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Objective: Vehicle materials developments raise concerns about new patterns of vehicle fire toxic gas emissions. This study aimed to describe toxicologic components in a recent material of fatal car crashes on Swedish roads in which the vehicle caught fire and compare the results to a previous material. Methods: Retrospective registry study. All fatal car crashes with fire in Sweden 2009–2018 were extracted from the Swedish Transport Administration's In-Depth Studies Database and compared with an earlier study of the time period 1998–2008. Results: A total of 79 crashes and 94 fatalities were included. Carbon monoxide (COHb) blood levels >10% were found in 13 cases. Hydrogen cyanide (HCN) blood levels 0.1–1.7 µg/g were found in 10 cases. In 29 of the cases the person had a blood alcohol level (BAC) >0.2‰, which is the legal driving limit in Sweden. A total of 15 people died due to burn injuries and 2 individuals died due to toxic gas emissions without any other fatal traumatic injury. Total number of deaths in fire-related crashes halved from 181 (1998–2008) to 94 (2009–2018) but the percentage of fatalities in burning vehicles was unaltered (5% vs. 6%). The proportion of fatalities with HCN in the blood increased from 2% between 1998–2008 to 10% during 2009–2018 (p = 0.006). The age of the car involved in a crash increased by 0.26 years per calendar year (p = 0.001). Conclusions: The proportion of fatalities with measured levels of HCN in the blood has increased. Eleven of the 15 burn injury fatalities had high levels of alcohol, HCN, or COHb, possibly contributing to an inability to leave a burning vehicle. Faster rescue brought by improved specific education and training of ambulance and rescue services personnel may be of future importance, as may on-scene antidote administration and revised regulations of vehicle flammability. [ABSTRACT FROM AUTHOR]

Abstract Background Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientifical evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients. Methods Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored. Results Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C) to 36.0°C (95% CI; 35.7-36.3°C) (p < 0.05) in patients assigned to passive warming only (n = 22) and from 35.6°C (95% CI; 35.2-36.0°C) to 36.4°C (95% CI; 36.1-36.7°C) (p < 0.05) in patients assigned to additional active warming (n = 26) with no significant differences between the groups. Cold discomfort decreased in 2/3 of patients assigned to passive warming only and in all patients assigned to additional active warming, the difference in cold discomfort change being statistically significant (p < 0.05). Patients assigned to additional active warming also presented a statistically significant decrease in heart rate and respiratory frequency (p < 0.05). Conclusions In mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response. Trial Registration ClinicalTrials.gov: NCT01400152

Abstract Background Traffic injuries can cause physical, psychological, and economical impairment, and affected individuals may also experience shortcomings in their post-accident care and treatment. In an earlier randomised controlled study of nursing intervention via telephone follow-up, self-ratings of health-related quality of life were generally higher in the intervention group than in the control group. Objective To evaluate the cost-effectiveness of nursing intervention via telephone follow-up by examining costs and quality-adjusted life years (QALYs). Methods A randomised controlled study was conducted between April 2003 and April 2005. Car occupants, cyclists, and pedestrians aged between 18 and 70 years and attending the Emergency Department of Umeå University Hospital in Sweden after an injury event in the traffic environment were randomly assigned to an intervention (n = 288) or control group (n = 280). The intervention group received routine care supplemented by nursing via telephone follow-up during half a year, while the control group received routine care only. Data were collected from a mail survey using the non-disease-specific health-related quality of life instrument EQ5D, and a cost-effectiveness analysis was performed including the costs of the intervention and the QALYs gained. Results Overall, the intervention group gained 2.60 QALYs (260 individuals with an average gain of 0.01 QALYs). The car occupants gained 1.54 QALYs (76 individuals, average of 0.02). Thus, the cost per QALY gained was 16 000 Swedish Crown (SEK) overall and 8 500 SEK for car occupants. Conclusion Nursing intervention by telephone follow-up after an injury event, is a cost effective method giving improved QALY to a very low cost, especially for those with minor injuries. Trial registration This trial registration number is: ISRCTN11746866.

