Papers by Lina Gyllencreutz
International Journal of Emergency Services
PurposeMajor incidents in tunnel environment will pose several challenges for the emergency servi... more PurposeMajor 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/approachParticipants 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.FindingsThe study revealed that the tunnel environment presents specific aspects of how commo...
Scandinavian Journal of Caring Sciences
AimThe aim of this study was to illuminate the meaning of being a nurse in the archipelago.Method... more AimThe aim of this study was to illuminate the meaning of being a nurse in the archipelago.Methodological Design and JustificationA 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 ApprovalApproval was granted by the Regional Ethical Committee and local management team. All participants provided consent to participate.Research MethodIndividual 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.ResultsThe 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 ...
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Background Adequate training and preparation of medical first responders (MFRs) are essential for... more 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 t...
International Journal of Emergency Services, 2022
PurposeMajor incidents in road tunnels remain a collaborative challenge for the emergency service... more PurposeMajor 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/approachFocus 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.FindingsThree 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 joi...
International Emergency Nursing, 2021
Underground environments present challenges for providing and managing effective emergency care. ... more Underground environments present challenges for providing and managing effective emergency care. Situational awareness (SA) has been suggested as a critical process to the management of care. Aim: This study aims to explore the process of SA in the tasks of an ambulance incident commander (AIC) during a fullscale underground mine exercise. Methods: Data consisted of video recordings, audiotapes and fieldnotes; these were subjected to content analysis based on the categories from the Busby Theory of Situational Awareness in Multi-casualty Incidents. Results: The results show that the underground mining environment presented the AIC with specific challenges for the SA process with respect to aspects such as situational information about the scene and the victims, as well as with making decisions for ambulance personnel so they could perform their work safely, and having a structured manner to counteract information overload. Both technical and non-technical aspects influenced the process. Conclusion: The AIC's situational awareness was largely built through coordinated communications and actions with collaborating actors. The results of this study can be used for further exploration of how to train and support people in medical leadership roles on aspects of SA in emergency care, as well as on how to evaluate educational outcomes through exercises.
BMJ Open, 2020
ObjectiveIdentify factors of preparedness for peer first response to underground mining emergenci... more ObjectiveIdentify factors of preparedness for peer first response to underground mining emergencies with injured victims.DesignCross-sectional questionnaire study of Swedish underground mineworkers.SettingSeven out of nine Swedish underground mines.ParticipantsA total of 741 mineworkers out of 1022 (73%) participated in this study.InterventionsNone.Outcome measuresLevel of preparedness for emergencies with injuries in underground mines.ResultsThree 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 pe...
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2021
Background In chemical incidents, infrequent but potentially disastrous, the World Health Organiz... more 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 informati...
Tidig och avancerad bedomning kravs nar patienter moter personal inom ambulanssjukvarden. Hur ar ... more Tidig och avancerad bedomning kravs nar patienter moter personal inom ambulanssjukvarden. Hur ar det mojligt att fragan om sankta kompetenskrav inom svensk ambulanssjukvard overhuvudtaget har vackt ...
Background: In chemical incidents, infrequent but potentially disastrous, the World Health Organi... more 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 and testable hypotheses are largely lacking. 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 obt...
International Journal of Emergency Management, 2021
Swedish underground mines are constantly improving their safety. However, major incidents still o... more 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 Medical incident commander leadership during a full-scale exercise 91 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.
BMJ Open, 2020
ObjectivesIncreased demands are placed on emergency services and their role and ability to act in... more ObjectivesIncreased demands are placed on emergency services and their role and ability to act in incidents in challenging environments, for example, road tunnels. Collaboration between officers from emergency services (fire brigade, police and ambulance services) is important for an effective rescue effort. In Gothenburg, Sweden, a position as a senior ambulance officer (SAO) within the emergency medical services (EMS) has been introduced to support the regular force during major incidents. The aim of this paper was to explore the perceptions and experiences of the SAO’s new management role in challenging incidents, such as those occurring in road tunnels.DesignA qualitative interview study.SettingThe study was carried out from February to June 2019 in Gothenburg, Sweden, which is a municipality with several road tunnels and a population of approximately 580 000 people. SAOs collaborate with the corresponding function within the police and fire brigade, both having senior officers ...
Nordic Journal of Nursing Research, 2020
To meet both current and future competence needs, improved and updated understanding of nurses’ s... more 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 m...
Prehospital and Disaster Medicine, 2019
Introduction:Major injury incidents in confined settings such as tunnels and underground mineral-... more Introduction:Major injury incidents in confined settings such as tunnels and underground mineral- and metalliferous mines are rare, but when they do happen, the consequences may be severe with potential for many injured. The incident site is underground and it is difficult for the rescue and emergency medical service to get an overview and reach the injured. Therefore, it is important for the emergency medical service, rescue service, and the company responsible for the underground environment to have a good collaboration.Aim:To develop best practices of conducting rescue response from a disaster medicine perspective in tunnels and underground mines through increased education.Method:Within an EU-program, the university collaborates with stakeholders such as rescue service, emergency medical service, and two mining companies. Within this project, an explorative case study with participatory research is conducted. This is managed with the help of representatives of the stakeholders, ...
