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Lennquist, Sten
Publications (10 of 19) Show all publications
Lennquist Montan, K., Hreckovski, B., Dobson, B., Ortenwall, P., Montan, C., Khorram-Manesh, A. & Lennquist, S. (2014). Development and evaluation of a new simulation model for interactive training of the medical response to major incidents and disasters. European Journal of Trauma and Emergency Surgery, 40(4), 429-443
Open this publication in new window or tab >>Development and evaluation of a new simulation model for interactive training of the medical response to major incidents and disasters
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2014 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 40, no 4, p. 429-443Article in journal (Refereed) Published
Abstract [en]

The need for and benefit of simulation models for interactive training of the response to major incidents and disasters has been increasingly recognized during recent years. One of the advantages with such models is that all components of the chain of response can be trained simultaneously. This includes the important communication/coordination between different units, which has been reported as the most common cause of failure. Very few of the presently available simulation models have been suitable for the simultaneous training of decision-making on all levels of the response. In this study, a new simulation model, originally developed for the scientific evaluation of methodology, was adapted to and developed for the postgraduate courses in Medical Response to Major Incidents (MRMI) organized under the auspices of the European Society for Trauma and Emergency Surgery (ESTES). The aim of the present study was to describe this development process, the model it resulted in, and the evaluation of this model. The simulation model was based on casualty cards giving all information normally available for the triage and primary management of traumatized patients. The condition of the patients could be changed by the instructor according to the time passed since the time of injury and treatments performed. Priority of the casualties as well as given treatments could be indicated on the cards by movable markers, which also gave the time required for every treatment. The exercises were run with real consumption of time and resources for all measures performed. The magnetized cards were moved by the trainees through the scene, through the transport lines, and through the hospitals where all functions were trained. For every patient was given the definitive diagnosis and the times within certain treatments had to be done to avoid preventable mortality and complications, which could be related to trauma-scores. The methodology was tested in nine MRMI courses with a total of 470 participants. Based on continuous evaluations and accumulated experience, the setup of the simulation was step-wise adjusted to the present model, including also collaborating agencies such as fire and rescue services as well as the police, both on-scene and on superior command levels. The accuracy of the simulation cards for this purpose was evaluated as "very good" by 63 % of the trainees and as "good" by 33 %, the highest two of the six given alternatives. The participants ranking of the extent that the course increased their competencies related to the given objectives on a 1-5 scale for prehospital staff had an average value of 4.25 +/- A 0.77 and that for hospital staff had an average value of 4.25 +/- A 0.72. The accuracy of the course for the training of major incident response on a 1-5 scale by prehospital staff was evaluated as 4.35 +/- A 0.73 and that by hospital staff as 4.30 +/- A 0.74. The simulation system tested in this study could, with adjustments based on accumulated experience and evaluations, be developed into a tool for the training of major incident response meeting the specific demands on such training based on recent experiences from major incidents and disasters. Experienced trainees in several courses evaluated the methodology to be accurate for this training, markedly increasing their perceived knowledge and skills in fields of importance for a successful outcome of the response to a major incident.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2014
Keywords
Simulation; Training; Major incident; Disaster; Mass-casualty; MRMI; MACSIM
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-110708 (URN)10.1007/s00068-013-0350-y (DOI)000340676300003 ()
Note

Funding Agencies|Swedish Governmental Board of Health and Welfare

Available from: 2014-09-23 Created: 2014-09-19 Last updated: 2017-12-05
Turegano, F. & Lennquist, S. (2013). Editorial Material: Untitled. European Journal of Trauma and Emergency Surgery, 39(2), 105-106
Open this publication in new window or tab >>Editorial Material: Untitled
2013 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 39, no 2, p. 105-106Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-92608 (URN)10.1007/s00068-013-0260-z (DOI)000317083200001 ()
Available from: 2013-05-14 Created: 2013-05-14 Last updated: 2017-12-06
Lennquist, S. (2011). Introduction to the third "Focus-on" issue specially devoted to papers within the field of the ESTES section for Disaster and Military Surgery. European Journal of Trauma and Emergency Surgery, 37(1), 1-2
Open this publication in new window or tab >>Introduction to the third "Focus-on" issue specially devoted to papers within the field of the ESTES section for Disaster and Military Surgery
2011 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 37, no 1, p. 1-2Article in journal, Editorial material (Other academic) Published
Abstract [en]