Summary: The loss of human lives and body injuries due to post‐crash fires, either by smoke inhalation or due to burn injuries, are unfortunately not uncommon. The literature indicates that fire events related to crashes are still a significant problem. The increased combustible load in newer vehicles is an important factor to be taken into account for the fire safety, as well as their potential to release toxic fumes while burning. Trends indicate that the survivable collision energy will continue to increase, and, at the same time, the probability of post‐crash fires rises with the collision energy. This means that the occupants of a vehicle may probably survive a high‐energy collision but might sustain severe injuries or death due to a post‐collision fire. This work reports a literature and interview study about post‐crash fires including statistics on the causes and dynamics of post‐crash fires in road vehicles based on the literature, crash and incident reports, as well as on interviews with medicine specialists. Results from this study indicate that fires in vehicles which originated by a collision event are a problem that remains to be solved. [ABSTRACT FROM AUTHOR]

Rationale: There is a lack of long‐term follow‐up studies focused on injured and uninjured survivors’ experiences of the recovery process after major traffic crashes. Aim: To explore all survivors’ experiences of long‐term physical and psychological consequences and recovery 5 years after a major bus crash. Methodological design and justification: A qualitative design was used to explore experiences in a 5‐year follow‐up study. Research methods: Participants were 54 survivors of a bus crash with 56 survivors and six fatalities. Telephone interviews were analysed with qualitative content analysis. Results: The first category, ‘Being resilient or suffering in daily life’, has four subcategories covering quick recovery, suffering in daily life, distress in traffic situations and long‐term pain. Reasons for quick recovery among survivors were previous crisis experiences, travelling alone, being uninjured and not being exposed to traumatic impressions. For the other survivors, being reminded of the crash caused disturbing reactions, such as sweating, anxiety and flashbacks. Survivors avoided going by bus if they could. A group of the injured survivors was still suffering from limiting and painful injuries. The second category, ‘Reassessing oneself and social connections’, has three subcategories covering self‐awareness, impact on relationships and connectedness. Survivors either developed a stronger bond to their significant other or separated from their partner within the first couple of years. Friendships and a sense of connectedness among survivors were sources of long‐lasting comfort and support. The theme overarching the categories is ‘Visible and existential marks in everyday life’, representing the various ways in which the crash influence the survivors’ lives. Conclusion: There is a need for more information about disruptive long‐lasting consequences, such as travel anxiety, and available treatments. Initially, health‐promoting connectedness can be facilitated by treating survivors as a group of people who belong together, from the day of the crash and throughout the recovery process. [ABSTRACT FROM AUTHOR]

The aim of this paper is to analyse and compare injuries and injury sources in pedestrian and bicyclist non-fatal real-life frontal passengercar crashes, considering in what way pedestrian injury mitigation systems also might be adequate for bicyclists. Data from 203 non-fatal vehicle-to-pedestrian and vehicle-to-bicyclist crashes from 1997 through 2006 in a city in northern Sweden were analysed by use of the hospitals injury data base in addition to interviews with the injured. In vehicle-to-pedestrian crashes (n = 103) head and neck injuries were in general due to hitting the windscreen frame, while in vehicle-to-bicycle crashes (n = 100) head and neck injuries were typically sustained by ground impact. Abdominal, pelvic and thoracic injuries in pedestrians and thoracic injuries in bicyclists were in general caused by impacting the bonnet. In vehicle-to-pedestrian crashes, energy reducing airbags at critical impact points with low yielding ability on the car, as the bonnet and the windscreen frame, might reduce injuries. As vehicle-to-bicyclist crashes occurred mostly in good lighting conditions and visibility and the ground impact causing almost four times as many injuries as an impact to the different regions of the car, crash avoidance systems as well as separating bicyclists from motor traffic, may contribute to mitigate these injuries. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to analyse factors influencing perceptions of preparedness in the response to terrorist attacks of operational personnel in Swedish emergency organizations. Design/methodology/approach – Data were collected using a questionnaire distributed to operational personnel from the police, rescue and ambulance services in eight Swedish counties; 864 responses were received and analysed. Findings – Three aspects of the perception of preparedness for terrorist attacks among Swedish emergency responders were studied: willingness to respond; level of confidence with tasks; and estimated management capability. Factors which positively influenced these perceptions were male sex, training in first aid and dealing with mass casualty incidents, terrorism-related management training (MT), table-top simulations, participation in functional exercises, and access to personal protective equipment (PPE); work experience was inversely related. Occupation in police or rescue services was positively associated with willingness to respond whereas occupation within the emergency medical services was positively associated with estimated management capability. Practical implications – These findings show that terrorism-related MT and access to PPE increase the perceptions of preparedness for terrorism among the emergency services, aiding judgements about investments in preparedness by crisis management planners. Originality/value – Limited research in disaster management and hazard preparedness has been conducted in a European context, especially regarding terrorism. Little is known about aspects of preparedness for terrorism in Sweden, particularly from the perspective of the emergency responders. [ABSTRACT FROM AUTHOR]