Prehospital and Disaster Medicine, 2019
Introduction:The underground mining industry has one of the most hazardous industrial occupations... more Introduction:The underground mining industry has one of the most hazardous industrial occupations, and requires an increased level of preparedness for injury incidents. The most important outcome for seriously injured victims is the reduction in morbidity and mortality. Receiving effective and timely care may mean the difference between life and death. However, mines are usually located in a rural area and the incident site may be deep underground which makes it an extraordinary challenge for the rescue services. A successful rescue response in an extraordinary milieu demands a high level of inter-organizational cooperation skills at the incident site.Aim:To analyze statements of collaborate activities during a major incident exercise in the underground mine industry, essentially for patient outcome.Methods:A Delphi technique was performed, asking opinions from experts in iterative rounds to generate, understand, and form consensus on group opinion around this complex issue. The exp...
Prehospital and Disaster Medicine, 2019
Introduction:Norway is a country with many road tunnels and therefore also has experience with re... more Introduction:Norway is a country with many road tunnels and therefore also has experience with rescue operations in tunnel environments. Major incidents always challenge involved emergency services’ management skills. Oslo, Norway has a specially trained medical on-scene commander, a function already existing in police and rescue service. Intra-agency communication and management of personnel are essential factors for a successful rescue effort.Aim:To investigate the medical management provided by the specially trained Norwegian medical on-scene commander in relation to tunnel incidents.Methods:Interviews were conducted with six of the seven medical on-scene commanders in Oslo. The collected data were analyzed using qualitative content analysis.Results:An overarching theme emerged: A need for mutual understanding of the tunnel incident. The medical on-scene commanders established guidelines for response in collaboration with the other emergency services. By creating a sense of trust...
Prehospital and Disaster Medicine, 2019
Introduction:Major injury incidents in underground metalliferous and mineral mines are rare, but ... more Introduction:Major injury incidents in underground metalliferous and mineral mines are rare, but if, e.g., a major fire would occur, it is the emergency medical service (EMS) together with the mining company and rescue service who perform the rescue operation. Therefore it is important to develop safe and efficient rescue operation procedures for all the organizations involved, especially the EMS personnel.Aim:To examine EMS personnel’s perceptions and experiences regarding underground mining incidents.Method:Individual interviews were performed with 13 Swedish EMS personnel. The interviews were transcribed verbatim and analyzed with qualitative content analysis.Results:The theme “providing the same care in a difficult environment” emerged. Depending on the type of incident, the EMS personnel considered if the injured mining workers could be cared for either outside or in the mine in order to access and care for the injured mining workers as quickly as possible. The EMS personnel me...
International Journal of Emergency Management, 2019
Mass casualty incidents (MCI) in tunnels can result in devastating consequences. Despite this, th... more Mass casualty incidents (MCI) in tunnels can result in devastating consequences. Despite this, there is a knowledge gap in the perspectives and experiences of strategic stakeholders in relation to the emergency medical response to MCI in tunnels. This study aims to explore and describe this issue. The study includes 11 interview participants from the emergency services organisations and governmental and municipal organisations in Sweden. The results indicate that the medical perspective is inadequately represented at a strategic level due, among other, to limited input from emergency medical representatives during planning stages and a lack of social networks. The results implicate a need to create and improve networks among the stakeholders from the involved organisations. Emergency medical personnel should not only be acknowledged for their expertise but should also be included to a greater extent in the planning stages and exercises. Medical and rescue personnel need time to jointly discuss how they, in the best way, can save lives in tunnel MCIs.
International Journal of Emergency Services, 2019
Purpose The purpose of this paper is to examine emergency medical service (EMS) personnel’s perce... more Purpose The purpose of this paper is to examine emergency medical service (EMS) personnel’s perceptions and experiences of managing underground mining injury incidents. Design/methodology/approach In total, 13 EMS personnel were interviewed according to a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using qualitative content analysis. Findings An underground mining environment was described as unfamiliar and unsafe and, with no guidelines for operational actions in an extreme environment, such as underground mines, the EMS personnel were uncertain of their role. They therefore became passive and relied on the rescue service and mining company during a major incident. However, the medical care was not considered to be different from any other prehospital care, although a mining environment would make the situation more difficult and it would take longer for the mine workers to be placed under definitive care. Originality/value This study comp...
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2019
Background: High demands are placed on the emergency medical services to handle rescue operations... more 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.
Education 3-13, 2018
Approximately 36,000 Swedish children seek medical care annually because of injuries during schoo... more Approximately 36,000 Swedish children seek medical care annually because of injuries during school time. The purpose of this field study is to investigate risky outdoor play at the school yard and to describe teachers' perceptions of risk and safety in relation to learning and development. The study includes observations of children (6-12 years old) during outdoor activities as part of the school's activities and includes focus-group interviews with teachers and children. Children were seen climbing high in play facilities, speeding down slides, or competing with sticks in the woods. Different views of risk and safety among the participants influence outdoor play activities. Teachers' knowledge of risk seems to be derived from common sense and personal experiences rather than from a professional perspective. A joint approach of educational and medicine disciplines is desirable when it comes to children's health and development.
Uploads
Papers by Lina Gyllencreutz