Ulf Björnstig

• Ph.D., M.D.
• Professor at Umeå University

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 fa...

Purpose Major incidents in road tunnels remain a collaborative challenge for the emergency services (fire and rescue service, police and ambulance), emergency dispatch centres (EDCs) and infrastructure owners. The aim of this paper is to investigate how collaborative partners to the ambulance services perceive the rescue effort and to identify fact...

Background: In chemical incidents, infrequent but potentially disastrous, the World Health Organization calls for inter-organizational coordination of actors involved. Multi-organizational studies of chemical response capacities are scarce. We aimed to describe chemical incident experiences and perceptions of Swedish fire and rescue services, emer...

The crash of a coach with 58 occupants at 100 kmph revealed the danger of covering ditch areas with sharp stones 5–20 cm in size. Stones and dirt were sprayed into the coach compartment resulting in serious injuries and death. Road safety works need to address this factor in the future.

Background: In chemical incidents, infrequent but potentially disastrous, the World Health Organization calls for inter-organizational coordination of actors involved. Multi-organizational studies of chemical response capacities are scarce and testable hypotheses are largely lacking. We aimed to describe chemical incident experiences and perception...

Objectives Increased demands are placed on emergency services and their role and ability to act in incidents in challenging environments, for example, road tunnels. Collaboration between officers from emergency services (fire brigade, police and ambulance services) is important for an effective rescue effort. In Gothenburg, Sweden, a position as a...

Objective Identify factors of preparedness for peer first response to underground mining emergencies with injured victims. Design Cross-sectional questionnaire study of Swedish underground mineworkers. Setting Seven out of nine Swedish underground mines. Participants A total of 741 mineworkers out of 1022 (73%) participated in this study. Inter...

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...

Background: High demands are placed on the emergency medical services to handle rescue operations in challenging environments such as tunnels. In Oslo, Norway a specialised management function within the emergency medical services, the medical on-scene commander, in line with the command structure within the police and fire brigade, might support...

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 justificati...

BackgroundA data acquisition from the medical sector may give one important view of the burden on the society caused by vehicle related injuries. The official police-reported statistics may only reflect a part of all vehicle-related injured seeking medical attention.The aim is to provide a comprehensive picture of the burden of vehicle related inju...

Background: The aim of this study was to survey the current equipment used for prevention, treatment and monitoring of accidental hypothermia in Swedish pre-hospital services. Methods: A questionnaire was sent to all road ambulance services (AS), the helicopter emergency medical services (HEMS), the national helicopter search and rescue service...

The objective was to study the epidemiology of fatal occupational injuries in Sweden as a basis for injury mitigation activities. Data of injury incidents from the years 2010–4 registered at the Swedish Working Authority and AFA Insurance was used along with national registers for hospitalised persons combined with national registers of individual...

Objective Underground mining is associated with obvious risks that can lead to mass casualty incidents. Information about such incidents was analyzed in an integrated literature review. Methods A literature search (1980-2015) identified 564 modern-era underground mining reports from countries sharing similar occupational health legislation. These...

Study/Objective To explore social connections among survivors, five years after a major bus crash. Background Consequences and recovery for survivors after transport disasters or mass-casualty incidents are being studied to a great extent. Receiving sufficient social and psychosocial support from family, friends, and others has been presented as a...

Study/Objective To study perceived collaboration among mining workers and managers, rescue service personnel, and ambulance personnel when mining incidents occur. Background Studies focused on rescue operations in mining incidents and on the emergency medical service´s part in the rescue operations are scarce. In Sweden, usually the local rescue a...

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...

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 servic...

As societies become more complex and interconnected, the global risk for catastrophic disasters is increasing. Demand for expertise to mitigate the human suffering and damage these events cause is also high. A new field of disaster medicine is emerging, offering innovative approaches to optimize disaster management. Much of the information needed t...

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...

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...

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...

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 (FE) techniq...

The purpose of this study was to evaluate the effect of wet clothing removal or the addition of a vapor barrier in shivering subjects exposed to a cold environment with only limited insulation available. Volunteer subjects (n = 8) wearing wet clothing were positioned on a spineboard in a climatic chamber (-18.5°C) and subjected to an initial 20 min...