The rail-bound sector has become a preferred target of terrorist attacks because of its vulnerability, and the most frequent way to carry out these attacks has been the use of explosive devices. The aim of this study is to investigate the effectiveness of modelling detonation effects inside train carriages using explicit finite element techniques. The numerical simulations consider fluid-structure interaction phenomena and several parametric studies are conducted. Carriage damage and injuries to the passengers are examined. Displacements in the model of the carriage structure do not vary greatly for small changes of the charge size, its location, or by open doors. Changing charge size, the location of the detonation, and door setting, however, had significant impact on the risk of eardrum rupture and fatality. Comparison of the simulation and real life data demonstrate a good agreement between the real and calculated displacements of the carriage, whereas the risk of death and eardrum rupture is slightly higher in the calculations. The model presented can reproduce a reliable actual situation if more parameters that influence injuries of blast waves were considered. [ABSTRACT FROM PUBLISHER]

Suicides by drowning have received limited attention by researchers. A recent finding that almost one-third of all drowning deaths in Sweden were classified as suicide instigated this study. We identified 129 cases of suicide by drowning in Northern Sweden and analyzed the circumstances and the psychiatric history prior to the suicide. Information was obtained from autopsy, police and medical records, as well as from the National Inpatient Register. One-third of the suicide victims had previously attempted suicide and half of the victims had been hospitalized due to mental health problems. One-third of these had left the hospital less than one week before the suicide. Alcohol and psychoactive drugs were present in 16% and 62% of the cases, respectively. A history of mental disorder and previous suicide attempt (s), especially by drowning, is an ominous combination necessitating efficient clinical identification, treatment and follow-up if a complete suicide is to be prevented. [ABSTRACT FROM AUTHOR]

Background The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care. Methods A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Results Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions The use of active heat from underneath increases the patients’ thermal comfort and may prevent the negative consequences of cold stress. [ABSTRACT FROM AUTHOR]

Background Chronic whiplash-associated disorders (WADs) are often associated with social functioning problems and decreased ability to perform previous activities. This may lead to decreased life satisfaction, which is insufficiently studied in the context of whiplash injuries. Symptoms included in chronic WAD are similar to symptoms frequently reported by persons who have sustained mild traumatic brain injury (MTBI)/concussion. In cases of MTBI, the severity and number of symptoms have been suggested to have a diagnostic value. The corresponding importance of symptoms in chronic WAD has not been documented. Most studies of whiplash injuries have focused on neck pain because this is the dominant complaint, while other symptoms are less studied. The frequency of long-term symptoms after whiplash injuries seems to vary. It is difficult to compare the long-term outcome since the follow-up after whiplash injury in most studies has been rather short. Therefore, the primary aim of this investigation was to study neck pain and other symptoms, disability, and life satisfaction five years after whiplash injury in a defined population and geographical area. Methods The study was carried out at a public hospital in northern Sweden and was a cross-sectional survey of patients five years after the injury event in a cohort of whiplash-injured patients. Five years after the emergency department visit, 186 persons aged 18–64 answered questionnaires on symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), disabilities (Rivermead Head Injury Follow Up Questionnaire, RHFUQ), and life satisfaction (LiSat-11). The answers were compared to those of a comparison cohort. Results The most common symptoms five years after whiplash injury were fatigue (41%), poor memory (39%), and headache (37%). Inability to sustain previous workload (44%) and fatigue at work (43%) were frequently reported disabilities. Only 39% were satisfied with their somatic health and 60% with their psychological health. Compared with healthy controls, the whiplash injured exhibited more symptoms and had lower life satisfaction. Women reported significantly higher pain intensity than men. Few significant differences between women and men regarding the other parameters were found. Conclusions This study shows that five years after a whiplash injury, patients reported symptoms that are typical of mild traumatic brain injury. Further, this study emphasizes the possibility of screening patients with chronic WAD for these symptoms as a complement to the assessment. Implications Untreated symptoms may negatively affect the outcome of pain rehabilitation. This implies that it might be clinically meaningful to quantify symptoms earlier in the rehabilitation process. [ABSTRACT FROM AUTHOR]

