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  • 1.
    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.

  • 2.
    Andersson, L-O
    et al.
    External.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Education in Military Medicine: The Swedish Model2005In: AMEE 2005 Abstracts, AMEE , 2005, p. 235-Conference paper (Refereed)
    Abstract [en]

    The Swedish Armed Forces Medical Centre is nationally responsible for the qualified education in military medicine. Studies at university level for conscript medical personnel were introduced in 1997, with the course Battlefield emergency care for nurses (7,5 ECTS points). Two years later, a parallel course for physicians was started. Other courses have also been studied at university level. Starting in 2001, a total of fifteen units throughout the country have arranged the Basic course in battlefield emergency care for Medical Orderly (15 ECTS points). The units have received academic support from local colleges and universities, while curriculum, study literature, supervision and examination have been the responsibility of the Armed Forces Medical Centre. The present reorganisation of the Swedish Armed Forces will result in a situation where the entire military medical education will be located in Gothenburg. Physicians, nurses and medics will be educated at the same campus. A close connection to the University of Gothenburg has been established, in order to promote the educational process of military medicine. Teachers at the Medical Centre will have positions as lecturers at the university, which will be favourable for the students in their acquisition of knowledge.

  • 3. Andersson, S-O
    et al.
    Dahlgren, L-O
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sjöström, B
    Criteria nurses use in assessing acute trauma in military emergency care2007In: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 15, no 3, p. 148-156Article in journal (Refereed)
    Abstract [en]

    Emergency medical care for seriously injured patients in war or warlike situations is highly important when it comes to soldiers’ survival and morale. The Swedish Armed Forces sends nurses, who have limited experience of caring for injured personnel in the field, on a variety of international missions. The aim of this investigation was to identify the kind of criteria nurses rely on when assessing acute trauma and what factors are affecting the emergency care of injured soldiers. A phenomenographic research approach based on interviews was used. The database for the study consists of twelve nurses who served in Bosnia in 1994–1996. The criteria nurses rely on, when assessing acute trauma in emergency care, could be described in terms of domain-specific criteria such as a physiological, an anatomical, a causal and a holistic approach as well as contextual criteria such as being able to communicate, having a sense of belonging, the military environment, the conscript medical orderly and familiarity with health-caring activity. The present study shows that the specific contextual factors affecting emergency care in the field must also be practised before the nurse faces military emergency care situations. This calls for realistic exercises and training programs, where experience from civilian emergency care is interwoven with the knowledge specific to military medical care.

  • 4. 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.

  • 5. 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.

  • 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
    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.

  • 7.
    Backlund, Per
    et al.
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Engström, Henrik
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Johannesson, Mikael
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Lebram, Mikael
    Högskolan i Skövde, Forskningscentrum för Informationsteknologi..
    Danielsson, Magnus
    Västra Götalandsregionen.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundberg, Lars
    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.
    The S.A.R.E.K Simulation Environment: Technical description of a flexible training environment for prehospital care.2017Report (Other academic)
    Abstract [en]

    This report contains a technical description of the result of the S.A.R.E.K (Simulation – Ambulance – Research – Education - Kinship) collaboration project and the Sim2020 project. The projects are collaborations between researchers in healthcare and IT, and prehospital care practitioners, with the aim to design, develop and test a contextualized simulation environment for prehospital care. We built a simulation environment representing the full depth and width of a prehospital care process. Breadth refers to including all phases of a prehospital mission, from dispatch to handover; while depth refers to detailed representations and recreation of artefacts, information and context for each of these phases. This report outlines the details of the overall design, all equipment and practical solutions used to create this. Apart from the installation which is described in this report we have also developed methods and carried out a variety of tests and experiments which are reported elsewhere. The focus of this report is the system and its components.

  • 8.
    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)
  • 9. 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.

