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  • 1.
    Ahl, Caroline
    et al.
    University of Borås, School of Health Science.
    Hjälte, L
    Johansson, C
    Wireklint-Sundström, Birgitta
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Culture and care in the Swedish ambulance services2005In: Emergency Nurse, ISSN 1354-5752, E-ISSN 2047-8984, Vol. 13, no 8, p. 30-36Article in journal (Refereed)
  • 2. Ambjörnsson, Joakim
    et al.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Strömsöe, Annelie
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital suspicion and identification of adult septic patients:Experiences of a screening tool2016Conference paper (Refereed)
    Abstract [en]

    Introduction:  Sepsis  is life threatening  and  requires  urgent healthcare  to reduce  suffering  and death. Therefore it is important that septic patients are identified early to enable treatment.

     

    Aim: To investigate to what extent EMS personnel identified patients with sepsis using the "BAS

    90-30-90"  model, and to describe assessments and medical procedures that were  undertaken by the personnel.

     

    Methods: This was a retrospective study where  185 EMS medical records were  reviewed. The inclusion was based on patients who were later diagnosed with sepsis in the hospital.

     

    Results: A physician assessed the patients  in 74 of the EMS cases, which lead to exclusion  of these  records  in  regard  to  the  EMS  personnel's  ability  to  identify  sepsis.  The  personnel documented  suspicion  of severe sepsis in eight (n=8) of the remaining 111 records (7.2%). The proportion  of patients  065 years  of age was 73% (n=135)  of which  37% (n=50) were over 80 years  old. Thirty-nine percent  (39%,  n=72)  were  females. The  personnel  documented blood pressure   in  91%  (n=168),  respiratory   rate  in  76%  (n=140),   saturation   in  100%  (n=185), temperature  in 76%  (n=141),  and  heart  rate  in  94%  (n=174)  of  the  records.  Systolic  blood pressure  <90 mmHg  was  documented  in 14,2%  (n=24),  respiratory  rate  030 in 36%  (n=50), saturation <90 in 49%   (n=91). temperature >38°C in 37.6% (n=53), and heart rate 090 in 70% (n=121) of the records. Documented medical procedures and treatments were intravenous  lines (70%, n=130), intravenous  fluids (10%, n=19) and administration  of oxygen (72%, n=133).

     

    Conclusion:  The EMS personnel identified  only a few septic patients  with the help of the BAS

    90-30-90  model when  all three criteria  would  be met for severe  sepsis. Either  advanced age (>65  years),   fever   (>38°C)   or  tachypnea (020  breaths/min)   appeared   to   increase  the personnel's suspicion  of sepsis. Oxygen, but not intravenous  fluids, was given in an adequate way.

  • 3.
    Andersson Hagiwara, Magnus
    et al.
    University of Borås, School of Health Science.
    Kängström, Anna
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Effect of Simulation on the Clinical Competence of Swedish Ambulance Nurses2014In: Australasian Journal of Paramedicine, ISSN 2202-7270, Vol. 11, no 2, p. 1-7Article in journal (Refereed)
    Abstract [en]

    ntroduction Simulation has become an established method for education and training of Emergency Medical Services personnel in different skills such as advanced airway techniques, also in evaluation and initial care of stroke patients and in pre - hospital trauma. Simula tion can be a useful method to improve learning. To our knowledge, there are only a few studies that relate simulation to the effect on clinical skills. The aim of the present study was to investigate the effect of simulation on the clinical competence in a pre - hospital trauma care course for ambulance nurses. Methods The study was performed using a before - after design. Seventeen ambulance nurse students who participated in a trauma care course were evaluated in two simulated trauma cases. All subjects had passed the initial theoretical part of the course. The pre - test was performed in the beginning of the following part of the course involving simulation and the post - test at the end of the course. The analysis was performed by assessment of performance, as seen on video - tapes from the pre - tests and the post - tests. A validated instrument was used to determine the level of student’ s clinical competence. Paired t - test was used to confirm differences between the pre - test and post - test results . Results There was a significant increase in the over - all results for the post - test, with a difference of 1.12 points (t=4.642, df=16, p= 0.001) Situation Awareness, Patient Assessment and Decision Making showed the most pronounced improvements. Conclusion The results imply t hat simulation in addition to traditional theoretical education improves the clinical competence of the students, in comparison to traditional education and training without any significant amount of simulation.