This case study includes 73 fatally and nonfatally injured passengers from a level-crossing train crash in Nosaby, Sweden, in 2004. The aim was to identify the injury panorama and the injury objects and to determine the injury-inducing variables. Data were analyzed with descriptive statistics, quantitative content analysis, and multivariate data analysis. The first carriage overturned, and its occupants were the ones who suffered the most severe and lethal injuries. Injury type and injury location for these passengers also differed significantly from the passengers on the other two carriages. Tables significantly influenced injury type and injury location in all carriages, whereas the injured persons’ seating position had significant effect only in the second and third carriage. Those who had travelled facing forward with a table in front of them in Carriages 2 and 3 were more likely to have sustained injuries to their abdomen or pelvis. Other injury-inducing objects were seats, interior structures, wood pellets from the truck, and other passengers. Neck sprains were significantly more prevalent among those who had travelled facing backward. Improved train crashworthiness also needs to include interior safety, which would have a potential to reduce crash injuries. [ABSTRACT FROM PUBLISHER]

Objective:To study the epidemiology and causes of death in fatal car crashes on Swedish roads in which the victim's vehicle caught fire. Methods:The data set is from the Swedish Transport Administrations in-depth studies of fatal crashes 1998–2008. Autopsies from all cases provided data on injuries, toxicological analyses, and cause of death. Results:In total, 181 people died in 133 burning cars, accounting for 5 percent of all deaths in passenger cars, sport utility vehicles, vans, and minibuses during 1998 to 2008. The cause of death for a third of the victims was fire related, as burns and/or smoke inhalation injuries, with no fatal trauma injuries. Twenty-five of these 55 deaths were persons 19 years or younger and included 15 of 18 rear seat deaths. Over half of the 181 deaths were in vehicles that had collided with another vehicle and, of these cases, half were killed in collisions with heavy vehicles. The percentage of drivers with illegal blood alcohol concentrations (27%) and suicides (5.5%) were not higher than in other fatal crashes on Swedish roads. The ignition point of the fire was indicated in only half of the cases and, of those, half started in the engine compartment and one fourth started around the fuel tank or lines. Conclusions:Car fires are a deadly postcrash problem. Reducing this risk would be primarily a responsibility for the automotive industry. A multifactor approach could be considered as follows: risk-reducing design, insulation, reduced flammability in motor compartment fluids and plastics, and automatic fire extinguishing equipment. Inspiration could be found in how, for example, the auto racing and aviation industries handle this problem. [ABSTRACT FROM AUTHOR]

Background: Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs. Methods: During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine. Results: During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (≤18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688 /4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons. Conclusion: Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program. [ABSTRACT FROM AUTHOR]

Objective: To examine the annual incidence of acute whiplash injuries after road traffic crashes in a geographic catchment area in Northern Sweden during the period 2000-2009. Design: Descriptive epidemiology determined by prospectively collected data from a defined population. Setting: The study was conducted at a public hospital in Sweden. Participants: The population of the hospital''s catchment area (136,600 inhabitants in 1999 and 144,500 in 2009). Methods: At the emergency department, all injured persons (approximately 11,000 per year) were asked to answer a questionnaire about the injury incident. Data from the medical records also were analyzed. From 2000-2009, 15,506 persons were injured in vehicle crashes. Persons who were subject to an acute neck injury within whiplash-associated disorder grades 1-3 were included. The overall and annual incidences were calculated as incidence. Age, gender, type of injury event, and direction of impact were described. The incidences were compared with national statistics on insurance claims from 2003, 2007, and 2008 to detect changes in the proportions of claims. Main Outcome Measures: The annual incidence of acute whiplash injuries. Secondary outcome measures were types of injury events, age and gender distribution, changes in the proportion of rear-end crashes during 2000-2009, and changes in the proportion of insurance claims during 2003-2008. Results: During 2000-2009, 3297 cases of acute whiplash injury were encountered. The overall incidence was 235/100,000/year. The average yearly increase in incidence was 1.0%. Women comprised 51.9% and men 48.1% of the injured. Car occupants (86.4%) and bicycle riders (6.1%) were most frequently injured. The proportion of rear-end crashes decreased from 55% to 45% from 2000-2009. The proportion of insurance claims significantly decreased between 2003 and 2008 (P < .0001, χ2 test). Conclusion: The incidence of emergency department visits attributable to acute whiplash injuries after road traffic crashes have been relatively stable during the past decade in our area, except in 2007 and 2008, when a peak occurred. [Copyright &y& Elsevier]