  • 10. Blimark, M
    et al.
    Ekeroth, U
    Lundberg, Lars
    Civilian-military collaboration in training for disasters2007Conference paper (Refereed)
  • 11. Blimark, M
    et al.
    Örtenwall, P
    Lundberg, Lars
    University of Borås, School of Health Science.
    DSTC as war surgery course2011Conference paper (Other academic)
  • 12. Eide, C
    et al.
    Ström, G
    Umeå Universitet.
    Gustafsson, T
    Uppsala Universitet.
    Carleberg, P
    XMReality, Linköping .
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Mixed Reality: to apply for “urgent education/performance” or for rehearsal only?2009Conference paper (Refereed)
    Abstract [en]

    Background: The Swedish Armed Forces are in a new suit concerning peacekeeping missions abroad. In the future the Forces may have less Medical specialists that are conducive to the use of more Technical supporting system. Here we suggest a Mixed Reality supporting system for convoluted medicine technical performance. Mixed Reality involves the merging of real and virtual worlds. The user utilizes a head mounted or a handheld visual display presenting texts, virtual objects, animation sequences, audio and environmental features as incorporated into the real environments. Summary of work: We conducted an evaluation study in which ten participants used Mixed Reality technology, compared to written instructions with a picture as support for executing tasks. The tasks were to perform the procedures of ”power up” and to unitize a ventilator circuit assembly for the LSTAT® (Life Support for Trauma And Transport, a Platform for medical evacuation of a patient/wounded soldier.) Summary of results: The Mixed Reality technology was in general considered beneficial and there were favourable reactions in these tasks, compared to the written instructions.

  • 13. Engström, Henrik
    et al.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Backlund, Per
    Lebram, Mikael
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Johannesson, Mikael
    Sterner, 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.
    The impact of contextualization on immersion in healthcare simulation2016In: Advances in Simulation, ISSN 2059-0628, Vol. 1, no 1, p. 1-11Article in journal (Refereed)
    Abstract [en]

    The aim of this paper is to explore how contextualization of a healthcare simulation scenarios impacts immersion, by using a novel objective instrument, the Immersion Score Rating Instrument. This instrument consists of 10 triggers that indicate reduced or enhanced immersion among participants in a simulation scenario. Triggers refer to events such as jumps in time or space (sign of reduced immersion) and natural interaction with the manikin (sign of enhanced immersion) and can be used to calculate an immersion score.

  • 14. 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.

  • 15.
    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.

  • 16. Heldal, Ilona
    et al.
    Backlund, Per
    Johannesson, Mikael
    Lebram, Mikael
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Connecting the links: Narratives, simulations and serious games in prehospital training.2017In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 235, p. 343-347Article in journal (Refereed)
    Abstract [en]

    Due to rapid and substantial changes in the health sector, collaboration and supporting technologies get more into focus. Changes in education and training are also required. Simulations and serious games (SSG) are often advocated as promising technologies supporting training of many and in the same manner, or increasing the skills necessary to deal with new, dangerous, complex or unexpected situations. The aim of this paper is to illustrate and discuss resources needed for planning and performing collaborative contextual training scenarios. Based on a practical study involving prehospital nurses and different simulator technologies the often-recurring activity chains in prehospital training were trained. This paper exemplifies the benefit of using narratives and SSGs for contextual training contributing to higher user experiences. The benefits of using simulation technologies aligned by processes can be easier defined by narratives from practitioners. While processes help to define more efficient and effective training, narratives and SSGs are beneficial to design scenarios with clues for higher user experiences. By discussing illustrative examples, the paper contributes to better understanding of how to plan simulation-technology rich training scenarios.

  • 17. Heldal, Ilona
    et al.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Technologies supporting longitudinal collaboration along patients’ pathway: Planning training for prehospital care.2015Conference paper (Refereed)
  • 18.
    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.

