Papers by Eric Carlström
Prehospital and Disaster Medicine, May 1, 2023
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Aug 17, 2021
Background: There is no global consensus on the use of prehospital triage system in mass casualty... more Background: There is no global consensus on the use of prehospital triage system in mass casualty incidents. The purpose of this study was to evaluate the most commonly used pre-existing prehospital triage systems for the possibility of creating one universal translational triage tool. Methods: The Rapid Evidence Review consisted of (1) a systematic literature review (2) merging and content analysis of the studies focusing on similarities and differences between systems and (3) development of a universal system. Results: There were 17 triage systems described in 31 eligible articles out of 797 identified initially. Seven of the systems met the predesignated criteria and were selected for further analysis. The criteria from the final seven systems were compiled, translated and counted for in means of 1/7's. As a product, a universal system was created of the majority criteria. Conclusions: This study does not create a new triage system itself but rather identifies the possibility to convert various prehospital triage systems into one by using a triage translational tool. Future research should examine the tool and its different decision-making steps either by using simulations or by experts' evaluation to ensure its feasibility in terms of speed, continuity, simplicity, sensitivity and specificity, before final evaluation at prehospital level.
Critical Care Medicine, Oct 1, 2017
Objective: To identify, classify, and describe safety hazards during the process of intrahospital... more Objective: To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients. Design: A prospective observational study. Data from participant observations of the intrahospital transport process were collected over a period of 3 months. Setting: The study was undertaken at two intensive care units in one university hospital. Patients: Critically ill patients transported within the hospital by critical care nurses, unlicensed nurses, and physicians. Interventions: None. Measurements and Main Results: Content analysis was performed using deductive and inductive approaches. We detected a total 365 safety hazards (median 7; IQR 4-10) during 51 intrahospital transport of critically ill patients, 80% of whom were mechanically ventilated. The majority of detected safety hazards were assessed as increasing the risk of harm, compromising patient safety (n= 204). Using the System Engineering Initiative for Patient Safety, we identified safety hazards related to the work system, as follows: team (n=61), tasks (n=83), tools and technologies (n=124), environment (n=48), and organization (n=49). Inductive analysis provided an in-depth description of those safety hazards, contributing factors, and process-related outcomes. Conclusions: Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety.
Samhandling is considered as a key solution when asymmetry occurs. An expectation of seamless sam... more Samhandling is considered as a key solution when asymmetry occurs. An expectation of seamless samhandling can be a special challenge to High Reliability Org anizations which have mechanistic traditions in common, i.e. an assumption of linearity and routine-based work. In this chapter, a model to operationalize samhandling is presented. This conceptual study is based on observational data from an inter-organizational exercise. A full-scale exercise of a train accident on the Öresund Bridge between Sweden and Denmark was observed. The overall goal of the exercise was to effectively solve the situation. However, different routines contributed to confusion and misunderstandings in the meeting on how to act. The exercise was dominated by a focus on linearity within the internal organizations, which hindered samhandling. In order to conceptualize samhandling, a three-level model is presented. It consists of "sequential samhandling", i.e. a simplified, assembly-line type work process, "parallel samhandling", i.e. carrying out tasks simultaneously, and "synchronous samhandling", i.e. tasks performed at the same time in a spontaneous and natural way. A three-level samhandling model such as the one presented can be a useful tool for managing disasters.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Mar 24, 2022
Background: There has been in increase in the use of systems for organizing lay responders for su... more Background: There has been in increase in the use of systems for organizing lay responders for suspected out-ofhospital cardiac arrests (OHCAs) dispatch using smartphone-based technology. The purpose is to increase survival rates; however, such systems are dependent on people's commitment to becoming a lay responder. Knowledge about the characteristics of such volunteers and their motivational factors is lacking. Therefore, we explored characteristics and quantified the underlying motivational factors for joining a smartphone-based cardiopulmonary resuscitation (CPR) lay responder system. Methods: In this descriptive cross-sectional study, 800 consecutively recruited lay responders in a smartphone-based mobile positioning first-responder system (SMS-lifesavers) were surveyed. Data on characteristics and motivational factors were collected, the latter through a modified version of the validated survey "Volunteer Motivation Inventory" (VMI). The statements in the VMI, ranked on a Likert scale (1-5), corresponded to(a) intrinsic (an inner belief of doing good for others) or (b) extrinsic (earning some kind of reward from the act) motivational factors. Results: A total of 461 participants were included in the final analysis. Among respondents, 59% were women, 48% between 25 and 39 years of age, 37% worked within health care, and 66% had undergone post-secondary school. The most common way (44%) to learn about the lay responder system was from a CPR instructor. A majority (77%) had undergone CPR training at their workplace. In terms of motivation, where higher scores reflect greater importance to the participant, intrinsic factors scored highest, represented by the category values (mean 3.97) followed by extrinsic categories reciprocity (mean 3.88) and self-esteem (mean 3.22). Conclusion: This study indicates that motivation to join a first responder system mainly depends on intrinsic factors, i.e. an inner belief of doing good, but there are also extrinsic factors, such as earning some kind of reward from the act, to consider. Focusing information campaigns on intrinsic factors may be the most important factor for successful recruitment. When implementing a smartphone-based lay responder system, CPR instructors, as a main information source to potential lay responders, as well as the workplace, are crucial for successful recruitment.
