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Wikström, Thore
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Nilsson, H., Jonson, C.-O., Vikström, T., Bengtsson, E., Thorfinn, J., Huss, F., . . . Sjöberg, F. (2013). Simulation-assisted burn disaster planning. Burns, 39(6), 1122-1130
Open this publication in new window or tab >>Simulation-assisted burn disaster planning
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2013 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 6, p. 1122-1130Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System (R) (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Burns; Rural areas; Surge capacity; Mass casualty incidents; Preparedness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86596 (URN)10.1016/j.burns.2013.01.018 (DOI)000324349700014 ()
Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2017-12-06Bibliographically approved
Lampi, M., Vikström, T. & Jonson, C.-O. (2013). Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 21(90)
Open this publication in new window or tab >>Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey
2013 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, Vol. 21, no 90Article in journal (Refereed) Published
Abstract [en]

Background: In a mass casualty situation, medical personnel must rapidly assess and prioritize patients for treatment and transport. Triage is an important tool for medical management in disaster situations. Lack of common international and Swedish triage guidelines could lead to confusion. Attending the Advanced Trauma Life Support (ATLS) provider course is becoming compulsory in the northern part of Europe. The aim of the ATLS guidelines is provision of effective management of single critically injured patients, not mass casualties incidents. However, the use of the ABCDE algorithms from ATLS, has been proposed to be valuable, even in a disaster environment. The objective for this study was to determine whether the mnemonic ABCDE as instructed in the ATLS provider course, affects the ability of Swedish physician's to correctly triage patients in a simulated mass casualty incident.Methods: The study group included 169 ATLS provider students from 10 courses and course sites in Sweden; 153 students filled in an anonymous test just before the course and just after the course. The tests contained 3 questions based on overall priority. The assignment was to triage 15 hypothetical patients who had been involved in a bus crash. Triage was performed according to the ABCDE algorithm. In the triage, the ATLS students used a colour-coded algorithm with red for priority 1, yellow for priority 2, green for priority 3 and black for dead. The students were instructed to identify and prioritize 3 of the most critically injured patients, who should be the first to leave the scene. The same test was used before and after the course.Results: The triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass casualty incidents and exercises.Conclusion: The mnemonic ABCDE doesn't significantly affect the ability of triage among Swedish physicians. Actions to increase Swedish physicians' knowledge of triage, within the ATLS context or separately, are warranted.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keywords
ATLS; Triage; Disaster; Education; Physicians; Mass casualty incident; Exercises
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103718 (URN)10.1186/1757-7241-21-90 (DOI)000329181100001 ()
Available from: 2014-01-24 Created: 2014-01-24 Last updated: 2019-02-11Bibliographically approved
Nilsson, H., Vikström, T. & Jonson, C.-O. (2012). Performance indicators for initial regional medical response to major incidents: a possible quality control tool. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 20(81)
Open this publication in new window or tab >>Performance indicators for initial regional medical response to major incidents: a possible quality control tool
2012 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, no 81Article in journal (Refereed) Published
Abstract [en]

Background

Timely decisions concerning mobilization and allocation of resources and distribution of casualties are crucial in medical management of major incidents. The aim of this study was to evaluate documented initial regional medical responses to major incidents by applying a set of 11 measurable performance indicators for regional medical command and control and test the feasibility of the indicators.

Methods

Retrospective data were collected from documentation from regional medical command and control at major incidents that occurred in two Swedish County Councils. Each incident was assigned to one of nine different categories and 11 measurable performance indicators for initial regional medical command and control were systematically applied. Two-way analysis of variance with one observation per cell was used for statistical analysis and the post hoc Tukey test was used for pairwise comparisons.

Results

The set of indicators for regional medical command and control could be applied in 102 of the130 major incidents (78%), but 36 incidents had to be excluded due to incomplete documentation. The indicators were not applicable as a set for 28 incidents (21.5%) due to different characteristics and time frames. Based on the indicators studied in 66 major incidents, the results demonstrate that the regional medical management performed according to the standard in the early phases (1–10 min after alert), but there were weaknesses in the secondary phase (10–30 min after alert). The significantly lowest scores were found for Indicator 8 (formulate general guidelines for response) and Indicator 10 (decide whether or not resources in own organization are adequate).

Conclusions

Measurable performance indicators for regional medical command and control can be applied to incidents that directly or indirectly involve casualties provided there is sufficient documentation available. Measurable performance indicators can enhance follow- up and be used as a structured quality control tool as well as constitute measurable parts of a nationally based follow-up system for major incidents. Additional indicators need to be developed for hospital-related incidents such as interference with hospital infrastructure.