  • 19. Johansson, A
    et al.
    Dahlgren, LO
    Lundberg, Lars
    Betydelsen av tidigare utbildning och klinisk erfarenhet för planering och genomförande av militär sjukvårdsövning för sjuksköterskor2007Conference paper (Other academic)
  • 20. Johansson, A
    et al.
    Dahlgren, LO
    Lundberg, Lars
    How to make military medical exercise more efficient2007Conference paper (Refereed)
  • 21.
    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)
  • 22. Jorum, E
    et al.
    Lundberg, Lars
    Torebjörk, E
    Peripheral projections of nociceptive unmyelinated axons in the human peroneal nerve1989In: Journal of Physiology, ISSN 0022-3751, E-ISSN 1469-7793, Vol. 416, no 1, p. 291-301Article in journal (Refereed)
    Abstract [en]

    1. Previous knowledge of the anatomical course of unmyelinated (C) axons along a peripheral nerve has been scarce and has led to the concept of the axons in a constantly interchanging position. 2. Results obtained by microneurography in the peroneal nerve at knee or ankle levels in awake humans demonstrated that the receptive fields of neighbouring C units in the nerve cluster in close vicinity on the skin of the foot or the ankle. These findings indicate that C afferents run closely together throughout large portions of the peripheral nerve. 3. Intraneural microstimulation performed at neural sites where nociceptive C units were recorded induced painful sensations projected to the skin. When the stimulus intensity was increased, there was typically a concentric increase in the area of projected pain, rather than recruitment of several scattered pain projections. This finding further supports the hypothesis of a neighbouring relation of nociceptive C axons within nerve fascicles, implying spatial recruitment of adjacent axons in the nerve with adjacent peripheral projections. 4. A pain locognosia test performed during ischaemic block of impulse conduction in myelinated fibres demonstrated a fairly precise cerebral localization of noxious events on the foot from the input of C afferent fibres alone.

  • 23. Koltzenburg, M
    et al.
    Lundberg, Lars
    Torebjörk, E
    Dynamic and static components of mechanical hyperalgesia in human hairy skin1992In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 51, no 2, p. 207-219Article in journal (Refereed)
    Abstract [en]

    The principle finding of the present study is that there are two types of mechanical hyperalgesia developing in human hairy skin following injurious stimuli. Mechanical hyperalgesia comprises a dynamic component (brush-evoked pain, allodynia) signalled by large myelinated afferents and a static component (hyperalgesia to pressure stimuli) signalled by unmyelinated afferents. While the static component is only found in the injured area, the dynamic component also extends into a halo of undamaged tissue surrounding the injury. The irritant chemicals, mustard oil or capsaicin, were applied transdermally in 20 subjects to a patch (2 × 2 cm) of hairy skin. Both substances evoked burning pain and hyperalgesia to mechanical stimuli. While stroking normal skin with a cotton bud was perceived only as touch prior to chemical stimulation, there was a distinctly unpleasant sensation afterwards. This component of mechanical hyperalgesia persisted for at least 30 min and was present in the skin exposed to the irritants (primary hyperalgesia) as well as in a zone of untreated skin surrounding the injury (secondary hyperalgesia) measuring 38 ± 4 cm2 after capsaicin. Pressure pain thresholds dropped to 55 ± 8% of baseline level after mustard oil and to 46 ± 9% after capsaicin. However, this drop of thresholds was short-lived, lasting 5 min following mustard oil but persisting more than 30 min following capsaicin treatment. The reduction of pressure pain thresholds was only observed for treated skin areas, but not in the surrounding undamaged tissue from where brush-evoked pain could be evoked. When pressure pain thresholds were lowered, the pain had a burning quality which differed distinctly from the quality of brush-evoked pain. On-going burning pain and both types of mechanical hyperalgesia were critically temperature dependent. Mildly cooling the skin provided instant relief from on-going pain, abolished brush-evoked pain and normalized pressure pain thresholds. Rewarming resulted in a reappearence of on-going pain and hyperalgesia. The effect of a nerve compression block of the superficial radial nerve on these sensations was tested in 14 experiments. When the ability to perceive light touch had been abolished, there was also no touch-evoked pain, indicating that this component of mechanical hyperalgesia is mediated by large-diameter primary afferents. At a later stage of the block when the subjects' ability to perceive cold stimuli had also been lost, application of cool stimuli still eliminated on-going burning pain, suggesting that pain relief afforded by cooling the skin acts at the peripheral receptor level and not by central masking. Importantly, at this stage of the block, when only unmyelinated primary afferents conducted, neither spontaneous pain, nor hyperalgesia to heat, nor the lowered pressure pain threshold had changed significantly. Based on the differences in quality of sensations, in spatial and temporal profiles and in susceptibility to differential nerve blocks, we conclude that irritant chemicals induce a dynamic and static component of mechanical hyperalgesia signalled by large-diameter or unmyelinated fibres, respectively. While the static component may be mediated by sensitized peripheral nociceptors, the dynamic component is probably the consequence of an altered processing of large diameter primary afferent input in the central nervous system subsequent to a maintained barrage of nociceptor activity. The parallel fluctuation of brush-evoked and burning background pain therefore suggest that on-going activity from nociceptors is required to maintain a central state that permits dynamic mechanical hyperalgesia to be expressed in humans.