Background: Ultrasound is widely accepted as a valuable diagnostic tool for detecting intra-abdominal and intrathoracic bleeding in trauma patients. Nevertheless, many doctors are reluctant to use it because they do not have sufficient training. This study aimed to define intraabdominal and intrathoracic fluid volumes that can be detected by sonography and their relation to fluid width in pigs to establish a clinically relevant animal model for teaching and training. Methods: Different volumes of normal saline were infused into the abdomen (50-2,000 mL) and chest (25-250 mL) in five anesthetized pigs. The maximum width of fluid as detected by ultrasound was recorded. The right upper quadrant, left upper quadrant, pelvis, and right paracolic section of the abdomen and right pleural cavity were studied. An experienced radiologist performed the studies. The effects on respiratory and cardiovascular functions were evaluated. Results: The sonographic findings in the pig were similar to those in humans. Up to 50 mL of intra-abdominal fluid and up to 25 mL of intrathoracic fluid could be detected by ultrasound. There was a significant correlation between the volume infused and the fluid width detected. The respiratory and cardiovascular monitoring of the animals showed that the infused intrathoracic volumes mimicked a survivable hemothorax. Conclusion: The pig may serve as an excellent clinically relevant model with which to teach surgeons detection of different volumes of intra-abdominal and intrathoracic fluids. The value of this model as an educational tool has yet to be tested.

Place, publisher, year, edition, pages
Springer, 2011
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-66140 (URN)10.1007/s00068-011-0077-6 (DOI)000287458300001 ()26814743 (PubMedID)2-s2.0-79251533401 (Scopus ID)
Available from: 2011-03-04 Created: 2011-03-04 Last updated: 2017-12-11Bibliographically approved
Lennquist, S. & Hodgetts, T. (2008). Evaluation of the response of the Swedish healthcare system to the tsunami disaster in South East Asia. European Journal of Trauma and Emergency Surgery, 34(5), 465-485
Open this publication in new window or tab >>Evaluation of the response of the Swedish healthcare system to the tsunami disaster in South East Asia
2008 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, Vol. 34, no 5, p. 465-485Article in journal (Refereed) Published
Abstract [en]

Objectives: When the tsunami in South East Asia hit the coast of Thailand on December 26, 2004, approximately 20,000 Swedish tourists were in the disaster zone. Of these, 548 died or were lost and more than 1500 were injured. The aim of this study was to evaluate the response of the Swedish health care system to the disaster in terms of assessment and support in the disaster zone, evacuation back to Sweden and continued treatment in Sweden. Methods: The evaluation was carried out based on (1) structured questionnaires to the staff of Thai hospitals, injured Swedish citizens and Swedish voluntary workers in the disaster zone, (2) semi-structured interviews with representatives of involved authorities, regional health care centres in Thailand and Sweden, hospital command centres, individuals treated for injuries and volunteer workers involved with supporting the injured, (3) on-site visits in the disaster zone, (4) analysis of reports following the tsunami. Results: A total of 11,000 injured were treated during the first 3 days following the tsunami at the six major hospitals in the Phang Nga, Phuket and Krabi provinces where the majority of the Swedish citizens were primarily taken care of. Of these 11,000, 3000 required hospital admission against a total bed capacity of 1400. Almost 1500 surgical operations were performed during the first 3 days across 33 operating theatres. Thai health care representatives and staff confirmed the requirement for teams from countries with many tourists in the area for practical and psychological support, interpretation, assessment for evacuation and undertaking early evacuation to home nations to release local health care resources. This need was also supported by the injured. Sweden, having the highest number of injured citizens next to the host country, was very late compared to other countries in sending assessment teams to the area and in supplying the needed support. Conclusions: With increased international travelling, many countries today have large numbers of their citizens in other parts of the world. For Sweden, this has been estimated to be 400,000 at any one time, often in areas known to be risk zones for natural disasters and terrorism. This fact of modern-day life demands welldesigned plans to support both citizens in the area and the local health care in several ways: non-medical support by mediating contact between injured and local medical staff, psychological and practical support, support in evacuating own citizens from the area to release local health care and (under specific conditions) medical support. This planning has to include prepared assessment teams that can be rapidly deployed to the scene and a command structure permitting rapid and accurate decisions on a governmental level. © 2008 Springer.

