<p><strong>Syfte:</strong> Att undersöka vad ambulanssjuksköterskor upplever kan finnas för problemområden vid arbete på skadeplats med maximalt fyra drabbade.</p><p><strong>Metod:</strong> Studien har en kvalitativ ansats. Nio ambulanssjuksköterskor i Uppsala, mellan 27 och 53 år, intervjuades. Ett bekvämlighetsurval gjordes. Tillstånd för studien anskaffades hos ambulansstationens verksamhetschef. Intervjuerna var semistrukturerade och spelades in med ljudupptagning. Intervjuerna transkriberades sedan och analyserades med kvalitativ innehållsanalys. Resultatet gav 11 kategorier och 19 underkategorier.<strong>Resultat:</strong> Prehospitala problem på skadeplats är mörker, dåligt väder samt trafik. Prehospital sjukvårdsledning används inte i tillräcklig mån. Mental förberedelse är viktigt inför ankomst till skadeplats. Det nya radiosystemet fungerar inte optimalt och därmed försvåras kommunikationen mellan ambulans, räddningstjänst och polis. Samarbetet med räddningstjänst på skadeplats behöver förbättras. Mer interprofessionell övning och utbildning efterfrågas. De svåraste patientgrupperna är barn samt traumafall. <strong>Slutsats:</strong> Prehospital sjukvårdsledning används för lite vid arbetet på en mindre skadeplats. Radiosystemet fungerar inte optimalt och det försvårar kommunikationen och samarbetet mellan ambulans, polis och räddningstjänst. Mer övning och utbildning behövs kring barn samt trauma. Mer interprofessionell övning och gemensamma utbildningar efterfrågas.</p> / <p>Purpose: <strong>To study problems that ambulance nurses experience at the scene of accident with a maximum of four affected persons. </strong>Methods:<strong> The study is qualitative. N</strong><strong>ine ambulance nurses in Uppsala, between 27 and 53 years, were interviewed. A convenience sample was chosen. The semi-structured interviews were sound recorded. Permission was acquired from the ambulance manager. After transcription a qualitative content analysis was performed. 11 categories and 19 subcategories were found. </strong>Results:<strong> Pre-hospital problems are bad weather and traffic. Pre-hospital leadership is not used enough. Mental preparation is important before arrival at scene of accident. The new radio communication system is not working properly, which hinders interprofessional communication. Collaboration with the rescue service needs to be improved. </strong><strong>The ambulance nurses request more training and education together with the other professions. The most demanding patient groups are children and trauma cases. </strong>Conclusions:<strong> Pre-hospital leadership is not used enough at a small scene of accident. The new radio system is not working properly which hinders the interprofessional communication. More training and education is needed when it comes to children and trauma. The ambulance nurses request more inter professional training and joint education. </strong></p>

Background: Globally, and in Sweden, passenger railway transport is steadily increasing. Sweden has been relatively free from severe train crashes in the last decades, but the railway infrastructure is alarmingly worn and overburdened, which may be one reason for an increasing number of reported mishaps. Worldwide, major train crashes/disasters are a frequent cause of mass casualty incidents. Several shortcomings, especially within the crash and post-crash phases cause severe consequences for the passengers. Aim: To investigate the consequences of train crashes on passengers, focusing on factors of importance in the crash and post-crash phases. The specific aims are: (I) to identify the historical development and magnitude of passenger train disasters globally on various continents and countries, (II, III) to identify injury panorama and injury objects in two train crashes, (IV) to explore survivor´s experiences from a train crash, and (V) to explore their experiences of journalists and media coverage. Methods: Study I is a register study based on 529 railway disasters worldwide, whereas studies II-V are case studies from the two latest severe train crashes in Sweden (Nosaby and Kimstad). These studies are based on 73 and 21 passengers respectively. Studies I-III is essentially quantitative where descriptive statistics (I, III), multivariate analysis (III), and content analysis (II, III) are used. Studies II and III are also supplemented by semi-structured interviews. Studies IV and V are qualitative and the interviews (n=14, n=30) have been analyzed with qualitative content analysis. Study IV is also supplemented with quantitative data. Results: The number of railway disasters, fatalities, and non-fatally injured passengers has increased throughout the last hundred years - particularly during the last four decades (1970–2009) when 88% of all disasters occurred (I). Passengers in the first overturned carriage suffered most severe and lethal injuries (III). Internal structures such as tables, chairs, internal walls, as well as luggage, other passengers (II, III), glass (II), and wood pellets (III) induced many of the injuries. Those who traveled facing forward with a table in front of them, in carriages that did not overturn, were more likely to sustain injuries to their abdomen/pelvis than those without a table (III). Passengers who traveled rear facing had higher rates of whiplash injuries. Surviving a train crash was experienced as "living in a mode of existential threat". The long term consequences however were diverse for different persons (IV). All experienced that they had cheated death, but some became "shackled by history", whereas others overcame the "haunting of unforgettable memories." The centrality of others and the importance of reconstructing the turn of events were important when "dealing with the unthinkable". The media coverage were experienced as positive in the recovery process and the journalists were also perceived as helpful (V). By some the journalist’s nevertheless were also perceived as harmful or negligible, and the subsequent media coverage as either uncomfortable or insignificant. Conclusion: Despite extensive crash avoidance systems severe railway crashes still occur. Improved interior safety, as has been implemented in the automobile and aviation industries, would have an important reduction in injuries and facilitate evacuation. Being surrounded by family, friends, fellow passengers and participating in crash investigations, and experiencing descriptive media coverage were some crucial factors when dealing with the traumatic event and should be promoted.