  • 4.
    Andersson Hagiwara, Magnus
    et al.
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Andersson-Gare, Boel
    Sjöqvist, Bengt-Arne
    Henricson, Maria
    Jonsson, Anders
    University of Borås, School of Health Science.
    The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study2014In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 14, no 70Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional "scoop and run" practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST).METHODS:In this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression.RESULTS:In this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST.CONCLUSIONS:The use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

  • 5.
    Andersson, S-O
    et al.
    Linköping Universitet.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Tingström, Pia
    Linköping Universitet.
    Abrandt Dahlgren, Madeleine
    Linköping Universitet.
    Fixing the wounded or keeping lead in the air-tactical officers' views of emergency care on the battlefield2015In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 180, no 2, p. 224-229Article, review/survey (Refereed)
    Abstract [en]

    The aim of this study was to identify tactical officers' views of prehospital emergency care in the field before an international mission. A qualitative study with a phenomenographic approach based on interviews was used. The result of this study is a set of descriptive categories on a collective level, showing the variation in how the tactical officers perceived the phenomenon of emergency care in the battlefield. The result can be viewed as (1) noncombat-oriented including being able to do one's specialist task, being able to talk with local people, and being able to give first aid, and (2) combat-oriented including soldiers' skills and roles in the unit, being able to act in the unit, and being able to lead the care of injured. These findings are important for officers' preparation for international missions. The interaction between military and medical knowledge on-site care should be developed between the tactical officer and the medical personnel in order to minimize suffering and to enhance the possibility for survival of the casualty.

  • 6. Andersson, Sten-Ove
    et al.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Tingström, Pia
    Abrandt Dahlgren, Madeleine
    Doctors' and nurses' perceptions of military pre-hospital emergency care - When training becomes reality.2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 32, p. 70-77, article id S1755-599X(17)30010-1Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify physicians' and nurses' perceptions of military pre-hospital emergency care before and after an international mission. A qualitative empirical study with a phenomenographic approach was used. The results after pre-deployment training can be categorised as (1) learning about military medicine and (2) taking care of the casualty. The results after an international mission can be categorised as (1) collaborating with others, (2) providing general health care and (3) improving competence in military medicine. These results indicate that the training should be developed in order to optimise pre-deployment training for physicians and nurses. This may result in increased safety for the provider of care, while at the same time minimising suffering and enhancing the possibility of survival of the injured.

  • 7. Andersson, Sten-Ove
    et al.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Tingström, Pia
    Abrandt Dahlgren, Madeleine
    Interaction, Action, and Reflection: How Medics Learn Medical Care in the Swedish Armed Forces2013In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 178, no 8, p. 861-866Article in journal (Refereed)
    Abstract [en]

    The objective of this study is to examine how medics within the Swedish Armed Forces perceive their learning outcome following military prehospital training. A qualitative study with a phenomenographic approach was used to investigate how learning is perceived among military medics. At meta level, the results can be viewed as an interaction, i.e., being able to collaborate in the medical platoon, including the ability to interact within the group and being able to lead; an action, i.e., being able to assess and treat casualties, including the ability to communicate with the casualty, to prioritize, and to be able to act; and a reflection, i.e., having confidence in one's own ability in first aid, including being prepared and feeling confident. interaction during the period of education is important for learning. action, being able to act in the field, is based on a drill in which the subject progresses from simple to complex procedures. reflection, learning to help others, is important for confidence, which in turn creates preparedness, thereby making the knowledge meaningful.