Background: Neck injuries following whiplash trauma can lead to long-term sequelae. Population-based studies covering traffic and non-traffic whiplash trauma are rare. The aim was to describe the incidence of neck injuries following whiplash trauma during one year, from a well-defined area served by a single hospital, and the resulting long-term si...

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 rep...

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 an...

The 21st century has provided many examples of the devastating effects attacks can have when public transportation has been targeted or used as weapons. Four hundred and seventy seven mass-casualty attacks (≥ 10 fatally injured and/or ≥ 100 non-fatally injured) against public transportation and terminal buildings during the years 1970–2009 were stu...

Complementary measures for the assessment of patient thermoregulatory state, such as subjective judgement scales, might be of considerable importance in field rescue scenarios where objective measures such as body core temperature, skin temperature, and oxygen consumption are difficult to obtain. The objective of this study was to evaluate, in heal...

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....

Objective: To investigate sex differences in symptoms, structure of symptoms, disability and life satisfaction 3 years after mild traumatic brain injury. Secondary aims were to find risk factors for adverse outcome. Design: Population-based cohort study. Patients: The cohort comprised 137,000 inhabitants at risk in a defined population served by a...

Objective: To characterize the long-term consequences of mild traumatic brain injury regarding post-concussion symptoms, post-traumatic stress, and quality of life; and to investigate differences between men and women. Design: Retrospective mixed-methods study. Subjects/patients and methods: Of 214 patients with mild traumatic brain injury seeking...

The objective of this study was to study whiplash injury outcome in front-seat occupants in rear-end impacts using double paired comparison technique. The combination of gender, seated position, and outcome was analyzed. Folksam, a Swedish insurance company, has a database of whiplash injuries. A questionnaire was used to collect study data. The re...

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....

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. Descriptive epidemiology determined by prospectively collected data from a defined population. The study was conducted at a public hospital in Sweden. The population of the hospital's c...

In the prehospital care of a cold and wet person, early application of adequate insulation is of utmost importance to reduce cold stress, limit body core cooling, and prevent deterioration of the patient's condition. Most prehospital guidelines on protection against cold recommend the removal of wet clothing prior to insulation, and some also recom...

Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientific 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. Patients were assigned t...

Globally, railway transport is increasing steadily. Despite the adoption of diverse safety systems, major railway incidents continue to occur. Higher speeds and increased passenger traffic are factors that influence the risk of mass-casualty incidents and make railway crashes a reality that merits extensive planning and training. Data on railway di...

The higher incidence of fractures in women than in men is generally attributed to the lower areal bone mineral density (areal BMD, g/cm(2)) of the former. The purpose of the present study was to investigate both areal BMD and injurious falls as risk factors for fractures. In a first cohort, areal BMD was measured in 5,131 men and women (age range 4...

Aim: To study the epidemiology of unintentional injuries in a population of 21,000 Swedish older adults (65+) and to compare the injury incidence with similar data collected two decades earlier. Method: This is a retrospective epidemiologic cross-sectional study based on a 1-year data set of all the 1753 registered injury events from a well-defi...

In a population-based case-control study, we demonstrate that middle-aged women who were active with walking or in different physical spare time activities were at lower risk of later sustaining a hip fracture compared to more sedentary women. In middle-aged women participating in the Umeå Fracture and Osteoporosis (UFO) study, we investigated whet...

Bicycles are a common mode of transportation and injured bicyclists cause a substantial burden on the medical sector. In Sweden, about half of fatally injured bicyclists are 65 years or older. This study analyzes the injury mechanisms, injuries, and consequences among bicyclists 65 years or older and compare with younger bicyclists (< or =64) and o...

Background The usefulness of the Swedish Parachute Association (SFF) national registry of skydiving injuries may benefit from a description of its base population and an evaluation of its sensitivity and specificity. Methods Cross-sectional analysis based on data collected through a web-based questionnaire (SKYNET), from all persons renewing a Swed...

In a cold, wet, or windy environment, cold exposure can be considerable for an injured or ill person. The subsequent autonomous stress response initially will increase circulatory and respiratory demands, and as body core temperature declines, the patient's condition might deteriorate. Therefore, the application of adequate insulation to reduce col...