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Bakgrund: Att förlora sitt barn är bland det värsta som en förälder kan uppleva. Vid förlusten försätts föräldrarna i en sorgeprocess. Vägen tillbaka kan vara lång för att återigen kunna känna en mening med livet. Syfte: Syftet var att beskriva föräldrars upplevelse av att leva vidare efter att plötsligt förlorat sitt barn i en olycka. Metod: En litteraturstudie har utförts. Resultatet bygger på nio kvalitativa och kvantitativa artiklar. Resultat: Föräldrar upplevde sorg, förtvivlan, hopplöshet och maktlöshet efter förlusten. Barnets död påverkade äktenskapet, vissa kände en starkare samhörighet medan andra upplevde att de gled ifrån varandra. Det sociala nätverket ändrades då de upplevde brist på stöd från vänner och anhöriga. Deras syn på livet blev annorlunda och nya värderingar skapades, samtidigt var det viktigt att hålla minnet av barnet vid liv. Diskussion: Förlusten förändrade livet radikalt vilket skapade en mental instabilitet, identitetsförändringar, starkare vilja till att ta vara på livet samt att personer i omgivningen drog sig undan och undvek kontakt. Detta har diskuterats i relation till Antonovskys och Erikssons teorier. Slutsats: Sorgen ter sig individuellt med känslor som växlar om vartannat, vilket sjuksköterskan, för bästa omvårdnad bör känna till. Forskning vore önskvärd om varför vissa föräldrar klarar av att gå vidare och andra inte. / Background: Losing a child is one of the worst things a parent can experience. When this happens a grieving process starts and the way back to a meaningful life can be long and difficult. Aim: The aim was to describe parents' experience of moving on after suddenly losing their child in an accident. Method: A literature review has been done and the result is based on nine qualitative and quantitative articles. Results: Parents experienced grief, despair, loss of control and hopelessness after losing their child. It affected the relationship between the parents, in some cases creating a stronger band between them whilst in others creating a distance. Lack of support from friends and family altered their social network. New values changed their outlook on life, whilst it was important to keep memories of their child alive. Discussion: Life changed radically causing mental instability, identity change and a stronger will to make the most of life leading to withdrawel of social contacts and support as discussed in relation to Antonovsky's and Eriksson's theory. Conclusion: Grief is individual with everchanging emotions, which nurses should be aware of in order to give the best possible care. Research on why some parents move on and others do not, would be valuable.

Syftet med undersökningen är att kartlägga skaderiskerna med att arbeta som marin maskinpersonal och jämföra skaderisken med anställda som har liknande arbeten iland. Undersökningen inbegriper även att kartlägga vilka typer av arbetsskador, som ger de mest allvarliga konsekvenserna för den anställde i förhållande till hur vanlig olyckan är. Undersökningen är en litteraturstudie där Arbetsmiljöverkets arbetsskadeanmälningar utgör grundmaterialet, där totalt 198 arbetsskador behandlades och kategoriserades. Transportstyrelsens statistik för ombordanställda jämfördes med Arbetsmiljöverket och Statistiska centralbyrån statistik över anställda iland. Detta för att se vilken yrkeskategori som hade högst skaderisk. Resultatet av undersökningen visar att arbetsolyckor under kategorierna ”Bära” och ”Halka/Snubbla/Trilla” och arbetssjukdomar under kategorin ”Tunga lyft/Arbetsställningar” är de arbetsskador, som ger de mest allvarliga konsekvenserna i förhållande till hur vanlig arbetsskadan är. Vid jämförelsen av skaderisken med liknande yrkeskategorier iland ligger maskinanställda till sjöss näst sämst till. Den yrkeskategori som är mest lik marin maskinpersonal har fyra gånger mindre skaderisk. / The aim with this thesis is to identify the risks of injury while working as marine engine staff and compare the risk of injury to employees who have similar jobs ashore. The thesis also includes identifying the types of work injuries, which leads to the most serious consequences for the employee in relation to how frequent the accident is. The thesis studied literature in which the Swedish Work Environment Authority's work injury reports are the base material, where a total of 198 injuries were treated and categorized. The Swedish Transport Agency’s statistics for employees at sea were compared with the Swedish Work Environment Authority’s and the Swedish Central Bureau of Statistics’ statistics for employees ashore. The result of the thesis show that work related accidents categorized as "Carry" and "Slip/Trip/Fall" and work related diseases categorized as "Heavy lifting/Working positions" are the injuries leading to the most serious consequences in relation to how frequent the accident is. When comparing the risk of injury with similar professions ashore, marine engine staff is the second worst. The profession most similar to marine engine staff has four times less risk of injury.

