Bakgrund: I det akuta skedet kräver svårt skadade traumapatienter omhändertagande av ett interprofessionellt team med flera specialiteter. Anestesi är en av dessa och utgörs av anestesiläkare och anestesisjuksköterska vars primära uppgift är att upprätthålla fri luftväg. För att kunna göra ett gott arbete för patienten krävs att anestesisjuksköterskan är flexibel, stresstålig och har lätt för att samarbeta i nya arbetskonstellationer. Syfte: Syftet med studien var att beskriva anestesisjuksköterskans upplevelse av att medverka i ett traumateam. Metod: En kvalitativ metod valdes och data samlades in genom semistrukturerade intervjuer. Åtta intervjuer hölls med anestesisjuksköterskor från ett mindre och ett medelstort sjukhus i västra Sverige. Datamaterialet analyserades med en kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre teman Att kunna arbeta i ett team, Att vara närvarande i mötet med patienten och Att invänta- genomföra- och avsluta vårdandet. Dessa delades in i ytterligare nio subteman. Konklusion: För att kunna bedriva effektiv och patientsäker vård krävs ett gott samarbete inom traumateamet. Samarbete främjas av tydligt ledarskap och god kommunikation. ATLS och tydlig arbetsfördelning är nödvändigt för att göra rätt bedömningar och sätta in relevanta åtgärder i det akuta läget. Det upplevs värdefullt att skapa en vårdande relation med patienten. När en vårdande relation etableras upplevs patientens oro och ångest minska.

Traffic efficiency applications over road networks have been investigated recently using VANETs. This area of research is primarily concerned with increasing the traffic fluency over road networks. In this thesis, we first propose an efficient and accurate protocol to detect congested road segments in a downtown area using VANETs. We refer to this protocol as the Efficient COngestion DEtection (ECODE) protocol. ECODE evaluates three different traffic characteristics of each road segment including traffic speed, traffic density, and the time required to travel the segment. Moreover, ECODE evaluates traffic characteristics and detects the congestion level in each direction of the road segment. In addition, we propose an intelligent, dynamic, distributed, and real-time path recommendations protocol. We refer to this protocol as Intelligent path reCOmenDation (ICOD) protocol. ICOD is the first path recommendation protocol that does not rely on a central database of gathered traffic data for each area of interest. Eliminating centralized behavior resolves bottleneck as well as single point of failure problems, which in turn minimizes congestion and collision problems in VANETs. Furthermore, ICOD selects the path towards each destination in a hop-by-hop manner, which makes the turn decision at each road intersection more accurate and real-time. Different variants of ICOD are introduced that consider travel time, travel distance, fuel consumption, gas emissions, and context-awareness of each road segment parameters. Moreover, two traffic balancing mechanisms are proposed in this thesis to distribute traffic over the road network evenly, namely Bal-Traf and Abs-Bal. These mechanisms eliminate the highly congested road segment scenarios that are caused by the path recommendation protocol. Bal-Traf detects and eliminates the highly congested output road segment at each road intersection. However, Abs-Bal aims to keep the traffic density balanced among all output road segments at each road intersection. Finally, we propose an Intelligent Traffic Light Controlling (ITLC) algorithm to schedule the phases of each traffic light at isolated road intersections. This algorithm aims to decrease the queuing delay time of competing traffic flows and to increase the throughput of each signalized road intersection. ITLC has also been adapted in this thesis to the Arterial Traffic Lights (ATLs) algorithm for arterial road network scenarios. In ATLs the expected platoons on the arterial street are considered in the scheduling algorithm of each traffic light located on the arterial street coordinates. Transmitting packets among these traffic lights report the main characteristics of each predicted platoon.

Aim To review the recent evidence that has resulted from experiences in and out of conflict in relation to improving imaging in cases of major trauma. Method A search of electronic databases, the internet and Cochrane library was undertaken to identify relevant publications which were analysed in terms of quality. Evidence that has emerged from civilian and military practice that could influence the practice of major trauma imaging in future was discussed. Results The importance of speed in assessing patients suffering major trauma is becoming more recognised. There is growing evidence that the use of portable ultrasound at the site of major trauma as first line investigation has potential. In more stable patients, the evidence for whole body CT at the expense of radiography is also growing. The concern regarding availability and radiation dose related to CT scanning remain significant but with the outcome of the recent Major Trauma Review and improvements in CT scanning techniques, such concerns are being addressed. There is limited research in the use of MRI in relation to major trauma. Conclusion Ultrasound at the sight of major trauma has potential but further research will be needed. Factors such as operator training in particular need to be considered. CT scanning remains an important diagnostic tool for patients suffering major trauma and this is borne out by the Major Trauma Review and NICE guidelines. The availability of CT scanning in relation to accident and emergency scanning is a factor the Major Trauma Review has highlighted and the close proximity of new CT scanners to accident and emergency is a factor that will need to be taken into account in strategic planning. Given the growing evidence of CT involvement, the continued practice of cervical spine and pelvic radiography in cases of major trauma should be questioned.