Protection against cold - a survey of available equipment in Swedish pre-hospital services.

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 (SAR) and the municipal rescue services (RS) in Sweden to determine the availability of insulation, active warming, fluid heating, and low-reading thermometers. RESULTS: The response rate was 77% (n = 255). All units carried woollen or polyester blankets for basic insulation. Specific windproof insulation materials were common in the HEMS, SAR and RS units but only present in about half of the AS units. Active warming equipment was present in all the SAR units, but only in about two-thirds of the HEMS units and about one-third of the AS units. About half of the RS units had the ability to provide a heated tent or container. Low-reading thermometers were present in less than half of the AS and HEMS units and were non-existent in the SAR units. Pre-warmed intravenous fluids were carried by almost all of the AS units and half of the HEMS units but infusion heaters were absent in most units. CONCLUSION: Basic insulation capabilities are well established in the Swedish pre-hospital services. Specific wind and waterproof insulation materials, active warming devices, low-reading thermometers and IV fluid heating systems are less common. We suggest the development and implementation of national guidelines on accidental hypothermia that include basic recommendations on equipment requirements.

Physical activity in middle-aged women and hip fracture risk: the UFO study.

UNLABELLED: 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. INTRODUCTION: In middle-aged women participating in the Umeå Fracture and Osteoporosis (UFO) study, we investigated whether physical activity is associated with a subsequent decreased risk of sustaining a hip fracture. METHODS: The UFO study is a nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures. We identified 81 female hip fracture cases that had reported lifestyle data before they sustained their fracture. Each case was compared with two female controls who were identified from the same cohort and matched for age and week of reporting data, yielding a total cohort of 237 subjects. Mean age at baseline was 57.2 ± 5.0 years, and mean age at fracture was 65.4 ± 6.4 years. RESULTS: Conditional logistic regression analysis with adjustments for height, weight, smoking, and menopausal status showed that subjects who were regularly active with walking or had a moderate or high frequency of physical spare time activities (i.e. berry/mushroom picking and snow shovelling) were at reduced risk of sustaining a hip fracture (OR 0.14; 95% CI; 0.05-0.53 for walking and OR 0.19; 95% CI; 0.08-0.46, OR 0.17, 95% CI; 0.05-0.64 for moderate and high frequency of spare time activities, respectively) compared to more sedentary women. CONCLUSION: An active lifestyle in middle age seems to reduce the risk of future hip fracture. Possible mechanisms may include improved muscle strength, coordination, and balance resulting in a decreased risk of falling and perhaps also direct skeletal benefits.

Fracture mechanisms and fracture pattern in men and women aged 50 years and older: a study of a 12-year population-based injury register, Umeå, Sweden.

UNLABELLED: 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. INTRODUCTION: Osteoporosis-related fracture is a major health problem: the number of hip fractures is expected to double to 2030. While osteoporosis is one of many risk factors, trauma is almost always involved. Therefore, we analyzed injury mechanisms in patients aged over 50. METHODS: We registered injury mechanism, cause, diagnosis in all trauma patients at Umeå University hospital, Sweden. This population-based register (1993-2004) comprises a total of 113,668 injuries (29,189 fractures). Patients >or=50 years contributed to 13,279 fractures. RESULTS: Low-energy trauma (fall <1 m) caused 53% of all fractures >or=50 years and older. In those over 75 low-energy trauma caused >80%. The seasonal variation of fractures was maximally 25%. With increasing age, proximal fractures became more common, in both upper and lower extremities. Proximal locations predominate in older age groups. CONCLUSIONS: Low-energy trauma was responsible for the largest and costliest part of the fracture panorama. In fact, almost all fractures in middle-aged and old people were caused by low-energy mechanisms; thus, most fractures in these patients have a fragility component, and the contribution of osteoporosis-related fractures is more important than previously thought. A better understanding of injury mechanisms also in low-energy trauma is a prerequisite for preventive interventions.

Parachuting from fixed objects: descriptive study of 106 fatal events in BASE jumping 1981-2006.