Abstract: Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines, opiates, and antidepressants. Tetrahydrocannabiol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work. [Copyright &y& Elsevier]

Objectives: The aim of the study was to measure and analyze backset, defined as the horizontal distance between the back of the occupant's head and a point located on the ventral/top aspect of the sewn rim of the head restraint, with the car stationary and during driving, in the driver's position in a modern car. Methods: A population of 65 subjects, 35 males and 30 females, was studied in a Volvo V70 car, model year 2007. The subjects were studied in the driver's position, in a self-selected posture. Stationary backset was measured with the technique described by Jonsson et al. (2007) and backset during driving with video analysis. Descriptive data were calculated, and variability and correlation analyses were performed. A t-test was used to test differences of means. Significance level was set to 0.05. Results: In comparison to stationary backset, mean backset during driving was 43 mm greater in males and 41 mm greater in females. Driving backset was 44 mm larger in males than in females. Driving backset was moderately correlated (0.37-0.43) to stature, seated height, and seat back angle in males and moderately correlated (0.44-0.52) to hip width, waist circumference, and weight in females. The overall intraclass correlation coefficient for backset during driving was 0.81 (CI: 0.75-0.86). Conclusions: These results may be of use in designing future updates of test protocols/routines for geometric backset, such as RCAR and RCAR-IIWPG. [ABSTRACT FROM AUTHOR]

Objectives: Knowledge regarding drownings related to land motor vehicle events is limited although reports of these events occur globally. This study elucidates crash and injury mechanisms in motor vehicle-related drownings in a Swedish population during 1992 through 2006 in order to suggest preventive countermeasures. Methods: The cases were identified in the National Board of Forensic Medicine database and crosschecked against the official statistics. All available autopsy reports, hospital records, and police records were analyzed. In addition, corresponding in-depth analyses performed by the Swedish Road Administration were reviewed and analyzed. Results: In total, 83 drownings occurred in 64 vehicles. The great majority of victims had no serious injuries (92% MAIS ≤ 2) and would probably have survived if they had not drowned. Most events took place in waters directly adjacent to a roadway (36%) or bridge (34%). The vehicles were most often (72%) found upside down, and most drownings occurred in shallow water (65% depth <2 m). One third (32%) of the drivers tested positive for alcohol (mean BAC of 2.0 g/L; range 0.16-2.6). The majority (69%) of the fatalities could possibly have been prevented if effective guardrails had been in place. Conclusions: Drownings in motor vehicles are not negligible events and in many cases they are preventable. Sufficient design and placement of guardrails can minimize these events, but further experimental investigation should be conducted to better understand these events and how to optimize vehicle design, rescue operations, and self-rescue. [ABSTRACT FROM AUTHOR]

The objective of the study was to compare stature, weight and backset (the horizontal distance (x) between the back of the occupant's head and the front of the seam on top of the head restraint) of the Biofidelic Rear Impact Dummy (BioRID II) to the same variables on seated volunteers in a car. The following methods were used. Data were collected from 154 randomly selected Swedish individuals (78 males and 76 females). The volunteers and the BioRID II were examined in a Volvo V70 car, year model 2003, in three positions: driver (hands on steering wheel), front passenger (hands in lap) and rear passenger. The study results were as follows: the BioRID II was found to correspond approximately to a 35th-45th percentile male in stature (-2 cm), a 35th percentile male in weight (-7 kg), a 96th percentile female in stature (+11 cm) and a 69th percentile female in weight (+8 kg). The BioRID II was designed to represent a male driver. The BioRID II backset corresponded well with the average of the male drivers of its stature. Larger deviations in backset were found for other volunteer sizes and other seating positions. The average backsets were 26 mm for females and 63 mm for males in the front seat positions. The volunteers had larger backset in the driver position (60 mm) than in the front passenger position (29 mm). Smaller differences in backset were seen between the BioRID II and the volunteers in the rear passenger position. This study provides data regarding the occupant size coverage of BioRID II, and unique data regarding backset, of different occupant positions in the car; driver with hands on steering wheel, and front and rear passengers with hands in lap, for female and male in relation to the BioRID II dummy. [ABSTRACT FROM AUTHOR]