Recent years have seen increasing acknowledgment that aircraft accidents affect not only those who are killed or injured, but also the families and friends of victims. Survivors, victims and their families require sensitive treatment in order to help them cope with what has occurred. Following high profile accidents including USAir 427 and TWA 800, the United State of America started a new program which they call it Family Assistance after Air Disaster. After that a several documents providing guidance for dealing with victims and their families were published in Australia, the UK and the EU. However, in the Middle East, there is no region-specific family assistance guidance for dealing with aircraft accidents. As such, operators tend to use plans which have been designed from a western perspective. This means that the impact of culture, ethical sensitivities and religion have not been addressed fully. This thesis explores the differences in dealing with the families of victims after an accident in the Middle East focusing on the Muslim population. Interviews were conducted with experts from airlines, family assistance providers, religious leaders and victim support groups. These were supplemented by a survey of passengers and family members in USA, Malaysia and Saudi Arabia to compare and contrast the expectations and needs of those who may be affected by an aircraft accident. Over 300 responses were received and the data were validated through further expert interviews. The results supported the findings of the literature review and matched with the bad experiences documented within case study accidents such as the mid-air collision involving Saudi Arabian Airlines flight 763. The study found that the three factors are inextricably linked, with religion being a strong factor in determining individual’s response to their loss; how they relate to others and the type of support they should be given. Suggestions are made regarding the design of a Family Assistance Centre, staff training, words that should / should not be used; and to explain how people may react.

A 12-month longitudinal study assessed the emotional reactions of an intercollegiate athletic team to a near fatal bus incident. PANAS-X and the Brief COPE, administered on five occasions, indicated NA declined over time. Most coping strategies showed significant changes in trajectory. Acceptance and Positive Reframing were high across waves. In October 2010, an intercollegiate athletic team and coaching staff were traveling by sleeper bus to an out-of-state match. The team members and coaches were in the back of the bus when they felt the bus swaying and heard the tires hit the rumble strips. The head coach went forward to find the bus driver unconscious and slumped over the steering wheel. Although the bus swerved into the oncoming lane of interstate traffic and back onto the other shoulder, the coach was able to steer the bus and stop it safely on the side of the road. The bus driver had suffered a fatal heart attack; fortunately, the coaches and players survived with only minor injuries. This study is a longitudinal follow up assessing the emotional reactions of the coaches and team to the bus incident across a twelve-month time frame. The Positive and Negative Affect Schedule - Expanded (PANAS-X; Watson & Clark, 1994) and the Brief COPE (Carver, 1997) were administered on five occasions. Negative affect declined over time, with a larger drop in waves more proximal to the incident. Positive affect demonstrated a curvilinear pattern showing increases on the second and third wave but dropped off at the end of the spring semester 2011 and the beginning of the fall semester 2011. There were significant changes in the coping trajectories for 10 of the 14 coping strategies from the Brief COPE. These data are of particular interest as we could locate no other studies in the published literature of individual athlete or team reactions to traumatic travel incidents, although ESPN (Lavigne, 2010) noted that bus safety should be a concern for team travel.

