tunnel incidents to avoid time-consuming misunderstandings. In study IV, the main finding was that none of the participants entered the dual- tube road tunnel correctly at the early stage of an incident. Secondly, theiiie-learning course did not significantly impact the ambulance commanders decision-making capabilities.

Conclusion: The resilience of ambulance services to road tunnel incidents requires a knowledgeable and decisive ambulance commander. Inter- and intraorganizational obstacles limit the ambulance commander to become familiar with the tunnel environment, generating ambiguous decision-making. Tailored assessment methods and educational material may improve the ambulance commander situational awareness. Findings also indicate that the ambulance services command structure may be less than optimal in its current form. A senior ambulance commander, hierarchically equal to corresponding emergency services command structures, could possibly strengthen prehospital medical management in unfamiliar and complex settings such as the currently studied.

Abstract [sv]

Bakgrund: Våra vägtunnlar blir alltmer komplexa vilket kan leda till fördröjning av räddningsinsatsen. Skickliga beslut behöver fattas för att minska tiden till vård. Sjukvårdsledaren, ansvarig för ambulanspersonalen på skadeplatsen, anses sakna utbildning och erfarenhet från att leda skadehändelser i vägtunnlar. Deras kompetens ifrågasätts ibland av befäl från samverkande blåljusorganisationer. Denna typ av marginalisering kan leda till att det medicinska fokuset hamnar i skymundan och att sjukvårdsledaren får en underställd roll. Sjukvårdsledarens roll och kunskapsbrist behöver utforskas och adresseras för att potentiellt stärka deras kompetens att leda skadehändelser i vägtunnlar.

Syfte: Det övergripande syftet med denna avhandling var att undersöka möjligheterna att stärka sjukvårdsledarnas förmåga att fatta beslut, för att skapa mer effektiva sjukvårdsinsatser vid skadehändelser i vägtunnlar.

Metod: I studie I och II genomfördes intervjuer med sjukvårdsledare (n=18) i Norge och Sverige avseende deras erfarenheter av att leda verkliga och simulerade skadehändelser i vägtunnlar. I studie III genomfördes intervjuer med deltagare (n=19) från organisationer som samverkar med den svenska ambulanssjukvården vid skadehändelser i vägtunnlar avseende deras uppfattning om vad sjukvårdsledaren behöver för att förbättra sitt sätt att leda. I studie IV utvecklades och testades en internetbaserad utbildning som baserats på fynden i studie I—III. Kursens påverkan på sjukvårdsledarens förmåga att fatta beslut vid skadehändelser i vägtunnlar testade genom en interventionsstudie (n=20) som innefattande två simuleringar av stora skadehändelser i vägtunnlar.

Resultat: I studie I framkom det att förtrogenhet med tunnelsystemet och samverkande organisationers uppgifter var viktigt för de norska sjukvårdsledarna i deras ledarroll. I studie II beskriver svenska sjukvårdsledare ledarrollen som något som är mer omfattande än att enbart leda arbetet på skadeplatsen, som exempelvis att bry sig om sina kollegor och arbeta förbyggande, trots att de fick begränsad tid avsatt för dessa uppgifter. Det huvudsakliga fyndet i studie IV var att ingen av deltagarna beslutade att gå in i tunnelsystemet (som har separata tunnelrör) på rätt sätt i det inledande skedet av en skadehändelse. Ett avvde sekundära fynden var att den internetbaserade utbildningen inte hade en signifikant påverkan på sjukvårdsledarens förmåga att fatta beslut.

Slutsats: Ambulanssjukvårdens motståndskraft mot skadehändelser i vägtunnlar kräver en kunnig och beslutskapabel sjukvårdsledare. Intra- och interorganisatoriska hinder begränsar sjukvårdsledarens möjlighet att bli förtrogen med tunnelmiljön vilket leder till ambivalens i beslutsfattandet. Utvärderingsmetoder och utbildningsmaterial som är skräddarsydda efter sjukvårdsledarens behov kan förbättra sjukvårdsledarens situationsförståelse. Fynden indikerar även att ambulanssjukvårdens ledningsstruktur kanske inte är helt optimal i dess nuvarande form. En mer senior sjukvårdsledare, hierarkiskt likställd med samverkande blåljusorganisationers ledningsstruktur kan möjligtvis stärka sjukvårdsledningen i den främmande och komplexa miljö som har studerats i denna avhandling.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2023. p. 72
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2251
Keywords
Road tunnel, incident management, disaster medicine, emergency medical services, e-learning, education, ambulance commander
National Category
Surgery Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-211184 (URN)9789180700986 (ISBN)9789180700979 (ISBN)
Public defence
2023-09-08, Major Groove, 6L-1, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Transport AdministrationRegion VästerbottenSwedish National Board of Health and WelfareEuropean Regional Development Fund (ERDF)
Available from: 2023-08-15 Created: 2023-06-29 Last updated: 2023-06-29Bibliographically approved

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Hylander, JohanSaveman, Britt-IngerBjörnstig, UlfGyllencreutz, Lina

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