Families in the Western world have a car and several family members share the same car. In this study, 154 participants have adjusted a driver's seat three times. The primary objective was to study intrapersonal repeatability and intraclass correlation (ICC) on seat; length adjustment, backrest angle, seat front edge and seat rear edge adjustment, related to participant age, sex, stature and weight. Length adjustment has the best intrapersonal repeatability within two repetitions, 49 mm and ICC-value 0.87. Females and younger participants (age <40 years) adjust seats generally more accurately. Females adjust the seat 41 mm more forward, 120 mm compared to men 79 mm counted from 0-starting position. Females sit with more upright seat backrests, 46° compared to 43° for males counted from 0-starting position. Females sit higher than males in both the frontal and rear part of the seat cushion. [ABSTRACT FROM AUTHOR]

Abstract: Between 1995 and 2004, 293 passenger car occupants died in collisions with other vehicles in northern Sweden (annual incidence: 3.3 per 100,000 inhabitants, 6.9 per 100,000 cars, or 4.8 per 109 km driven); half of these deaths involved heavy vehicles. The annual number of passenger car occupant deaths per 100,000 cars in car–truck/bus collisions has remained unchanged since the 1980s, but in car–car collisions it has decreased to one third of its former level. As crash objects, trucks and buses killed five times as many car occupants per truck/bus kilometer driven as did cars. The collisions were characterized by crashes in the oncoming vehicle''s lane, under icy, snowy, or wet conditions; crashes into heavy vehicles generally occurred in daylight, on workdays, in winter, and on 90 and 70km/h two-lane roads. Head and chest injuries accounted for most of the fatal injuries. Multiple fatal injuries and critical and deadly head injuries characterized the deaths in collisions with heavy vehicles. An indication of suicide was present in 4% of the deaths; for those who crashed into trucks, this percentage was doubled. Among the driver victims, 4% had blood alcohol levels above the legal limit of 0.2g/L. Frontal collision risks might be reduced by a mid-barrier, by building less injurious fronts on trucks and buses, by efficient skid prevention, and by use of flexible speed limits varying with road and light conditions. [Copyright &y& Elsevier]

Objectives. The horizontal distance between the back of the head and the frontal of the head restraint (backset) and rearward head movement relative to the torso (cervical retraction) were studied in different occupant postures and positions in a modern car. Methods. A stratified randomized population of 154 test subjects was studied in a Volvo V70 year model 2003 car, in driver, front passenger, and rear passenger position. In each position, the subjects adopted (i) a self-selected posture, (ii) a sagging posture, and (iii) an erect posture. Cervical retraction, backset, and vertical distance from the top of the head restraint to the occipital protuberance in the back of the head of the test subject were measured. These data were analyzed using repeated measures ANOVA and linear regression analysis with a significance level set to p < 0.05. Results. In the self-selected posture, the average backset was 61 mm for drivers, 29 mm for front passengers, and 103 mm for rear passengers (p < 0.001). Women had lower mean backset (40 mm) than men (81 mm), particularly in the self-selected driving position. Backset was larger and cervical retraction capacity lower in the sagging posture than in the self-selected posture for occupants in all three occupant positions. Rear passengers had the largest backset values. Backset values decreased with increased age. The average cervical retraction capacity in self-selected posture was 35 mm for drivers, 30 mm for front passengers, and 33 mm for rear passengers (p < 0.001). Conclusions. Future design of rear-end impact protection may take these study results into account when trying to reduce backset before impact. Our results might be used for future development and use of BioRID manikins and rear-end tests in consumer rating test programs such as Euro-NCAP. [ABSTRACT FROM AUTHOR]

Objective : To investigate serum levels of cortisol (a biochemical marker of stress), S-100B and neuron-specific enolase (two biochemical markers of brain tissue injury), in acute phase in mild traumatic brain injury patients and the occurrence of post-traumatic stress-related symptoms 1 year after the trauma. Methods : Blood samples were taken in patients ( n &ThickSpace;=&ThickSpace;88) on admission and &nvsim;7 hours later for analysis. Occurrence of post-traumatic stress-related symptoms was assessed for 69 patients using items from the Impact of Event Scale questionnaire (IES) at follow-up at 15&ThickSpace;±&ThickSpace;4 months after the injury. Results : Serum levels of cortisol were more increased in the first sample (cortisol/1, 628.9&ThickSpace;±&ThickSpace;308.9&ThickSpace;nmol&ThickSpace;L -1 ) than in the second blood sample (cortisol/2, 398.2&ThickSpace;±&ThickSpace;219.4&ThickSpace;nmol&ThickSpace;L -1 ). The difference between these samples was statistically significant ( p &ThickSpace;<&ThickSpace;0.001). Altogether 12 patients (17%) showed post-traumatic stress related symptoms at the time of the follow-up. Stepwise forward logistic regression analysis of symptoms and serum concentrations of markers revealed that only S-100B in the second sample was statistically significantly ( p &ThickSpace;<&ThickSpace;0.05) associated to symptoms (three symptoms of the avoidance sub-set of IES). Conclusion : A major increase in serum concentrations of cortisol indicates that high stress levels were reached by the patients, in particular shortly (&nvsim;3 hours) after the trauma. The association between the occurrence of post-traumatic stress related symptoms and serum levels of S-100B (generally considered as a biochemical marker of brain injury) seem to reflect the complexity of interactions between brain tissue injury and the ensemble of stress reactions. [ABSTRACT FROM AUTHOR]