Depuis 2005, le réseau routier montréalais accueille de nouveaux aménagements cyclables afin de promouvoir le vélo comme mode de transport à part entière. Cette stratégie vise à faciliter l'usage utilitaire du vélo afin de réduire l'empreinte carbone du transport motorisé. Cet objectif de doubler le nombre actuel de kilomètres de voies cyclables d'ici la prochaine décennie est prévu à l'intérieur d'une structure urbaine montréalaise compacte et déjà consolidée. Cette structure est plus propice aux infrastructures cyclables partageant la chaussée sans une barrière physique : bandes cyclables et chaussées désignées. De telles solutions sont novatrices pour ne pas dire osées en Amérique du Nord du fait qu'elles requièrent une plus grande interaction entre véhicules à moteur et cyclistes. Ce projet de recherche se donne pour objectifs de dresser un portrait de l'accueil des cyclistes sur le réseau routier à Montréal afin de constater si les nouveaux aménagements sont plus à risque que les premières solutions. Cette démarche est rendue possible par la disponibilité de données secondaires des accidents impliquant cyclistes et véhicules motorisés de 2003 à 2007. Les conclusions des analyses descriptives, de distributions spatiales et de statistiques n'ont pas permis de démontrer de manière significative que ces aménagements à même la chaussée sans barrière physique constituent un environnement de transport dangereux ou semblent contribuer à augmenter le niveau d'insécurité routière. Les chiffres ont plutôt montré une stabilité relative du nombre d'accidents et une chute des cas les plus sévères. Il y a eu une poussée en 2004 mais elle est antérieure à l'implantation des nouvelles infrastructures. De plus, le taux d'accidents entre cyclistes et circulation lourde n'est pas plus alarmant vu la structure économique actuelle, le pourcentage de camions à Montréal et la localisation des nouveaux aménagements cyclables sur rue plus probables sur le réseau artériel pour leur capacité d'hébergement. Les analyses descriptives sur la distribution spatiale des accidents montrent qu'ils ne sont pas uniformément distribués à Montréal. Certains arrondissements semblent être plus périlleux pour les cyclistes que d'autres. En agrégeant les données d'accidents en deux grandes catégories à l'intérieur du périmètre où les accidents cyclistes sont les plus fréquents (ceux ayant eu lieu sur les nouveaux liens cyclables et ceux survenus sur la piste cyclable plus familière à Montréal), les résultats de l'analyse comparée ont montré une grande similitude dans les patrons des accidents. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : cyclistes, bandes cyclables, pistes cyclables, chaussées désignées, blessures graves, dommages matériels, mobilité soutenable, sécurité routière, site propre intégral, aménagement hors rue

Injuries are considered to be a major public health issue. More than 4600 people die each year and 10 % of all hospitalization in Sweden is related to injuries. The cost in a societal perspective is estimated to 59 billion a year. Injuries are possible to prevent. However it needs knowledge that the injury has occurred and the surrounding circumstances. This study used data from an accident and injury registration in outpatient health care, in the Swedish municipality of Gotland. The purpose of this study was to describe the injury patterns regarding place and cause of injury focused on age and gender differences. Data from the registration were categorized and statistically processed in SPSS after content analysis of narrative text.  Statistical measures used where frequencies, incidences and significances. The results show that there are more men than women who are injured in the ages 0-63 years. The largest number of injuries was found in the age group 0-19 years. Fall was the leading cause of injuries. Home was the most common place where injuries occurred. Existing statistics on a national level may have limited use in local injury prevention program. There could be specific determinants of injuries locally that have to be addressed. Local injury registration and analyzes that include demographic and socioeconomic factors could increase the potential for effective injury prevention. / Skador är ett stort folkhälsoproblem, drygt 4 600 personer dör varje år och 10 % av all sjukhusvård i Sverige är orsakade av skador. Samhällskostnaderna uppskattas till 59 miljarder kronor på år. En förutsättning för att kunna förebygga skador är att få vetskap om dem. Det krävs även kunskap kring hur olyckan har gått till. Denna studies data inhämtades från en olycks- och skaderegistrering, inom den öppna hälso- och sjukvården, på Gotland. Syftet med studien var att beskriva kontaktorsak, skadeplats och skadeorsak med fokus på ålders- och könsskillnader. Data från registreringsblanketter kategoriserades och behandlades statistiskt i SPSS efter att fritextbeskrivningar tolkats innehållsanalytiskt.  Statistiska mått som användes vid bearbetning av materialet var frekvenser, incidenser och signifikanser. Resultatet visar att det är flera män än kvinnor som skadar sig i åldrarna 0-63 år. Störst antal skadade återfanns i åldersgruppen 0-19. Fall var den främsta orsaken till skador. De flesta olyckor skedde i bostaden. Existerande statistik på riksnivå kan ha begränsad användning lokalt eftersom det kan finnas specifika bestämningsfaktorer för skador som påverkar skademönster. Lokala skaderegistreringar och analyser som innefattar demografiska och socioekonomiska faktorer kan öka möjligheterna till ett effektivt skadepreventivt arbete.