  • 24. LaMotte, R
    et al.
    Lundberg, Lars
    Torebjörk, E
    Pain, hyperalgesia and activity in nociceptive C units in humans after intradermal injection of capsaicin1992In: Journal of Physiology, ISSN 0022-3751, E-ISSN 1469-7793, Vol. 448, p. 749-764Article in journal (Refereed)
    Abstract [en]

    1. Capsaicin, the potent algesic substance in chilli peppers, was applied topically to, or injected intradermally into or outside, the receptive fields of 14 C mechanoheat (polymodal) nociceptor units in awake humans. The nociceptor discharges were recorded using microelectrodes inserted into the peroneal nerve. Simultaneously, the subjects estimated the magnitude of pain as a function of time during the first 1.5-3 min after injection. Magnitude estimates of pain produced by heat and/or mechanical stimuli were also obtained before and after capsaicin in order to assess the magnitude of cutaneous hyperalgesia. 2. An injection within or adjacent to, but not greater than 4 mm outside, the receptive fields of C nociceptor units evoked discharges. The magnitude of pain and the mean discharge rate of the units were both maximal on injection, declining rapidly over the next 1-3 min, which indicates that these nociceptors contribute to the magnitude and duration of pain evoked by capsaicin injection. 3. Reduced or abolished excitability in C nociceptors after capsaicin injection within the receptive fields correlated with analgesia at the injection site. 4. Capsaicin injection produced a wide surround area of mechanical hyperalgesia, i.e. pain on gently stroking the skin or abnormally intense pain on punctate stimulation. Nevertheless, the injections did not lower the thresholds or enhance the responses to such mechanical stimuli of C nociceptor units with their receptive fields in this hyperalgesic area. 5. Topical application of capsaicin evoked on-going discharges in four units tested. Both nociceptor response thresholds and pain thresholds were lowered for heat from 45 to 35 degrees C. A newly developed weak response to stroking the skin in two units after capsaicin was accompanied by faint pain. 6. On-going activity in sensitized C nociceptors and concomitant pain were effectively reduced by cooling the skin in the receptive area. 7. It is concluded that activity in C mechanoheat (polymodal) nociceptors contributes to the magnitude and duration of pain evoked by intradermal injection of capsaicin. The after-effects of capsaicin on C nociceptor excitability depend on concentration: high concentration (by injection) leads to desensitization, whereas low concentration (by topical application) leads to sensitization. On-going discharges and lowered response thresholds to heat in these units after topical application of capsaicin correlates with background pain as well as lowered pain thresholds to heat of the affected skin (primary hyperalgesia). The unchanged responsiveness of C nociceptors in the skin well outside the injection area indicates that central rather than peripheral sensitization accounts for the observed mechanical hyperalgesia in this region (secondary hyperalgesia).