Summary: A traffic injury can be traumatic from both physical and emotional points of view. Nine people injured in a traffic environment were interviewed 6 months after the incident in a qualitative study about their experiences of pre-hospital and hospital care and subsequent rehabilitation. The transcribed data were analysed using qualitative content analysis. Four themes emerged: (i) facing commotion, (ii) experiencing trust and security, (iii) lacking security and support, and (iv) struggling to return to everyday life. The main findings in the study indicate that the quality in the interaction between people injured in traffic events and their care providers are of utmost importance. Interaction must be seen as a dialectic process in which caregivers are open to the injured person’s needs. An open-minded caregiver makes recovery easier for the injured. [Copyright &y& Elsevier]

Abstract: Exact risk patterns in skydiving fatalities are not well known, but incomplete world injury data indicate that many are preventable. A comprehensive national material for Sweden of 37 skydiving fatalities 1964–2003 were reviewed to identify risk factors. In relation to jump volume, the period 1994–2003 had a fatality rate 11 times lower than 1964–1973. Student skydivers had the highest risk of fatal outcome, often caused by instability in freefall leading to unstable parachute activation with subsequent line entanglement, or parachute activation failure. Unintentional water landings also contributed to student fatality, with life jacket malfunctions, neglect to use life jackets, and automatic reserve parachute activation devices activated by water as aggravating factors. One-third of all fatalities had an inflated and operational parachute at some point prior to injury. A drastic worldwide increase in fatal landing incidents with fast wing parachutes during the 1990s did not occur in Sweden. Every fourth fatality caused by rapid deceleration against ground or water survived impact and died during transports or in hospitals. Rescue units and health care providers can improve management of skydiving incidents from knowledge about the incident and injury mechanisms we have described, and the skydiving community can target risk factors in preventive safety work. [Copyright &y& Elsevier]

The crash took place on Friday, 24 January 2003. Due to technical problems, a train was cancelled in Ludvika, a village in central Sweden. A replacement coach was to transport the passengers 115 km to Vásterås, via the same route. In darkness, at 4.23 pm, i.e. during working hours, the coach went off the road on a left-hand curve. The driver reduced the speed to 49 km/h before the curve, but lost control of the coach, which skidded off the road, down a high road bank and landed on its right side. The coach's structural damage was mainly located on the right side. Of the 49 occupants, 11 were partially or totally ejected, and 6 were fatally injured. Forty occupants had injuries classified as ISS 1-15, three as ISS 16-30 and six as ISS 41-75. All those in the last group sustained fatal injuries. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to use the Haddon matrix to analyse crash and injury mechanisms in a severe coach crash, to investigate if a safety belt would have reduced injuries, and highlight the triage problem in a mass casualty situation during severe circumstances. Methods: A specific coach crash was chosen as the subject for the case study. All 34 occupants on board were interviewed about the crash, their injuries, and how they sustained their injuries. Medical records concerning ambulance and hospital treatment have been examined. Police reports and other documents concerning the vehicle, weather conditions and the road have been examined. The materials were structured in different cells according to Haddon's matrix. Results: The coach went off a road via a guard-rail and landed on the right side, in a 90° position right across a small river. The main reason for the coach to deviate from the road was strong and gusty side winds imposing lateral forces on the coach, making steering impossible. The impact from the crash was greatest in the front part of the coach, as this part fell 3 metres from the bridge guard-rail down to the river bank. The most frequent injury mechanism was that occupants were hit by other falling occupants. Most occupants would have benefited from having worn seat belts. Ten ambulances and one helicopter from different locations were called upon and the first ambulance arrived 30 minutes after the alarm (a 67-km drive). The helicopter, with an anaesthetist on board, arrived after 1 hour and 20 minutes (a 120-km flight). Nine occupants with moderate injuries and 10 seriously or severely injured occupants were transported by ambulance or helicopter to the hospital. Fifteen occupants, triaged as priority 3, were transported by a chartered coach to hospital where they arrived after about 3 hours. Conclusion: If 100% of the occupants had used a two-point belt, about two-thirds of the injured occupants with MAIS 2+ injuries would have sustained an injury reduction. A further injury reduction by roughly 20% could have been achieved by shifting from two-point belts to three-point belts. Triage of injured occupants could be different from normal practice because of the limited space inside a coach, and the use of ordinary equipment is not always possible inside a crashed vehicle. The fact that most of the side windows remained in position after the crash probably prevented many occupants from serious and fatal injuries caused by ejection or partial ejection. [ABSTRACT FROM AUTHOR]

