Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-26T17:51:00.419Z Has data issue: false hasContentIssue false
  • English
  • Français

Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study

Published online by Cambridge University Press:  30 January 2017

Isabelle Doohan Open the ORCID record for Isabelle Doohan [Opens in a new window] ,
Ulf Björnstig Open the ORCID record for Ulf Björnstig [Opens in a new window] ,
Ulrika Östlund  and
Britt-Inger Saveman Open the ORCID record for Britt-Inger Saveman [Opens in a new window]
Isabelle Doohan*
Affiliation:
Department of Surgical and Perioperative Sciences, Section of Surgery - Centre for Research and Development in Disaster Medicine, Umeå University, Umeå, Sweden Department of Nursing, Umeå University, Umeå, Sweden Affiliated to Artic Research Centre at Umeå University, Umeå, Sweden
Ulf Björnstig
Affiliation:
Department of Surgical and Perioperative Sciences, Section of Surgery - Centre for Research and Development in Disaster Medicine, Umeå University, Umeå, Sweden
Ulrika Östlund
Affiliation:
Center for Collaborative Palliative Care, Linnaeus University, Kalmar/Växjö, Sweden Center for Research & Development, Uppsala University/Region Gävleborg, Sweden
Britt-Inger Saveman
Affiliation:
Department of Nursing, Umeå University, Umeå, Sweden Affiliated to Artic Research Centre at Umeå University, Umeå, Sweden
*
Correspondence: Isabelle Doohan, MSc Department of Surgical and Perioperative Sciences Section of Surgery Umeå University, SE-901 87 Umeå, Sweden E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery.

Methods

The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis.

Results

Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors’ recoveries. The integrated findings are in the form of four “core cases” of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash.

Conclusion

The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery.

DoohanI, BjörnstigU, ÖstlundU, SavemanBI. Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study. Prehosp Disaster Med. 2017;32(2):165–174.

Keywords

Emergency Medical Servicesinjuriesmass-casualty incidentsurvivors
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 2 , April 2017 , pp. 165 - 174
Copyright
© World Association for Disaster and Emergency Medicine 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: none