  • 25.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    A new research platform for training of EMS personnel2015In: Prehosp Disaster Med, 2015, Vol. 30(Suppl. 1), p. 153-153Conference paper (Refereed)
  • 26. Lundberg, Lars
    BATLS: Battlefield Advanced Trauma Life Support2009Collection (editor) (Other academic)
  • 27. Lundberg, Lars
    BATLS: Battlefield Advanced Trauma Life Support2010Collection (editor) (Other academic)
  • 28. Lundberg, Lars
    BATLS (Battlefield Advanced Trauma Life Support): Ny traumautbildning i svenska Försvarsmakten2000In: Annales Medicinae Militaris Fenniae, ISSN 0300-8797, Vol. 1, p. 28-29Article in journal (Other academic)
  • 29. Lundberg, Lars
    BATLS/BARTS Battlefield Advanced Trauma Life Support/Battlefield Advanced Resuscitation Techniques and Skills2001Collection (editor) (Other academic)
  • 30.
    Lundberg, Lars
    [External].
    Choice of oxime for Sweden’s third generation autoinjector2004Conference paper (Other academic)
  • 31. Lundberg, Lars
    Cold Injury2004In: The British Military Surgery Pocket Book / [ed] P Roberts, British Army , 2004, p. 582-590Chapter in book (Other academic)
  • 32. Lundberg, Lars
    Kompendium i obstetrik & gynekologi1986Book (Other academic)
  • 33. Lundberg, Lars
    Pain and hyperalgesia in the human skin1992Doctoral thesis, monograph (Other academic)
  • 34.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Simulation in military medical training2012Conference paper (Other academic)
  • 35.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Skadepanorama och medicinska åtgärder vid stridsrelaterade skador2012Conference paper (Other academic)
  • 36.
    Lundberg, Lars
    University of Borås, School of Health Science. [external].
    Swedish Trauma Association’s future ambition on trauma training2011Conference paper (Other academic)
  • 37.
    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)
  • 38.
    Lundberg, Lars
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    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.
    Simulation in pre-hospital care2013In: Emergency MedicineArticle, review/survey (Refereed)
  • 39. Lundberg, Lars
    et al.
    Andersson, S-O
    [external].
    Kvalitetssäkring av militärmedicinsk utbildning i Sverige2005Conference paper (Other academic)
  • 40.
    Lundberg, Lars
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fagius, J
    Neurologi & neurokirurgi1986Book (Other academic)
  • 41.
    Lundberg, Lars
    et al.
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Applying military medical training models on the training of civilian ambulance nurses2012Conference paper (Refereed)
    Abstract [en]

    Background: The pre-mission training of military medical personnel is based on simulation, using either moulage patients or full-scale simulation manikins. Furthermore, the training is preferably conducted in a realistic environment, including the logistic procedures required. Summary of work: The military approach to medical training has been considered interesting to apply on the postgraduate and continuing education for civilian ambulance nurses. One MD (professor) and one RN (associate professor) are now working part-time for the Armed Forces Centre for Defence Medicine and part-time for the University of Borås. A general aim is to improve the trauma education for civilian ambulance nurses, including prehospital procedures for command & control, and by introducing selected military techniques such as tourniquets and haemostatic agents to stop life-threatening bleedings also in civilian practice. Conclusions: We have a reason to believe that this recently initiated collaboration between military medicine and civilian prehospital medicine is mutually beneficial. The civilian Emergency Medical Services will become better trained and prepared, while the Armed Forces are likely to get a larger recruitment base of skilled medical personnel for future service in international missions. Take-home messages: Collaboration between organisations with similar interests, in this case the prehospital management of trauma victims, is likely to be mutually beneficial.