Objective: To describe causes of death and other characteristics of “avoidable” deaths in patients admitted to hospital after trauma, and estimate and analyse changes in the avoidable death rate during the years studied. Design: Retrospective analysis of medico legal autopsy material. Setting: One northern and one western area in Sweden 1988-1996. Subjects: 335 cases who died in hospital after trauma. Main outcome measures: Avoidable death, defined as an Injury Severity Score (ISS) of 35 or less and Abbreviated Injury Scale (AIS) [sub head] of 4 or less and cause of death. Results: We found 70 avoidable deaths (21%). Among these, 15 (21%) died of head injuries, 17 (24%) of thoracic, abdominal, or pelvic injuries, and 38 (54%) of medical complications. The number of deaths after trauma decreased considerably from 1988-90 to 1994-96, but the proportion who died in hospital remained almost constant. The proportion of avoidable deaths decreased from 22% to 17%, mainly because the proportion of deaths from medical complications was halved. Conclusion: The standard of Swedish in-hospital trauma care has improved, particularly with a reduction in post-traumatic complications. However, there is still room for improvement in the treatment of complications among elderly people. [ABSTRACT FROM AUTHOR]

The aim of the study was to elucidate the crash and injury mechanisms in bicycle fatalities in the northern haff of Sweden. All available autopsy protocols, hospital records end police reports were scrutinized. In 11 years, 146 bicyclists were fatally injured. The majority of the victims were males (66%) and the median age was 60 years. Most of the crashes (81%) occurred from May through October, during weekdays (84%), and during daylight (86%). Almost all victims (88%) died in a motor vehicle collision, in 21% with a truck. None was wearing a helmet. Poor hearing and cerebral arterosclerosis were probable risk factors among the elderly. Of the victims tested, 10% were under the in fluence of alcohol, half of whom were involved in single-bicycle crashes. In an additional five cases, the motor vehicle driver was impaired by alcohol. All injuries were due to blunt trauma and 69% of the victims died from head injuries. In 91% of all cases, there was an Abbreviated injury Scale (AIS) score of the head region of ≥3. The results indicate that separation of bicyclists from motor vehicle traffic by separate cycling tracks and protection of the head by a helmet would be beneficial. [ABSTRACT FROM PUBLISHER]

The present study was aimed at determining whether drivers testing positive for drugs and/or alcohol were more often responsible for the crash than the test-negative ones. Data on 241 fatally injured and 102 hospitalized motor-vehicle drivers was collected in Northern and Western Sweden. Blood samples were taken from these drivers and screened for the presence of alcohol, licit drugs, and illicit drugs. A judgment of responsibility, and assessment of the traffic situation and crash characteristics were based on police reports. Alcohol-positive drivers ( n= 49) were more often (96% vs. 70%, p < 0.0001) judged to be responsible for the crash than test-negative drivers. Ninety-three percent of the drug-positive drivers were judged to be responsible, but they were not significantly more often responsible than the test-negative drivers. Drug-positive drivers differed from the alcohol-positive drivers in that they more often crossed over to the wrong side of the road and crashed into an oncoming vehicle. The findings support previous studies that reducing the number of drug-positive drivers in traffic is bound to lead to a reduction in crashes resulting in injury. Further analysis with a larger sample is needed to elucidate the association between crash responsibility and drugs other than alcohol. [ABSTRACT FROM AUTHOR]