  • 8. Andersson, Sten-Ove
    et al.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Tingström, Pia
    Dahlgren, Madeleine Abrandt
    Fixing the wounded or keeping lead in the air-tactical officers' views of emergency care on the battlefield.2015In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 180, no 2, p. 224-229Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify tactical officers' views of prehospital emergency care in the field before an international mission. A qualitative study with a phenomenographic approach based on interviews was used. The result of this study is a set of descriptive categories on a collective level, showing the variation in how the tactical officers perceived the phenomenon of emergency care in the battlefield. The result can be viewed as (1) noncombat-oriented including being able to do one's specialist task, being able to talk with local people, and being able to give first aid, and (2) combat-oriented including soldiers' skills and roles in the unit, being able to act in the unit, and being able to lead the care of injured. These findings are important for officers' preparation for international missions. The interaction between military and medical knowledge on-site care should be developed between the tactical officer and the medical personnel in order to minimize suffering and to enhance the possibility for survival of the casualty.

  • 9.
    Axelsson, Christer
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Anders
    Sjöberg, Henrik
    Jiménez-Herrera, Maria
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gellerstedt, Martin
    Ljungström, Lars
    The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting2016In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, no 3, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Purpose:  There is a lack of knowledge  about the early phase of severe infection. This reportdescribes the early chain of care in bacteraemia as follows:  (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start ofintravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.

    Basic Procedures: All  patients  in the Municipality of Gothenburg  (Sweden) with apositive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.

    Main Findings/Results:  In all, 696 patients fulfilled the inclusion criteria. Their mean agewas 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms  and signs.The EMS nurse  suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes  versus three hours and 21 minutes among the remaining patients (P = .0006). The corresponding figures for cases with “true pathogens” were one hour and19 minutes  versus three hours and 15 minutes  (P = .009).

    Conclusion:  Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms  and signs. The EMS nurse  suspected sepsis in six percent of cases. Regardless  of whether or not patients with true pathogens  were isolated,  a suspicion of sepsis by the EMS clinician at thescene was associated with a shorter delay to the start of antibiotic treatment.

  • 10.
    Backlund, Per
    et al.
    Högskolan i Skövde.
    Heldal, I
    Söderström, E
    Högskolan i Skövde.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Maurin Söderholm, Hanna
    University of Borås, Faculty of Librarianship, Information, Education and IT.
    Pre-hospital training and simulation initiative2014In: Society in Europe for Simulation Applied to MedicineArticle, review/survey (Refereed)
  • 11. Backlund, Per
    et al.
    Heldal, Ilona
    Söderström, Ewa
    Lundberg, Lars
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Maurin Söderholm, Hanna
    University of Borås, Swedish School of Library and Information Science.
    Pre-hospital training and simulation initiative2014Conference paper (Refereed)
    Abstract [en]

    Background The pre-hospital process is a complex one involving aspects such as medical skills as well as care taking, team performance, inter-organizational cooperation and communication. This calls for novel training methods and technology support. Our review of literature (covering the areas of pre-hospital care, training simulator technologies and methods and process modelling) indicates that the different aspects are typically trained in isolation, e.g. medical skills using patient simulators.Objective The pre-hospital training center project addresses the overall complexity of the pre-hospital process by taking all of the aspects into account when designing scenarios and technology support for training the complete prehospital process (covering alarm, on-scene activities, transportation and hand-over). This is indeed a challenging task as we need to develop both training methods and technology support for a very complex training situation.Methods The project will develop a prototype scenario along with technology support to enact it. The training scenario will involve many of the aspects listed above and will be tested in a field experiment with ambulance personnel. Results The expected outcome of the project is a platform for establishing a pre-hospital simulation and training center. The initial technologies, research results and experiences will be used to form a consortium for further work and development. Conclusions We have identified a need for a pre-hospital training center with the unique and ambitious idea of covering the entire pre-hospital process as well as its many interacting aspects. To the best of our knowledge this approach is not at all common and we expect the complexity to be so high that it is a challenging enough research area that can only be addressed if we have a well-designed simulation and training center in place with all the different areas of knowledge represented, i.e. pre-hospital medicine as well as simulation and visualization technology.