  • 42.
    Lundberg, Lars
    et al.
    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.
    Applying military medical training models on the training of civilian ambulance nurses2012Conference paper (Refereed)
    Abstract [en]

    Background: The pre-mission training of military medical personnel is based on simulation, using either moulage patients or full-scale simulation manikins. Furthermore, the training is preferably conducted in a realistic environment, including the logistic procedures required. Summary of work: The military approach to medical training has been considered interesting to apply on the postgraduate and continuing education for civilian ambulance nurses. One MD (professor) and one RN (associate professor) are now working part-time for the Armed Forces Centre for Defence Medicine and part-time for the University of Borås. A general aim is to improve the trauma education for civilian ambulance nurses, including prehospital procedures for command & control, and by introducing selected military techniques such as tourniquets and haemostatic agents to stop life-threatening bleedings also in civilian practice. Conclusions: We have a reason to believe that this recently initiated collaboration between military medicine and civilian prehospital medicine is mutually beneficial. The civilian Emergency Medical Services will become better trained and prepared, while the Armed Forces are likely to get a larger recruitment base of skilled medical personnel for future service in international missions. Take-home messages: Collaboration between organisations with similar interests, in this case the prehospital management of trauma victims, is likely to be mutually beneficial.

  • 43.
    Lundberg, Lars
    et al.
    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.
    Applying military medical training models on the training of civilian ambulance nurses2012In: AMEEArticle, review/survey (Refereed)
  • 44.
    Lundberg, Lars
    et al.
    University of Borås, School of Health Science.
    Jonsson, Anders
    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)
    Abstract [en]

    Background Exsanguination from extremity wounds is a major cause of potentially preventable deaths in the military environment. With the widespread use of different techniques to control this type of bleeding, such as tourniquets and haemostatic agents, it has now become possible to dramatically improve the survival rate for these casualties. Objective Varying techniques for pre-deployment training of haemorrhage control have been tested and used by the Swedish Armed Forces, for example different types of patient simulators. The recently developed military trauma patient simulators have for example become a major improvement for the training of standard tourniquet application. However, very proximal ‘junctional’ bleedings located in for example axillae and groins still represent a special training problem, since tourniquets cannot be used on these locations. Methods Based upon an idea presented by Moorhouse et al.*, we have developed a hybrid training model, consisting of a modified Laerdal® SimMan® 2G manikin, with a slab of meat with artificial ‘vessels’ running through the base of a series of wounds. Artificial blood under pressure is used to produce a bleeding effect. Results This hybrid model has been used for two years in the training of medics and combat life savers. It represents a realistic bleeding model, which can be used over and over again. Also, the cost for training is low compared to other alternatives. Conclusions Existing patient simulators are not suitable for training of haemorrhage control on proximal extremity locations. Live tissue training on anaesthetized animals is not a first alternative for this kind of training. We consider the proposed hybrid simulation model as the best training method so far.

  • 45.
    Lundberg, Lars
    et al.
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Vikström, T
    Ruter, A
    Weak and strong points in training of prehospital command and control: are results possible to measure2008In: International Review of the Armed Forces Medical Services / Revue internationale des services de santé des forces armées, ISSN 0259-8582, Vol. 81, no 3, p. 131-134Article in journal (Refereed)
  • 46.
    Lundberg, Lars
    et al.
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Vikström, T
    Rüter, A
    Performance indicators for prehospital command and control developed for civilian use tested in a military training setting: a pilot study2008In: Journal of the Royal Army Medical Corps, ISSN 0035-8665, Vol. 154, no 4, p. 236-238Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to determine if a set of performance indicators for command and control (C2) primarily developed for civilian use could be applied also to a military training context as well. Method: The initial decision-making in the on-scene medical management in a multinational military medical evacuation exercise in Afghanistan was studied, using this set of indicators. Results: Two performance indicators were appropriate to this setting. Of the nine applicable indicators, the standards set for civilian use were met in four, in three other they were not met, and there was a lack of documentation in two indicators. Conclusion: Measurable performance indicators for prehospital command and control were to some extent found to be applicable also to a military environment. Future developments may make it possible for the concept of measuring results using civilian performance indicators to become a quality control tool in a military setting.