Place, publisher, year, edition, pages
BioMed Central, 2012
Keywords
Emergency response, Disaster management, Casualty incident, Quality measurement, Resource management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89534 (URN)10.1186/1757-7241-20-81 (DOI)000313973900001 ()
Note

Funding Agencies|Swedish National Board of Health and Welfare||

Available from: 2013-02-28 Created: 2013-02-26 Last updated: 2017-12-06
Nilsson, H., Vikström, T. & Rüter, A. (2010). Quality control in disaster medicine training: Initial regional medical command and control as an example. American journal of disaster medicine, 5(1), 35-40
Open this publication in new window or tab >>Quality control in disaster medicine training: Initial regional medical command and control as an example
2010 (English)In: American journal of disaster medicine, ISSN 1932-149X, Vol. 5, no 1, p. 35-40Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to show the possibility to identify what decisions in the initial regional medical command and control (IRMCC) that have to be improved. DESIGN: This was a prospective, observational study conducted during nine similar educational programs for regional and hospital medical command and control in major incidents and disasters. Eighteen management groups were evaluated during 18 standardized simulation exercises. MAIN OUTCOME MEASURE: More detailed and quantitative evaluation methods for systematic evaluation within disaster medicine have been asked for. The hypothesis was that measurable performance indicators can create comparable results and identify weak and strong areas of performance in disaster management education and training. Methods: Evaluation of each exercise was made with a set of 11 measurable performance indicators for IRMCC. The results of each indicator were scored 0, 1, or 2 according to the performance of each management group. RESULTS: The average of the total score for IRMCC was 14.05 of 22. The two best scored performance indicators, No 1 "declaring major incident" and No 2 "deciding on level of preparedness for staff" differed significantly from the two lowest scoring performance indicators, No 7 "first information to media" and No 8 "formulate general guidelines for response." CONCLUSION: The study demonstrated that decisions such as "formulating guidelines for response and "first information to media" were areas in initial medical command and control that need to be improved. This method can serve as a quality control tool in disaster management education programs.

Place, publisher, year, edition, pages
Weston, MA, USA: Weston Medical Publishing, LLC, 2010
Keywords
performance indicators, disaster management, education, quality measurement
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-57033 (URN)20349701 (PubMedID)
Available from: 2010-06-14 Created: 2010-06-09 Last updated: 2014-10-07
Wakasugi, M., Nilsson, H., Hornwall, J., Vikström, T. & Rüter, A. (2009). Can performance indicators be used for pedagogic purposes in disaster medicine training?. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 17(15)
Open this publication in new window or tab >>Can performance indicators be used for pedagogic purposes in disaster medicine training?
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2009 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 17, no 15Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although disaster simulation trainings were widely used to test hospital disaster plans and train medical staff, the teaching performance of the instructors in disaster medicine training has never been evaluated. The aim of this study was to determine whether the performance indicators for measuring educational skill in disaster medicine training could indicate issues that needed improvement.

METHODS: The educational skills of 15 groups attending disaster medicine instructor courses were evaluated using 13 measurable performance indicators. The results of each indicator were scored at 0, 1 or 2 according to the teaching performance.

RESULTS: The total summed scores ranged from 17 to 26 with a mean of 22.67. Three indicators: 'Design', 'Goal' and 'Target group' received the maximum scores. Indicators concerning running exercises had significantly lower scores as compared to others.

CONCLUSION: Performance indicators could point out the weakness area of instructors' educational skills. Performance indicators can be used effectively for pedagogic purposes.

Place, publisher, year, edition, pages
London, UK: BioMed Central, 2009
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18987 (URN)10.1186/1757-7241-17-15 (DOI)19292895 (PubMedID)
Available from: 2009-06-07 Created: 2009-06-07 Last updated: 2017-12-13Bibliographically approved
Olofsson, P., Berg, S., Casimir Ahn, H., Brudin, L., Wikström, T. & Johansson, K. J. (2009). Gastrointestinal microcirculation and cardiopulmonary function during experimentally increased intra-abdominal pressure. Critical Care Medicine, 37(1), 230-239
Open this publication in new window or tab >>Gastrointestinal microcirculation and cardiopulmonary function during experimentally increased intra-abdominal pressure
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2009 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 37, no 1, p. 230-239Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to assess gastric, intestinal, and renal cortex microcirculation parallel with central hemodynamics and respiratory function during stepwise increase of intra-abdominal pressure (IAP).

Design: Prospective, controlled animal study.

Setting: Research laboratory, University Hospital.

Subjects: Twenty-six anesthetized and mechanically ventilated pigs.

Interventions: Following baseline registrations, CO2 peritoneum was inflated (n = 20) and IAP increased stepwise by 10 mm Hg at 10 mins intervals up to 50 mm Hg and subsequently exsufflated. Control animals (n = 6) were not insufflated with CO2.