  • 12. Fortes Lähdet, E.
    et al.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Analysis of Triage Worldwide2009In: Emergency Nurse, ISSN 1354-5752, E-ISSN 2047-8984, Vol. 17, no 4, p. 16-19Article in journal (Refereed)
    Abstract [en]

    Several triage methods have been developed and adopted around the world but none has been devised for specific patient populations such as older people or those with special needs. This literature review outlines the development of triage since the 1950s, briefly discusses some of the models in use around the world, including one that is used in the care of older people, and outlines the issues that should be taken into account when deciding which method to adopt.

  • 13.
    Hagiwara Andersson, Magnus
    et al.
    University of Borås, School of Health Science.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Henricson, Maria
    Sjökvist, Bengt-Arne
    Jonsson, Anders
    University of Borås, School of Health Science.
    Decision support system in prehospital care: a randomized controlled simulation study2013In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, no 1, p. 143-153Article in journal (Refereed)
    Abstract [en]

    Introduction Prehospital emergency medicine is a challenging discipline characterized by a high level of acuity, a lack of clinical information and a wide range of clinical conditions. These factors contribute to the fact that prehospital emergency medicine is a high-risk discipline in terms of medical errors. Prehospital use of Computerized Decision Support System (CDSS) may be a way to increase patient safety but very few studies evaluate the effect in prehospital care. The aim of the present study is to evaluate a CDSS. Methods In this non-blind block randomized, controlled trial, 60 ambulance nurses participated, randomized into 2 groups. To compensate for an expected learning effect the groups was further divided in two groups, one started with case A and the other group started with case B. The intervention group had access to and treated the two simulated patient cases with the aid of a CDSS. The control group treated the same cases with the aid of a regional guideline in paper format. The performance that was measured was compliance with regional prehospital guidelines and On Scene Time (OST). Results There was no significant difference in the two group's characteristics. The intervention group had a higher compliance in the both cases, 80% vs. 60% (p < 0.001) but the control group was complete the cases in the half of the time compare to the intervention group (p < 0.001). Conclusion The results indicate that this CDSS increases the ambulance nurses' compliance with regional prehospital guidelines but at the expense of an increase in OST.

  • 14.
    Hagiwara, Magnus
    et al.
    University of Borås, School of Health Science.
    Henricson, M
    Jonsson, Anders
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Decision-Support Tool in Prehospital Care:A Systematic Review of Randomized Trials2011In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 26, no 4, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient. Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/ Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials. Results: Use of the DST in prehospital care may have the possibility to decrease “time to definitive care” and improve diagnostic accuracy among prehospital personnel, but more studies are needed. Conclusions: The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care.

  • 15.
    Hagiwara, Magnus
    et al.
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Henricson, Mia
    Exclusion of context knowledge in the development of prehospital guidelines: results produced by realistic evaluation.2013In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, no 46Article in journal (Refereed)
    Abstract [en]