Research Square (Research Square), Oct 31, 2022
Background: Hospitals are subject to internal and external threats, which could necessitate an ev... more Background: Hospitals are subject to internal and external threats, which could necessitate an evacuation. Such evacuation needs deliberate surge and collaboration, particularly collaborative use of community capacities to handle affected patients, personnel, devices, and hospital structures using consensus systems. Therefore, it is crucial to identify hospital evacuation procedures' aws and assess the possibility of implementing measures using community resources. This study aimed to explore Thai hospitals' current evacuation readiness and preparation regarding surge capacity and collaboration according to the Flexible Surge Capacity concept. Methods: The previously used hospital evacuation questionnaire was adopted. It contained relevant questions about hospital evacuations' responses and preparedness encompassing surge capacity and collaborative elements and an open-ended question to collect possible perspectives/comments. Results: The ndings indicate glitches in evacuation protocols and triage systems and inadequacies in surge planning and multi-agency collaboration. Additionally, it was evident that hospitals had limited information about communities' capabilities and limited collaboration with other public and private organizations. Conclusion: Although implementing the measures for concept integration to hospital evacuation is challenging, pragmatic research exploring planning for community engagement according to the exible surge capacity to build a concrete hospital evacuation plan would enhance hospital readiness and its generalizations. The latter needs to be tested in simulation exercises.
Australian Critical Care, 2020
Uncertainty Cardiovascular Population Scale
European Journal for Person Centered Healthcare, Nov 18, 2013
PLOS ONE, Jun 7, 2019
Background Whilst many health benefits are associated with regular exercise, medical complication... more Background Whilst many health benefits are associated with regular exercise, medical complications may occur during higher-intensity activities, such as long distance running contests. The most common complication is collapse. However, the incidence and characteristics of these collapses are not very well studied. Method This is a retrospective study of severe collapse, defined as a patient in need of advanced medical care after a collapse, during the large Gothenburg's half marathon, Gö teborgsvarvet. The study included 230,501 competitors during the study-period of 5 years (2013-2017) with data being collected from medical race tents and using ambulance data. Vital signs, treatment and blood gas samples were noted and analyzed. Results The incidence of severe collapse was 1.53 per 1000 starting runners. The average age for patients was 34 years old and no difference in incidence were seen between male and female runners. The typical collapsed runner presented with tachycardia, normal systolic blood pressure, elevated body temperature and metabolic acidosis. The most common medical encounter was exercise-associated collapse.
Australian Critical Care, 2020
Background: Intrahospital transport is a high-risk procedure for critically ill patients, yet the... more Background: Intrahospital transport is a high-risk procedure for critically ill patients, yet there is little known about how the transport team manages critical incidents that occur. Objectives: The aim of this study was to explore critical care nurses' and physicians' experiences and practices associated with critical incidents during the transfer process in critically ill patients. Methods: As a part of an ethnographic study, semistructured interviews were performed using the critical incident technique. Data were collected in two intensive care units at one university hospital in a Swedish metropolitan city. Critical care nurses (n ¼ 15) and physicians (n ¼ 5) were interviewed, together describing a total of 46 critical incidents. Data were analysed using qualitative content and thematic analysis approaches. Results: Content analysis of nurses' and physicians' practices resulted in a description of requirements for safe transports, including organisational prerequisites, professional skills and attributes, as well as actions and behaviours of safely performing transfers. Exploring the experiences of nurses and physicians in transporting critically ill patients yielded three main themes. The first theme, a hazardous process, revealed how caring for critically ill patients during intrahospital transfers was perceived as an unsafe, demanding task that presents several threats to the patient's safety. However, despite worries and concerns, participants trusted their own abilities to handle unexpected events, resulting in the second theme, performing when it matters. The third theme, towards safe practice, captured suggestions for improvement and attitudes towards existing safety hazards. Conclusions: To prevent and manage critical incidents during intrahospital transport, findings of this study suggest that nontechnical skills such as situational awareness and teamwork are essential. In addition, the team must possess the requisite technical skills and knowledge to undertake transports. Finally, organisations are required to provide a supportive and sustainable transport environment that includes fewer transport-related hazards.