Measurements and Main Results: The microcirculation of gastric mucosa, small bowel mucosa, small bowel seromuscular layer, colon mucosa, colon seromuscular layer, and renal cortex were selectively studied at all pressure levels and after exsufflation using a four-channel laser Doppler flowmeter (Periflex 5000, Perimed). Central hemodynamic and respiratory function data were registered at each level and after exsufflation. Cardiac output decreased significantly at IAP levels above 10 mm Hg. The microcirculation of gastric mucosa, renal cortex and the seromuscular layer of small bowel and colon was significantly reduced with each increase of IAP. The microcirculation of the small bowel mucosa and colon mucosa was significantly less affected compared with the serosa (p < 0.01).

Conclusions: Our animal model of low and high IAP by intraperitoneal CO2-insufflation worked well for studies of microcirculation, hemodynamics, and pulmonary function. During stepwise increases of pressure there were marked effects on global hemodynamics, respiratory function, and microcirculation. The results indicate that intestinal mucosal flow, especially small bowel mucosal flow, although reduced, seems better preserved in response to intra-abdominal hypertension caused by CO2-insufflation than other intra-abdominal microvascular beds.

Keywords
intra-abdominal hypertension, gastrointestinal microcirculation, cardiopulmonary function
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16533 (URN)10.1097/CCM.0b013e318192ff51 (DOI)
Available from: 2009-01-30 Created: 2009-01-30 Last updated: 2017-12-14Bibliographically approved
Rüter, A. & Vikström, T. (2009). Improved Staff Procedure Skills Lead to Improved Management Skills: An Observational Study in an Educational Setting. Prehospital and Disaster Medicine, 24(5), 376-379
Open this publication in new window or tab >>Improved Staff Procedure Skills Lead to Improved Management Skills: An Observational Study in an Educational Setting
2009 (English)In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 24, no 5, p. 376-379Article in journal (Refereed) Published
Abstract [en]

Introduction: Good staff procedure skills in a management group during incidents and disasters are believed to be a prerequisite for good management of the situation. However, this has not been demonstrated scientifically. Templates for evaluation results from performance indicators during simulation exercises have previously been tested. The aim of this study was to demonstrate the possibility that these indicators can be used as a tool for studying the relationship between good management skills and good staff procedure skills.

Hypothesis: Good and structured work (staff procedure skills) in a hospital management group during simulation exercises in disaster medicine is related to good and timely decisions (good management skills).

Methods: Results from 29 consecutive simulation exercises in which staff procedure skills and management skills were evaluated using quantitative measurements were included. The statistical analysis method used was simple linear regression with staff procedure skills as the response variable and management skills as the predictor variable.

Results: An overall significant relationship was identified between staff pro-cedure skills and management skills (p ≤0.05).

Conclusions: This study suggests that there is a relationship between staff procedure skills and management skills in the educational setting used. Future studies are needed to demonstrate if this also can be observed during actual incidents.

 

 

 

 

Place, publisher, year, edition, pages
Cambridge University Press, 2009
Keywords
Disaster medicine, science, performance indicators, process modelling, concept modelling, implementation, prehospital command and control, standards, quality control.
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-57564 (URN)10.1017/S1049023X00007172 (DOI)
Available from: 2013-04-11 Created: 2009-11-07 Last updated: 2017-12-12Bibliographically approved
Olofsson, P. H., Mellblom, L., Berg, S., Ahn, H. C., Wikström, T., Johansson, K. J. M. & Söderholm, J. D. (2009). Increased transmucosal uptake of E. coli K12 in porcine small bowel following experimental short term abdominal compartment syndrome.
Open this publication in new window or tab >>Increased transmucosal uptake of E. coli K12 in porcine small bowel following experimental short term abdominal compartment syndrome
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2009 (English)Article in journal (Other academic) Submitted
Abstract [en]

Background: Abdominal compartment syndrome (ACS) may lead to bacterial translocation and possibly be of importance for development of multiorgan failure. However, the underlying mechanisms have not been fully elucidated. In a porcine model we recently demonstrated preserved intestinal mucosal blood flow during experimental short duration ACS. In the present study we used the same model to determine mucosal barrier function and morphology in the small bowel and colon of pigs before and after short term ACS.

Methods: The study comprised 12 anaesthetized pigs exposed to experimental ACS and 6 control animals. Via laparotomy, samples of small bowel and colon were taken out for studies before short term ACS, where the abdomen was inflated with CO2 and IAP was increased stepwise by 10 mm Hg at 10-minute intervals up to 50 mm Hg, and again 10 minutes after exsufflation. Mucosal microcirculation was measured by laser Doppler flowmetry, and mucosal tissues were mounted in modified Ussing chambers for assessment of barrier function (E. coli K12 uptake and 51Cr-EDTA permeability). Specimens were also fixed in formaldehyde, stained with eosin-hematoxylin and evaluated blindly using an 8-grade scale for assessment of mucosal damage.