Keywords
Aeromedical evacuation, Assessment teams, Disaster planning, Mass-casualty incidents Natural disasters, Tsunami
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-50087 (URN)10.1007/s00068-008-8807-0 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2011-01-11
Lennquist, S. (2007). Management of major accidents and disasters: An important responsibility for the trauma surgeons. Journal of Trauma, 62(6), 1321-1329
Open this publication in new window or tab >>Management of major accidents and disasters: An important responsibility for the trauma surgeons
2007 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 62, no 6, p. 1321-1329Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45945 (URN)10.1097/TA.0b013e31805ba373 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13
Olofsson, P., Abu-Zidan, F. M., Wang, J., Nagelkerke, N., Lennquist, S. & Wikstrom, T. (2006). The effects of early rapid control of multiple bowel perforations after high-energy trauma to the abdomen: implications for damage control surgery. Journal of Trauma, 61(1), 185-191
Open this publication in new window or tab >>The effects of early rapid control of multiple bowel perforations after high-energy trauma to the abdomen: implications for damage control surgery
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2006 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 61, no 1, p. 185-191Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: This study evaluates the effects of early rapid control of multiple bowel perforations on cardiovascular and pulmonary function in high-energy traumatic shock compared with conventional small bowel resection anastomosis.

METHODS: Fifteen anesthetized pigs, 10 to 12 weeks old, were exposed to a reproducible high-energy trauma and were divided into two groups. In the first group, the resection anastomosis group (RA, n = 8), small-bowel injuries were treated with resection and anastomosis; in the second group, the multiple bowel ligation group (BL, n = 7), small-bowel injuries were treated by resection and ligation. Repeated measurement analysis of variance was used to study the within group change overtime, the between group difference, and the interaction between them. Mean outcome measures were intravascular pressures, cardiac output, vascular resistance, lactic acid, and blood gases.

RESULTS: The high-energy injuries caused traumatic shock in both groups with reduced cardiac output (p < 0.001) and lactic acidemia (p < 0.001). The BL group had a trend for higher cardiac output (p = 0.06). The rise in systemic and pulmonary vascular resistance was significantly reduced in the BL group compared with the RA group (p < 0.05). The BL group had a strong trend for higher oxygen extraction ratio (p = 0.06). There was a trend for less oxygen consumption in the BL group (p = 0.07). There was no difference in the lactic acidemia between the two groups.

CONCLUSIONS: Early rapid control of multiple bowel perforations after high-energy trauma resulted in less impairment of cardiovascular function than conventional resection anastomosis of the bowel.

Keywords
Bowel ligation, Damage control, Traumatic shock, Lactic acidemia, Cardiac output, Vascular resistance
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17794 (URN)10.1097/01.ta.0000221807.69844.63 (DOI)16832269 (PubMedID)
Available from: 2009-04-21 Created: 2009-04-21 Last updated: 2017-12-13Bibliographically approved
Lennquist, S. (2005). Education and training in disaster medicine. Scandinavian Journal of Surgery, 94(4), 300-310
Open this publication in new window or tab >>Education and training in disaster medicine
2005 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 94, no 4, p. 300-310Article in journal (Refereed) Published
Abstract [en]

[No abstract available]

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-33459 (URN)19480 (Local ID)19480 (Archive number)19480 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Abu-Zidan, F., Siosteen, A., Wang, J., Al-Ayoubi, F. & Lennquist, S. (2004). Establishment of a teaching animal model for sonographic diagnosis of trauma. Journal of Trauma, 56(1), 99-104
Open this publication in new window or tab >>Establishment of a teaching animal model for sonographic diagnosis of trauma
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2004 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 56, no 1, p. 99-104Article in journal (Refereed) Published
Abstract [en]