Samverkansövningar : Om lärande och nytta
This study relates to collaboration exercises, with particular focus on the full-scale exercises ... more This study relates to collaboration exercises, with particular focus on the full-scale exercises between the police, rescue services and ambulance. To succeed in a complex situation, it requires that the personnel’s ability to collaborate across organisations be developed and refined.The overall aim of this study was to examine how collaboration is practised and how exercises lead to learning and usefulness. A research summary was initially done in this study. Based on that, a number of key concepts were developed that proved helpful when we followed the Swedish collaboration exercises through interviews and observations. The collected analysis has since been the basis for the design of a new exercise model, 3LC, three-level collaboration. It is based on the experiences we have had in studies of traditional exercises.The 3LC exercises that were conducted consisted of two practical sessions and three seminars. Each session was followed by an evaluative seminar with the aim that participants themselves would reflect and develop their patterns of behaviour. The two practical sessions were identical. It gave the participants the opportunity to rehearse and methodically try new approaches. The first exercise session was carried out according to the procedures that normally apply and govern the actions at an actual event. The second exercise session was preceded by a self-critical seminar where participants themselves identified what could be improved for the next exercise session.The research project was carried out from 2011 to 2014. A total of 19 collaboration exercises were studied, including 16 full-scale exercises. A total of 97 interviews and 125 hours of observation were carried out in this study. A questionnaire (CLU instrument) was developed, which was answered by 272 exercise participants.The study shows that collaborative sessions in the exercises contributed to the participants learning more and having greater usefulness from the exercises. 3LC exercises were perceived to enhance learning by 26 per cent and usefulness by 17 per cent, compared with traditional exercises. Collaborative exercises are benefitted when participants analyse their weaknesses themselves. Repetitive elements where participants try out alternative strategies improve preparedness prior to actual events.
Den gula linjen : En kritisk studie av artefakters symbolvärde i hälso-och sjukvårdsteam
Research Square (Research Square), Feb 5, 2021
Background: Sudden cardiac arrest is one of the leading causes of death globally. The recommended... more Background: Sudden cardiac arrest is one of the leading causes of death globally. The recommended clinical management in out-of-hospital cardiac arrest cases is the immediate initiation of high-quality Cardiopulmonary Resuscitation (CPR). Training mannequins should be combined with technology that provide students with detailed immediate feedback on the quality of CPR performance. This study aimed to verify the impacts of the type of feedback (basic or detailed) the responders receive from the device while learning CPR and how it in uences the quality of their performance and the motivation to improve their skills. Methods: The study was conducted at the Medical University of Lublin among 694 multi professional health students during rst aid classes on Basic Life Support (BLS). The students rst practiced on an adult mannequin with a basic control panel; afterward, the same mannequin was connected to a laptop, ensuring a detailed record of the performed activities through a projector. Next, the participants expressed their subjective opinion on how the feedback provided during the classes, basic vs detailed, motivated them to improve the quality of their CPR performance. Additionally, during the classes, the instructor conducted an extended observation of students' work and behavior. Results: In the students' opinion, the CPR training with detailed feedback devices provided motivation for learning and improving CPR pro ciency than the one with a basic control panel. Furthermore, the comments given from devices seem to be more acceptable to the students, who did not see any bias in the device's evaluation compared to that of the instructor. Conclusions: Detailed device feedback motivates student health practitioners to learn and improve the overall quality of CPR. The use of mannequins that provide detailed feedback during BLS courses can improve survival in out-of-hospital cardiac arrest.
Sjuksköterskan som chef och ledare : en utmaning
Dolda artefakters betydelse : -En kritisk studie av kulturella uttryck inom psykiatrin
Typifiering eller normering? : En kritisk studie av teamteoretiska modeller
I den har studien fokuseras den starka passion som finns for typologier inom teamforskningen. Det... more I den har studien fokuseras den starka passion som finns for typologier inom teamforskningen. Det finns typologier av teamprocesser, strukturella teamtyper och modeller for implementering av teamar ...
Blåljusövningar och lärande : - en ny typ av samverkansövning
This study examines the degree of interaction between SOS Alarm, the police, the fire and rescue ... more This study examines the degree of interaction between SOS Alarm, the police, the fire and rescue service and the ambulance service. The study asks the question: How do the emergency organizations interact at the scene of an incident? The four organizations are studied with the help of an interaction model on three levels. This ranges from a lowintensity, sequential and parallel interaction to a high-intensity synchronous interaction. Data were collected during 2007-2008. The study shows that the organizations prefer to remain "on their side" when dealing with an incident. They reduce uncertainty by choosing sequential and parallel forms of interaction. Rhetorically, however, they concur with a synchronous interaction, although this is rarely implemented. Earlier studies has shown a reluctance to interact. However, the level of interaction on the accident scene has not been pinpointed before. The result has practical implications in order to reduce the autonomy of the police, the fire and rescue service and the ambulance service on the accident scene.
Blåljusorganisationer på olycksplatsen : om samverkansminimering
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Papers by Eric Carlström