Results: Transmucosal passage of E. coli was three-fold increased in the small bowel after ACS (22.6 [18.2 – 54.4] units) vs. baseline (8.1 [2.0 – 13.9]; P< 0.050) with a significant correlation to alterations of mucosal microcirculation. In the colon bacterial passage was unchanged, whereas 51Cr-EDTA permeability after ACS increased to 181% of baseline (P<0.05) and was correlated to significant mucosal histopathological changes (P<0.03).

Conclusion: Short term ACS with reperfusion induced significant dysfunction of the intestinal mucosal barrier. The response patterns concerning barrier dysfunction differed between small bowel and colonic mucosa, with increased bacterial passage and paracellular permeability, respectively.

Keywords
Short term ACS, intestinal barrier function, animal model, Ussing chamber
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17795 (URN)
Available from: 2009-04-21 Created: 2009-04-21 Last updated: 2010-04-23Bibliographically approved
Olofsson, P., Wikström, T., Nagelkerke, N., Abu-Zidan, F. M. & Wang, J. (2009). Multipel Small Bowel Ligation Compared to Conventional Primary Repair after Abdominal Gunshot Wound with Haemorrhagic Shock. Scandinavian Journal of Surgery, 98(1), 41-47
Open this publication in new window or tab >>Multipel Small Bowel Ligation Compared to Conventional Primary Repair after Abdominal Gunshot Wound with Haemorrhagic Shock
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2009 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 98, no 1, p. 41-47Article in journal (Refereed) Published
Abstract [en]

Aims: The aim of this study was to evaluate the effects of early rapid control of multiple bowel perforations on cardiovascular function in combined abdominal missile trauma and haernorrhagic shock compared with conventional surgery.

Methods: Eighteen anesthetised pigs were injured with a standardised abdominal missile trauma. The animals were bled to a mean arterial pressure of 50 mm Hg for 30 minutes, after which they were resuscitated and had laparotomy. They were divided into conventional surgery group (n=9) with primary resection and anastomosis of bowel injuries and early rapid multiple bowel ligation group (n=9). Repeated measurement analysis of variance was used for analysis.

Results: There was profound hypotension, reduced cardiac output, increased vascular resistance and lactic acidaemia in both groups. Lactic acidaemia persisted longer in the early rapid multiple bowel ligation group. There were no significant differences in mean arterial pressure, cardiac output, stroke volume or systemic vascular resistance between the groups. The mean operation time was significantly shorter in the early rapid multiple bowel ligation group (13.3 (1.5) (SEM) minutes, compared with 116.4 (1.74) (SEM) minutes in the conventional surgery group, p = <0.001).

Conclusions: Damage control principles have shortened the operating time in our model but did not improve the cardiovascular function and caused more lactic acidaemia than conventional repair.

Keywords
Animal model, bowel injuries, damage control surgery, haemorrhage, shock, trauma
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17604 (URN)
Available from: 2009-04-06 Created: 2009-04-06 Last updated: 2017-12-13Bibliographically approved
Rüter, A. & Vikström, T. (2009). Performance indicators - from theory to implementation: one method of scientific approach to disaster medicine. Urgence Pratique, 93, 41-44
Open this publication in new window or tab >>Performance indicators - from theory to implementation: one method of scientific approach to disaster medicine
2009 (English)In: Urgence Pratique, ISSN 1244-1791, Vol. 93, p. 41-44Article in journal (Other academic) Published
Abstract [en]

The objective of this paper is to demonstrate a possible tool for the use of a quantitative research method that can be applied in disaster medicine.

Method: Stepwise, using the technique of concept and process modelling, key processes in forms of performance indicators for command and control at disaster and major incidents were identified. A standard was linked to each indicator. Based in these indicators, an educational program was developed. In this program results from examinations were expressed in numbers and can thereby allow statistical methods to be applied.

Results: Application of this model on prehospital command and control demonstrated weak and strong points. The method has been implemented in 13 out 21 regions and is used as a quality control tool.

Conclusions: The use of performance indicators developed by using results from modelling processes could possibly serve as a tool for conducting quantitative research in disaster medicine.

Place, publisher, year, edition, pages
Ganges, France: Urgence Pratique Publications, 2009
Keywords
Disaster medicine, science, performance indicators, process modelling, concept modelling, implementation, prehospital command and control, standards, quality control.
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:liu:diva-51565 (URN)
Note

This is the English version of the original publication: Anders Rüter and Anders Vikström, Indicateurs de performance: De la théorie à la pratique. Approche scientifique à propos de la médicine de catastrophe, 2009, Urgence Pratique, (93), 41-44. Copyright French version: Urgence-Practique http://www.urgence-pratique.com/

Available from: 2009-11-07 Created: 2009-11-07 Last updated: 2016-04-18Bibliographically approved
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