In this chapter, the author uses the Haddon Matrix to describe the disasters affecting each mode of transportation and the British Major Incident Medical Management System (MIMMS) to illustrate how these events are managed. The chapter deals with air disasters, sea (ship and ferry) disasters, rail (train/railway) disasters, and motor vehicle (bus/c...

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 st...

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 int...

The influence of bone mass, bone size and previous low energy fractures upon prospective fractures has not been investigated in a referral osteoporotic population. We investigated the association between bone mass, bone size, previous fractures, body constitution, and prospective validated fractures in 5701 women and 1376 men, aged 30 years and old...

To investigate whether nursing intervention via telephone follow-up can affect health-related quality of life among road users in the postinjury phase. Injuries in the traffic environment often cause both physical impairment and psychological trauma. Therefore, it is important to investigate whether nursing via telephone follow-up after discharge c...

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 hospitalize...

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. The cases were identified in the National...

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. A population of 65 subjects, 35 males and 30 fe...

To compare four field-appropriate torso-warming modalities that do not require alternating-current (AC) electrical power, using a human model of nonshivering hypothermia. Five subjects, serving as their own controls, were cooled four times in 8 degrees C water for 10-30 minutes. Shivering was inhibited by buspirone (30 mg) taken orally prior to coo...

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 f...

To analyse the characteristics of fatal incidents in fixed object sport parachuting (building, antenna, span, earth (BASE) jumping) and create a basis for prevention. Descriptive epidemiological study. Data on reported fatal injury events (n = 106) worldwide in 1981-2006 retrieved from the BASE fatality list. Assessment of risk factors: Human, equi...

Aerodynamic properties of high-sided coaches with various body shapes were investigated in order to improve directional stability. The idea was to find out whether it would be possible, from an aerodynamic point of view, to suggest an optimal coach body design. The subject has previously been paid little attention in the scientific literature. The...

To describe the patients' perceptions of quality of care (QoC) in an emergency department (ED) and to analyse associations between patients' background characteristics and estimated QoC. Each year 1.4 out of every 100 inhabitants are injured in the traffic environment and receive care at the ED. No study has yet analysed different injured road user...

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 10(9)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 h...

In a study of a 12-year population-based injury register, Umeå, Sweden, we analyzed the fracture mechanisms and fracture pattern in men and women 50 years and older. Low-energy trauma was responsible for the major and costliest part of the fracture panorama, but the pattern differs between age groups. Osteoporosis-related fracture is a major health...

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,...

The aim was to describe epidemiological and medical aspects of 449 cases of traumatic brain injury (TBI) from a well-defined geographical area with a population of 137,000 inhabitants. An episode of disturbed consciousness was a prerequisite for inclusion in the study. The incidence of TBI was 354/100,000 inhabitants. Median age was 23 years, range...

To create a basis for prevention of modern skydiving injuries. Descriptive epidemiological study. National total material. Data on all reported injury events (n = 257) in Swedish skydiving 1999-2003 (total 539,885 jumps) were retrieved from the Swedish Parachute Association. Non-fatally injured skydivers were sent a questionnaire asking for event a...

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. A stratified randomized population of 154 test subjects was studied in a Volvo V70 year model 2003 car,...

The incidence of trampoline-related injuries in Sweden has increased at an explosive rate. In 2005, the injury rate in Umeå for individuals aged 7 to 17 years was 5 per 1000 individuals, 2.2 times the risk for this age group of being injured in a car crash and 0.4 times the risk of being injured in a bicycle crash. Almost all were under the age of...

During 1990 and 1991, 9% of all sports injuries that required emergency care at the University Hospital of Umeå were caused by floorball. Seventy-eight per cent of the injuries were minor (AIS 1) and 21% were moderate (AIS 2). Sprains of the ankle and knee joints were most frequent, constituting 30% and 11% of all injuries, respectively. Licensed p...

More than half of car crash fatalities are belted occupants, and the majority of these occur as a consequence of frontal crashes. In an earlier study of crash configuration characteristics, we have shown that 48% of fatalities occurred in frontal small overlap (SO) crashes in which less than 30% of the vehicle front was engaged. Only 23% of fatalit...