    Background Prehospital work is accomplished using guidelines and protocols, but there is evidence suggesting that compliance with guidelines is sometimes low in the prehospital setting. The reason for the poor compliance is not known. The objective of this study was to describe how guidelines and protocols are used in the prehospital context. Methods This was a single-case study with realistic evaluation as a methodological framework. The study took place in an ambulance organization in Sweden. The data collection was divided into four phases, where phase one consisted of a literature screening and selection of a theoretical framework. In phase two, semi-structured interviews with the ambulance organization's stakeholders, responsible for the development and implementation of guidelines, were performed. The third phase, observations, comprised 30 participants from both a rural and an urban ambulance station. In the last phase, two focus group interviews were performed. A template analysis style of documents, interviews and observation protocols was used. Results The development of guidelines took place using an informal consensus approach, where no party from the end users was represented. The development process resulted in guidelines with an insufficiently adapted format for the prehospital context. At local level, there was a conscious implementation strategy with lectures and manikin simulation. The physical format of the guidelines was the main obstacle to explicit use. Due to the format, the ambulance personnel feel they have to learn the content of the guidelines by heart. Explicit use of the guidelines in the assessment of patients was uncommon. Many ambulance personnel developed homemade guidelines in both electronic and paper format. The ambulance personnel in the study generally took a positive view of working with guidelines and protocols and they regarded them as indispensable in prehospital care, but an improved format was requested by both representatives of the organization and the ambulance personnel. Conclusions The personnel take a positive view of the use of guidelines and protocols in prehospital work. The main obstacle to the use of guidelines and protocols in this organization is the format, due to the exclusion of context knowledge in the development process.

  • 16.
    Herlitz, Johan
    et al.
    University of Borås, School of Health Science.
    Bång, Angela
    University of Borås, School of Health Science.
    Wireklint-Sundström, Birgitta
    University of Borås, School of Health Science.
    Axelsson, Christer
    University of Borås, School of Health Science.
    Bremer, Anders
    University of Borås, School of Health Science.
    Hagiwara, Magnus
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Ljungström, Lars
    Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care.2012In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, no 42Article in journal (Refereed)
    Abstract [en]

    Background Sepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis. Aim To describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis. Methods A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases. Results In overall terms, we found a small number of articles (n=12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis. Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT. There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers. Conclusion Severe sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.

  • 17.
    Hindorf, Maria
    et al.
    LiU.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Swedish Specialized Boarding Element Members' Experiences of Naval Hostile Duty2018In: Journal of Special Operations Medicine, ISSN 1553-9768, Vol. 01, no 18(3), p. 45-49Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Swedish naval specialized boarding element participated in Operation Atalanta in 2013 to mitigate piracy by escorting and protecting ships included in the United Nations World Food Program in the Indian Ocean. We describe the experiences of the Swedish naval specialized boarding-element members during 4 months of international naval hostile duty. Some studies have reported experiences of naval duty for the Coast Guard or the merchant fleet; however, we did not find any studies that identified or described experiences of long-time duty onboard ship for the naval armed forces.

    MATERIALS AND METHODS: The respondents wrote individual notes of daily events while onboard. Conventional content analysis was used on the collected data, using an inductive approach.

    RESULTS: The findings revealed three broad themes: military preparedness, coping with the naval context, and handling physical and mental strain. Different categories emerged indicating that the participants need the ability to adapt to the naval environment and to real situations.

    CONCLUSION: The Swedish navalforces should train their specialized element members in coping strategies. 