References

1. Björnstig, U, Forsberg, R. Transportation Disasters. In: Koenig KL, Schultz CH, eds. Disaster Medicine: Comprehensive Principles and Practices. New York, USA: Cambridge University Press; 2010: 253-274.Google Scholar
2. Ben-Ishay, O, Mitaritonno, M, Catena, F, Sartelli, M, Ansaloni, L, Kluger, Y. Mass casualty incidents - time to engage. World J Emerg Surg. 2016;11(8).CrossRefGoogle ScholarPubMed
3. Hobfoll, S. Resource caravans and resource passageways: a new paradigm for trauma responding. Intervention. 2014;12(4).CrossRefGoogle Scholar
4. Norris, FH, Friedman, MJ, Watson, PJ. 60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research. Psychiatry. 2002;65(3):240-260.CrossRefGoogle Scholar
5. Galea, S, Nandi, A, Vlahov, D. The epidemiology of post-traumatic stress disorder after disasters. Epidemiologic Reviews. 2005;27:78-91.CrossRefGoogle ScholarPubMed
6. Dyb, G, Jensen, TK, Nygaard, E, et al. Post-traumatic stress reactions in survivors of the 2011 massacre on Utoya Island, Norway. Br J Psychiatry. 2014;204(5):361-367.CrossRefGoogle ScholarPubMed
7. Hobfoll, SE, Watson, P, Bell, CC, et al. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry. 2007;70(4):283-315.CrossRefGoogle ScholarPubMed
8. Bisson, JI, Tavakoly, B, Witteveen, AB, et al. TENTS guidelines: development of post-disaster psychosocial care guidelines through a Delphi process. Br J Psychiatry. 2010;196(1):69-74.CrossRefGoogle ScholarPubMed
9. Cox, RS, Danford, T. The need for a systematic approach to disaster psychosocial response: a suggested competency framework-CORRIGENDUM. Prehosp Disaster Med. 2014;29(5):551.CrossRefGoogle ScholarPubMed
10. Bryant, RA, Harvey, AG, Guthrie, RM, Moulds, ML. Acute psychophysiological arousal and posttraumatic stress disorder: a two-year prospective study. J Trauma Stress. 2003;16(5):439-443.CrossRefGoogle ScholarPubMed
11. Roth, RS, Geisser, ME, Bates, R. The relation of post-traumatic stress symptoms to depression and pain in patients with accident-related chronic pain. J Pain. 2008;9(7):588-596.CrossRefGoogle ScholarPubMed
12. Creswell, JW, Zhang, W. The application of mixed methods designs to trauma research. J Trauma Stress. 2009;22(6):612-621.CrossRefGoogle ScholarPubMed
13. Schnurr, PP, Green, BL. Understanding relationships among trauma, posttraumatic stress disorder, and health outcomes. Adv Mind Body Med. 2004;20(1):18-29.Google ScholarPubMed
14. Norris, F, Slone, L, Baker, C, Murphy, A. Early physical health consequences of disaster exposure and acute disaster-related PTSD. Anxiety, Stress, and Coping. 2006;19(2):95-110.CrossRefGoogle Scholar
15. van der Berg, B, Grievink, L, van der Velden, PG, et al. Risk factors for physical symptoms after a disaster: a longitudinal Study. Psychological Medicine. 2008;38:499-510.CrossRefGoogle Scholar
16. Bonanno, GA, Diminich, ED. Annual research review: positive adjustment to adversity--trajectories of minimal-impact resilience and emergent resilience. J Child Psychol Psychiatry. 2013;54(4):378-401.CrossRefGoogle ScholarPubMed
17. Rehnsfeldt, A, Arman, M. Dressing an existential wound (DEW) - a new model for long-term care following disasters. Scand J Caring Sci. 2015.CrossRefGoogle Scholar
18. Andrew, S, Halcomb, EJ. Mixed Methods Research for Nursing and the Health Sciences. Chichester, United Kingdom: Wiley - Blackwell; 2009.CrossRefGoogle Scholar
19. Creswell, JW. Research Design. Qualitative, Quantitative, and Mixed Methods Approaches. 4th ed. Los Angeles, California USA: SAGE; 2014.Google Scholar
20. Pluye, P, Hong, QN. Combining the power of stories and the power of numbers: mixed methods research and mixed studies reviews. Annu Rev Public Health. 2014;35:29-45.CrossRefGoogle ScholarPubMed
21. Östlund, U, Kidd, L, Wengström, Y, Rowa-Dewar, N. Combining qualitative and quantitative research within mixed method research designs: a methodological review. Int J Nurs Stud. 2011;48(3):369-383.CrossRefGoogle ScholarPubMed
22. Cooper, S, Porter, J, Endacott, R. Mixed methods research: a design for emergency care research? Emerg Med J. 2011;28(8):682-685.CrossRefGoogle ScholarPubMed
23. Polit, DF, Beck, CT. Generalization in quantitative and qualitative research: myths and strategies. Int J Nurs Stud. 2010;47(11):1451-1458.CrossRefGoogle ScholarPubMed