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. Blood samples were taken in patients (n = 88) on a...

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 anal...

The risk for injuries in rollover coach crashes are dependent on whether the occupants are belted or not. However, the influence of the different belt systems for reducing injuries has remained unclear. Since many injuries sustained are caused by impacts with the interior, passenger interactions or ejection through a window, the advantages by prope...

To identify causes and trends of violent deaths among children younger than 4 years in a northern region. Retrospective analysis of medico-legal autopsy and police data. Data from all 72 deaths from "external causes" 1977-2004, in children < 4 years from the northern half of Sweden were analysed. The death rate was 7.1 per 100,000 children and year...

A ten year complete data set from the health sector, comprising 284 injured bus and coach occupants from a well defined area, was analyzed. The annual injury incidence was 2 per 10,000 inhabitants, 3/4 were women. In non-crash incidents, 54% were injured; 2/3 while alighting from a bus or coach. In crashes, 46% were injured; 2/3 in collisions with...

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 1964-1...

To investigate, in patients with mild traumatic brain injury, serum concentrations of S-100B and neurone-specific enolase in acute phase and post-concussion symptoms, disabilities and life satisfaction 1 year after the trauma. Prospective study. Eighty-eight patients (age range 18-87 years). Blood samples were taken on admission and about 7 hours l...

A bus in motion is affected by aerodynamical side and lift forces that may interfere with the stability of the vehicle. These forces depend on the speed and direction of the resulting wind in relation to the bus. Cross-wind gusts may generate side forces so suddenly that great directional deviation is imposed on the bus prior to any possible driver...

Traffic injuries cause a heavy burden on society in most motorized countries. Pre-hospital and hospital trauma care may have a potential to reduce these losses. By tradition the pre-hospital ambulance care has not until the last decades been integrated in the medical sector organization in Sweden. Nowadays it is regarded as the extended arm of trau...

This paper provides results from in-depth real world crash investigations of fatal frontal crashes with belted occupants. A new method has been used regarding data collection of vehicle deformations. This method allows a detailed analysis of actual load paths acting on the vehicle during the crash event.By using this method it was identified that s...

This is a community-based sequential case series of 50 individuals who committed suicide by jumping from bridges in two regions of Sweden. Of the 50 subjects, 32 were men and 18 women, with a median age of 35 years. At least 40 had psychiatric problems. The frequency of suicide was highest during the summer months and during the weekends. A total o...

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 Västerås, 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 reduce...

Traffic injuries cause a heavy burden on society in most motorized countries. Pre-hospital and hospital trauma care may have a potential to reduce these losses. By tradition the pre-hospital ambulance care has not until the last decades been integrated in the medical sector organization in Sweden. Nowadays it is regarded as the extended arm of trau...

Medically impairing injuries among medical personnel (n = 209) were analyzed based on data obtained from the Work-Related No-Fault Liability Insurance's (TFA) injury registration system. Almost half (98; 47%) were injured during patient care, of which 29 were injured as a result of physical trauma inflicted by the patient. When moving themselves be...

Restraint systems, such as air bags and seat belts with pretensioners, reduce effectively the risk of serious injuries of car occupants. However, this equipment may have some adverse effects. In a frontal air bag deployment the cushion expands with a speed of about 200 km/h towards the driver. A person within the expansion zone, i.e. within 20 cent...

The risks associated with bus and tram traffic (Am. cable car) for unprotected road users, within a well-defined geographic area, were analyzed in a descriptive study using data from the hospital's special traffic injury register and from all other available sources of crash and injury data. The risk of suffering a non-fatal injury was four times h...

Injuries due to interaction with dogs and cats are not uncommon, and constituted 1.4% of all injuries in an unselected policlinical and inpatient material. This material was collected from a population of 135,000 people in Northern Sweden, and during 2 years 280 patients with injuries related to these domestic animals were found (Ndogs = 212, Ncats...

To study non-fatal unintentional injuries among teenagers and to suggest preventive measures. The emergency care unit of the University Hospital, Umeå, Sweden. All injured teenagers (N = 1044) attending the emergency care unit during 1991 were asked to answer a questionnaire focusing on when, where and how the injury occurred. All available medical...