Background: Ultrasound is widely accepted as a valuable diagnostic tool for detecting intra-abdominal and intrathoracic bleeding in trauma patients. Nevertheless, many doctors are reluctant to use it because they do not have sufficient training. This study aimed to define intraabdominal and intrathoracic fluid volumes that can be detected by sonography and their relation to fluid width in pigs to establish a clinically relevant animal model for teaching and training. Methods: Different volumes of normal saline were infused into the abdomen (50-2,000 mL) and chest (25-250 mL) in five anesthetized pigs. The maximum width of fluid as detected by ultrasound was recorded. The right upper quadrant, left upper quadrant, pelvis, and right paracolic section of the abdomen and right pleural cavity were studied. An experienced radiologist performed the studies. The effects on respiratory and cardiovascular functions were evaluated. Results: The sonographic findings in the pig were similar to those in humans. Up to 50 mL of intra-abdominal fluid and up to 25 mL of intrathoracic fluid could be detected by ultrasound. There was a significant correlation between the volume infused and the fluid width detected. The respiratory and cardiovascular monitoring of the animals showed that the infused intrathoracic volumes mimicked a survivable hemothorax. Conclusion: The pig may serve as an excellent clinically relevant model with which to teach surgeons detection of different volumes of intra-abdominal and intrathoracic fluids. The value of this model as an educational tool has yet to be tested.

Keywords
ultrasound, multiple trauma, teaching, training, animal model, pig
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46286 (URN)
Note

DOI does not work: 10.1097/01.TA.000038546.82954.3D

Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2018-03-12
Horiuchi, Y., Droog Tesselaar, E., Henricson, J., Wikström, T., Lennquist, S. & Sjöberg, F. (2004). Role of histamine release in nonspecific vasodilatation during anodal and cathodal iontophoresis. Microvascular research, 67(2), 192-196
Open this publication in new window or tab >>Role of histamine release in nonspecific vasodilatation during anodal and cathodal iontophoresis
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2004 (English)In: Microvascular research, ISSN 0026-2862, Vol. 67, no 2, p. 192-196Article in journal (Refereed) Published
Abstract [en]

Nonspecific vasodilatation during iontophoresis is an important confounding factor in experimental pharmacology. In this investigation, we studied the involvement of sensory nerves and histamine-related reactions in causing nonspecific vasodilatation in a model of anodal and cathodal iontophoresis of sodium chloride. Firstly, we applied a mixture of local anesthetic (EMLA) cream to confirm its suppressive effect on nonspecific vasodilatation and to measure its efficacy in three different dosages (duration: 1, 2, and 3 h). We then investigated the role of histamine in nonspecific vasodilatation by giving an oral antihistamine drug (cetirizine) to subjects who had and had not been given EMLA. We found substantial suppression of the nonspecific vasodilatation in all EMLA-treated groups (all dosages) compared with untreated controls (with suppression rates of 60–65%). Dosage had no significant effect. A further suppression of nonspecific vasodilatation was seen after oral cetirizine during anodal and cathodal iontophoresis in both EMLA-treated and untreated groups. The antihistamine effect was most pronounced during anodal iontophoresis. These results suggest a histaminergic increase in perfusion that may be independent of neurogenic mechanisms and depend on polarity (anode or cathode). Local nerve blocks (EMLA) together with cetirizine may therefore be used to reduce nonspecific vasodilatation in both anodal and cathodal iontophoresis.

Keywords
Microcirculation, Iontophoresis, Nonspecific vasodilatation, EMLA, Cetirizine, Histamine, Laser Doppler
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14457 (URN)10.1016/j.mvr.2003.12.002 (DOI)
Available from: 2007-05-04 Created: 2007-05-04 Last updated: 2009-08-18
Lennquist, S. (2003). Education and training in disaster medicine- time for a scientific approach. International Journal of Disaster Medicine, 1
Open this publication in new window or tab >>Education and training in disaster medicine- time for a scientific approach
2003 (English)In: International Journal of Disaster Medicine, ISSN 1503-1438, E-ISSN 1755-4713, Vol. 1Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25218 (URN)9657 (Local ID)9657 (Archive number)9657 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
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