24. Arnberg, FK, Hultman, CM, Michel, PO, Lundin, T. Fifteen years after a ferry disaster: clinical interviews and survivors’ self-assessment of their experience. Eur J Psychotraumatol. 2013: 4.Google Scholar
25. Keskinen-Rosenqvist, R, Michélsen, H, Schulman, A, Wahlström, L. Physical symptoms 14 months after a natural disaster in individuals with or without injury are associated with different types of exposure. J Psychosom Res. 2011;71(3):180-187.CrossRefGoogle ScholarPubMed
26. Swedish Accident Investigation Authority. Report RO 2015:02 Bus accident on road 27 outside Tranemo [In Swedish]. http://www.havkom.se/en/investigations/vaegtrafik-oevrigt/bussolycka-pa-riksvaeg-27-utanfoer-tranemo. Published 2015. Accessed December 4, 2015.Google Scholar
27. Abbreviated Injury Scale. Association for the Advancement of Automotive Medicine Web site. http://www.aaam.org/about-ais.html. Accessed February 11, 2016.Google Scholar
28. Brewin, CR, Rose, S, Andrews, B, et al. Brief screening instrument for post-traumatic stress disorder. Br J Psychiatry. 2002;181:158-162.CrossRefGoogle ScholarPubMed
29. Braun, V, Clarke, V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.CrossRefGoogle Scholar
30. Traffic Analysis. Road traffic injuries 2014. http://trafa.se/en/road-traffic/road-traffic-injuries/. Published 2015. Accessed February 11, 2016.Google Scholar
31. Hodgetts, T, Mackaway-Jones, K. Major Incident Medical Management and Support: The Practical Approach. London, United Kingdom: BMJ Publishing Group; 1995.Google Scholar
32. Rapid Emergency Triage and Treatment System (RETTS). Predicare Web site. http://predicare.se/en/. Accessed February 12, 2016.Google Scholar
33. Johannesson, KB, Arinell, H, Arnberg, FK. Six years after the wave. Trajectories of posttraumatic stress following a natural disaster. J Anxiety Disord. 2015;36:15-24.CrossRefGoogle ScholarPubMed
34. Arnberg, FK, Michel, PO, Lundin, T. Posttraumatic stress in survivors 1 month to 19 years after an airliner emergency landing. PLoS One. 2015;10(3).CrossRefGoogle Scholar
35. Doohan, I, Saveman, BI. Need for compassion in prehospital and emergency care: a qualitative study on bus crash survivors’ experiences. Int Emerg Nurs. 2015;23(2):115-119.CrossRefGoogle ScholarPubMed
36. Gouweloos, J, Postma, IL, Te Brake, H, Sijbrandij, M, Kleber, RJ, Goslings, JC. The risk of PTSD and depression after an airplane crash and its potential association with physical injury: a longitudinal study. Injury. 2016;47(1):250-256.CrossRefGoogle ScholarPubMed
37. Fujita, G, Nishida, Y. Association of objective measures of trauma exposure from motor vehicle accidents and posttraumatic stress symptoms. J Trauma Stress. 2008;21(4):425-429.CrossRefGoogle ScholarPubMed
38. Andrews, B, Brewin, CR, Philpott, R, Stewart, L. Delayed-onset posttraumatic stress disorder: a systematic review of the evidence. Am J Psychiatry. 2007;164(9):1319-1326.CrossRefGoogle ScholarPubMed
39. Grimm, A, Hulse, L, Preiss, M, Schmidt, S. Behavioral, emotional, and cognitive responses in European disasters: results of survivor interviews. Disasters. 2014;38(1):62-83.CrossRefGoogle ScholarPubMed
40. Bonanno, GA, Galea, S, Bucciarelli, A, Vlahov, D. Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack. Psychol Sci. 2006;17(3):181-186.CrossRefGoogle ScholarPubMed
41. Almedom, AM, Glandon, D. Resilience is not the absence of PTSD any more than health is the absence of disease. J Loss Trauma. 2007;12(2):127-143.CrossRefGoogle Scholar
42. Rehnsfeldt, A, Arman, M. Significance of close relationships after the tsunami disaster in connection with existential health--a qualitative interpretive study. Scand J Caring Sci. 2012;26(3):537-544.CrossRefGoogle ScholarPubMed
43. Thoits, PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145-161.CrossRefGoogle ScholarPubMed
44. Brewin, CR. Systematic review of screening instruments for adults at-risk of PTSD. J Trauma Stress. 2005;18(1):53-62.CrossRefGoogle ScholarPubMed
45. Walters, JT, Bisson, JI, Shepherd, JP. Predicting post-traumatic stress disorder: validation of the Trauma Screening Questionnaire in victims of assault. Psychol Med. 2007;37(1):143-150.CrossRefGoogle ScholarPubMed