  • 18.
    Hyllner, Monica
    et al.
    Göteborgs Universitet.
    Törnqvist, Annika
    Göteborgs Universitet.
    Eide, Camilla
    Göteborgs Universitet.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    The Use of the Life Support for Trauma and Transport (LSTAT) platform in a civilian postoperative setting2009In: NATO MedicalArticle, review/survey (Refereed)
  • 19. Hyllnér, M.
    et al.
    Törnqvist, A.
    Eide, C.
    Ström, G.
    Frennås, P.
    Jonsson, Anders
    University of Borås, School of Health Science.
    The Use of the Life Support for Trauma and Transport (LSTAT) platform in a civilian postoperative setting2009Conference paper (Refereed)
  • 20.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Att hantera traumatiska erfarenheter2003Conference paper (Refereed)
  • 21.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fotodokumentation av stora olyckor2001In: Hälso och sjukvårdsstämmanArticle, review/survey (Refereed)
  • 22.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lineaus-Palme a pedagogic touch2006In: TempusArticle, review/survey (Refereed)
  • 23.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nursing in a Global Perspective2002In: Jordan UniversityArticle, review/survey (Refereed)
  • 24.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Photodocumentation at Car Crashes2002In: Emergencies and Public SafetyArticle, review/survey (Refereed)
  • 25.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Posttraumatisk stress: förekommer det inom ambulanssjukvården2001In: TM Räddningsmedicin, Vol. 2, no 22Article, review/survey (Other (popular science, discussion, etc.))
  • 26.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Posttraumatisk stress: förekommer det inom ambulanssjukvården2001In: TM Räddningsmedicin, Vol. 2, no 22Article in journal (Other (popular science, discussion, etc.))
  • 27.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Posttraumatisk stress hos ambulanspersonal2001Conference paper (Refereed)
  • 28.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Stress efter traumatiska händelser: Ambulanspersonalens vardag2004Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Aims: Paper I: To examine the prevalence of posttraumatic stress reactions among ambulance personnel and to investigate whether different levels of Sense Of Coherence are related to different consequences of traumatic stress.Paper II: To uncover the essence of traumatic events experienced by Swedish ambulance personnel. Paper III: To investigate the association between daily work exposure to traumatic events and emotional and mental wellbeing, and if self knowledge influence how well you handle the effects of daily work exposure to such events.Paper IV: To uncover and deepen the understanding of the way ambulance staff experience and handle traumatic events, and to develop the understanding of the life world of the participants.Methods: Paper I & III: To estimate the prevalence of trauma related disorders (Paper I), a representative group of 362 ambulance personal was surveyed through use of Antonovsky s 13-item version of SOC-13 Scale. To measure reactions to traumatic events two instruments were used, Impact of Event Scale (IES-15) and the Post Traumatic Symptom Scale (PTSS-10). A correlate was established between posttraumatic symptoms using IES-15 and the Professional Self Description Form (Paper III).Paper II & IV In the study (Paper II) written stories from 52 ambulance personnel describing an experienced traumatic event were analysed by the van Kaam method. In the study ten ambulance personnel were interviewed. To reach a deeper understanding an interpretative Heideggerian approach was applied, based on an existential perspective (Paper IV).Results: Paper I & III: A total of 223 of the ambulance personnel reported that they had had experience of what they described as traumatic situations. Of those who reported a traumatic situation 15.2% scored 31 or more on the IES-15 sub scale. On the PTSS-10 sub scale 12.1% scored 5 or more, which indicates a relatively strong reaction. The study indicates that lower sense of coherence predicts post-traumatic stress. Other predictors for the extent of traumatic stress were longer job experience, age, physical and psychological workload (Paper I). There were significant differences on PSDF sub scales between those with or without posttraumatic symptoms (Paper III). Paper II & IV: Findings indicate that the ambulance personnel have a strong identification with the victims and it is impossible to prepare for events that are unforeseen and meaningless. To handle the overwhelming feelings of identification, the personnel have to gain understanding through talking about those feelings (Paper II). The findings show that post-traumatic stress symptoms, guilt, shame and self-reproach are common after duty related traumatic events (Paper IV).Conclusions: The mental health and emotional well being of ambulance personnel appears to be at risk in accident and emergency work. The high prevalence of PTSD symptoms in ambulance personnel indicates a normal inability to cope with posttraumatic stress caused by their daily work.