  • 47.
    Lundberg, Lars
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jorum, E
    Holm, E
    Torebjörk, E
    Intraneural electrical stimulation of cutaneous nociceptive fibres in humans: effects of different pulse patterns on magnitude of pain1992In: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 146, no 1, p. 41-48Article in journal (Refereed)
    Abstract [en]

    A study was performed to elucidate how different impulse frequencies and impulse patterns in cutaneous nociceptive fibres influence the subjective magnitude of pain. Groups of nociceptive Aδ and C fibres were co-activated by electrical intraneural stimulation at constant intensity in cutaneous fascicles of the peroneal nerve in healthy human subjects. The resulting pain sensations were rated on a modified visual analogue scale. Five-second trains were administered randomly at irregular intervals of at least 30 s. Five of the stimulus patterns had regular interpulse intervals, corresponding to frequencies of 1, 2, 4, 10 and 15 Hz, and three other patterns were constructed to mimic to some extent the initially phasic and subsequently slowly adapting discharge patterns which may be encountered in recordings from human nociceptors. The results from these experiments using stimulation frequencies within physiological discharge ranges for human nociceptors indicate that the subjective magnitude of pain increases monotonously as a function of stimulus frequency, and that patterns mimicking nociceptor discharges in response to natural stimuli give rise to greater peak magnitudes of pain than artificial regular patterns with a corresponding number of impulses.

  • 48.
    Lundberg, Lars
    et al.
    University of Borås, School of Health Science.
    Kihl, B
    Olsson, J-O
    Long-term experience of self-injection therapy with prostaglandin E1 for erectile dysfunction1996In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, ISSN 0036-5599, Vol. 30, no 5, p. 395-397Article in journal (Refereed)
    Abstract [en]

    A total of 42 evaluable patients 36-80 years old were treated with intracavernous injection of prostaglandin E1 for erectile dysfunction. They reported retrospectively via a questionnaire their long-term experience of this method. Twenty-four patients (57%) were after 46.9 months still using the technique, while 18 patients (43%) had abandoned the method after 21.4 months of use. No major complications were observed or reported.

  • 49.
    Lundberg, Lars
    et al.
    University of Borås, School of Health Science.
    Molde, Å
    [external].
    Dalenius, E
    [external].
    BATLS/BARTS/BBTLS training for Swedish Armed Forces medical personnel: a ten year retrospective study2008In: Journal of the Royal Army Medical Corps, ISSN 0035-8665, Vol. 154, no 1, p. 34-37Article in journal (Refereed)
    Abstract [en]

    Objective: The British BATLS/BARTS concept was introduced in Sweden in 1998. Perceived changes within the student group, regarding purposes for taking the course and previous trauma training were the subject of the study. Methods: Records from all Swedish courses during 1998-2007 were examined and analyzed. Results: In all, 61 courses with a total of 1254 students were conducted. Among the participants were 295 doctors, 764 nurses, 176 medical orderlies and 19 belonging to other categories. The course has by time become a pre-mission course. Also, a large number of the students now have previous (often civilian) trauma life support training. Conclusion: When the British BATLS/BARTS concept was introduced in Sweden ten years ago, the general level of trauma training among medical personnel was inadequate for the wartime needs of the Armed Forces. Today, the majority of individuals selected for international service already have previous trauma life support training. This has led to the courses now being aimed mainly at improving their knowledge of the tactical medical skills particular to the environment in which they will serve.

  • 50.
    Lundberg, Lars
    et al.
    University of Borås, School of Health Science.
    Molde, Å
    [external].
    Örtenwall, P
    [external].
    Hälso- och sjukvård under krig och väpnade konflikter2009In: Katastrofmedicin / [ed] S Lennqvist, Liber , 2009, p. 373-388Chapter in book (Other academic)
12 1 - 50 of 68
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