  • 29.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Stress efter traumatiska händelser. Vårdarens vardag2005In: An-Iva RFArticle, review/survey (Refereed)
  • 30.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Stress inom ambulanssjukvård2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Stockholm: Liber , 2009, 1Chapter in book (Other academic)
  • 31.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Svensson, Leif (Editor)
    Stress inom ambulanssjukvården2009In: Prehospital akutsjukvård, Stockholm: Liber , 2009, p. 39-48Chapter in book (Other academic)
  • 32.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    TeleMed and ICT in ambulance care decision support2006In: NS-RuralsArticle, review/survey (Refereed)
  • 33.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Traumatic stress among Nurses2006In: JNC NursingArticle, review/survey (Refereed)
  • 34.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Work related post-traumatic stress as described by Jordanian emergency nurses: Work related post-traumatic stress as described by Jordanian emergency nurses2006In: Accident & Emergency Nursing, Vol. 14, no 2, p. 89-96Article, review/survey (Refereed)
  • 35.
    Jonsson, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andreasson, Jörgen
    Suserud, B-O
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Åström, S
    Ambulance personnel should take pictures at the site of accidents.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 3162-3, no 8, p. 26-27Article, review/survey (Other academic)
  • 36.
    Jonsson, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Halabi, Jehad
    University of Jordan.
    Posttraumatic stress among Jordanian Nurses, Nursing2004In: Nursing, Riyadh SAArticle, review/survey (Refereed)
  • 37.
    Jonsson, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Halabi, Jehad
    The Jordanian-Swedish experience of exchange programs in promoting intercultural dialogue in nursing practice, management and education2005In: International Council of NursesArticle, review/survey (Refereed)
  • 38.
    Jonsson, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Halabi, Jehad
    University of Jordan.
    The Linnaeus-Palme exchange programme - promoting intercultural dialogue in education2004In: EAIEArticle, review/survey (Refereed)
  • 39.
    Jonsson, Anders
    et al.
    University of Borås, School of Health Science.
    Karlsson, K
    Niemelä, P
    Heart rate as a marker of stress in ambulancepersonnel: a pilot study of body's response to the ambulance alarm2011In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 26, no 1, p. 21-26Article in journal (Refereed)
    Abstract [en]

    Introduction: Studies have demonstrated the presence of stress and post-traumatic stress among ambulance personnel, but no previous research has focused on the body’s reaction in the form of the change in heart rate of ambulance staff in association with specific occupational stress. Hypothesis: The purpose of this study is to investigate whether work as an ambulance professional generates prolonged physiological arousal that can be measured by heart rate in different situations. Methods: Twenty participants carried a pulse-meter in the form of a wristwatch, which continuously measured and stored their heart rate 24 hours per day for a period of seven days. All ambulance alarms that occurred during the test period were recorded in journals, and the participants completed diaries and a questionnaire describing their experiences. The alarms were divided into different phases. Correlations between heart rate in the different phases were computed. Results: Analysis of study data indicated a significant rise of heart rate unrelated to physical effort during an emergency alarm and response. This increased heart rate was noticed throughout the mission and it was not related to the length of experience the staff had in the ambulance profession. In addition, a non-significant trend suggested that alarms involving acutely ill children lead to an even higher increase in heart rate. In addition, this research showed that constant tension existed during sleep, while available for an emergency, indicated by a noticeable increase in heart rate during sleep at work compared to sleeping at home. Conclusions: A rise in heart rate was experienced during all acute emergency missions, regardless of a subject’s experience, education, and gender. Missions by themselves generated a rate increase that did not seem to correlate with physical effort required during an emergency response. This study shows that working on an ambulance that responds to medical emergencies is associated with a prolonged physiological arousal.

  • 40.
    Jonsson, Anders
    et al.
    University of Borås, School of Health Science.
    Lundberg, Kristina
    University of Borås, School of Health Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Kjellström, Sofia
    Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties2014In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 8, no 179, p. 821-826Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this qualitative study is to explore the Swedish military personnel's experience of what it means to perform a caring role in a combat zone. This study assesses the challenges faced by military medical personnel in the context of a combat zone. METHODS: The design was descriptive with a qualitative inductive approach. Twenty military medical personnel (physicians, nurses, and combat lifesavers) were interviewed individually. They had been involved in international military operations between 2009 and 2012. This study was analyzed using qualitative content analysis. RESULTS: The analysis produced four categories: being in a primarily noncaring organization, caring in emotionally charged relationships, lacking an open dialog about expectations of killing and having to prioritize scarce resources. CONCLUSIONS: This study shows that medical personnel easily adapt to a military setting. They care but also perform other tasks when they are in a combat zone. The medical personnel want to give care to host nation but use drugs they can spare.

  • 41.
    Jonsson, Anders
    et al.
    University of Borås, School of Health Science.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Silverplats, Katarina
    The development of a military hybrid simulation model for the training of haemorrhage control in proximal extremity bleedings2014Conference paper (Other academic)
  • 42.
    Jonsson, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Segesten, Kerstin
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Daily stress and conception of self in Swedish ambulance personnel2004In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 19, no 3, p. 226-234Article, review/survey (Refereed)
  • 43.
    Jonsson, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Segesten, Kerstin
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Guilt, shame and need for a container, a study of post-traumatic stress among ambulance personnel2004In: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 12, no 4, p. 215-223Article, review/survey (Refereed)
  • 44.
    Jonsson, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Segesten, Kerstin
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    The meaning of traumatic events as described by nurses in ambulance service2003In: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 11, no 3, p. 141-152Article, review/survey (Refereed)
  • 45.
    Jonsson, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Segesten, Kerstin
    Mattson, Bengt
    University Gothenburg.
    Post-traumatic stress among Swedish ambulance personnel2003In: Emergency Medicine Journal, ISSN 1472-0205, E-ISSN 1472-0213, Vol. 20, p. 79-84Article, review/survey (Refereed)
  • 46.
    Jonsson, Anders
    et al.
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Forskning om ambulanssäkerhet2008In: Samverkan 112, ISSN 1650-7487, no 6Article in journal (Other (popular science, discussion, etc.))
  • 47.
    Jonsson, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Suserud, Björn-Ove
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Forskning om ambulanssäkerhet2008In: Samverkan 112Article, review/survey (Other (popular science, discussion, etc.))
  • 48.
    Karlsson, Kåre
    et al.
    Högskolan i Jönköping.
    Niemelä, Patrik
    SKAS.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Törnhage, Carl-Johan
    Skaraborgs sjukhus.
    Using Shoulder Straps Decreases Heart Rate Variability and Salivary Cortisol Concentration in Swedish Ambulance Personnel2016In: SH@W Safety and Health at Work, ISSN 2093-7911, E-ISSN 2093-7997, Vol. 7, no 1, p. 32-37Article, review/survey (Refereed)
  • 49.
    Lundberg, Kristina
    et al.
    University of Borås, School of Health Science.
    Kjellström, Sofia
    Jonsson, Anders
    University of Borås, School of Health Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Experiences of Swedish Military Medical Personnel in Combat Zones: Adapting to Competing Loyalties2014In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 179, no 8, p. 821-826Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this qualitative study is to explore the Swedish military personnel's experience of what it means to perform a caring role in a combat zone. This study assesses the challenges faced by military medical personnel in the context of a combat zone. METHODS: The design was descriptive with a qualitative inductive approach. Twenty military medical personnel (physicians, nurses, and combat lifesavers) were interviewed individually. They had been involved in international military operations between 2009 and 2012. This study was analyzed using qualitative content analysis. RESULTS: The analysis produced four categories: being in a primarily noncaring organization, caring in emotionally charged relationships, lacking an open dialog about expectations of killing and having to prioritize scarce resources. CONCLUSIONS: This study shows that medical personnel easily adapt to a military setting. They care but also perform other tasks when they are in a combat zone. The medical personnel want to give care to host nation but use drugs they can spare.

  • 50.
    Lundberg, Lars
    et al.
    University of Borås, School of Health Science.
    Andersson Hagiwara, Magnus
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Simulation in pre-hospital care2013Conference paper (Other academic)
12 1 - 50 of 66
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