OBJECTIVE: To analyse the characteristics of fatal incidents in fixed object sport parachuting (building, antenna, span, earth (BASE) jumping) and create a basis for prevention. DESIGN: Descriptive epidemiological study. PARTICIPANTS: Data on reported fatal injury events (n = 106) worldwide in 1981-2006 retrieved from the BASE fatality list. ASSESSMENT OF RISK FACTORS: Human, equipment and environmental factors. MAIN OUTCOME MEASUREMENTS: Identification of typical fatal incident and injury mechanisms for each of the four fixed object types of BASE jumping (building, antenna, span, earth). RESULTS: Human factors included parachutist free fall instability (loss of body control before parachute deployment), free fall acrobatics and deployment failure by the parachutist. Equipment factors included pilot chute malfunction and parachute malfunction. In cliff jumping (BASE object type E), parachute opening towards the object jumped was the most frequent equipment factor. Environmental factors included poor visibility, strong or turbulent winds, cold and water. The overall annual fatality risk for all object types during the year 2002 was estimated at about one fatality per 60 participants. CONCLUSIONS: Participants in BASE jumping should target risk factors with training and technical interventions. The mechanisms described in this study should be used by rescue units to improve the management of incidents.

Pedal cycling fatalities in northern Sweden.

The aim of the study was to elucidate the crash and injury mechanisms in bicycle fatalities in the northern half of Sweden. All available autopsy protocols, hospital records and 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 influence 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 > or = 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.

Sick leave and disability pension among passenger car occupants injured in urban traffic.

STUDY DESIGN: A follow-up cohort study of passenger car occupants injured in car crashes in an urban area in Sweden. OBJECTIVES: To analyze the injuries, injury events, and long-term consequences of injuries in car crashes. SUMMARY OF BACKGROUND DATA: The consequences of car crashes usually are described in terms of the number of people injured, the severity of injuries, or the number of inpatient days. Certain types of crash injuries can results in long-term sick leave and granting of disability pension. The increased socioeconomic significance of these outcomes is not always indicated by analysis of commonly used variables. METHODS: Two hundred fifty-five passenger car occupants aged 16-64 years who were injured in car crashes in urban traffic were analyzed in terms of length of sick leave and receipt of disability pension. RESULTS: Strain of the cervical spine was the most common type of injury (55%, 141 injuries), and these injuries accounted for 82% of all sick leave taken within 2.5 years after the injury event. Injury to the cervical spine in 16 of 18 cases resulted in long-term sick leave or dependence on disability pension. The most common injury mechanism was rear-end collisions (39%). This type of crash resulted in 64% of all sick-leave days within 2.5 years after the injury event. Twelve out of 18 injured people on long-term sick leave or receiving disability pension had been in cars struck from behind. CONCLUSIONS: It is important to include long-term consequences in the form of sick leave and disability pension when describing the consequences of different types of car crashes and injuries.

Acute Achilles tendon rupture in badminton players.

All patients with badminton-related acute Achilles tendon ruptures registered during 1990 to 1994 at the University Hospital of Umeå were retrospectively followed up using a questionnaire. Thirty-one patients (mean age, 36.0 years), 27 men and 4 women, were included. Thirty patients (97%) described themselves as recreational players or beginners. The majority of the injuries (29 of 31, 94%) happened at the middle or end of the planned game. Previous local symptoms had been noticed by five patients (16%). Long-term results showed that patients treated with surgery had a significantly shorter sick leave absence than patients treated without surgery (50 versus 75 days). There was no obvious selection favoring any treatment modality. None of the surgically treated patients had reruptures, but two reruptures occurred in the nonsurgically treated group. There seemed to be fewer remaining symptoms and a higher sports activity level after the injury in the surgically treated group. Our results indicate that local muscle fatigue may interfere with strength and coordination. Preventive measures such as specific treatment of minor injuries and adequate training of strength, endurance, and coordination are important. Our findings also indicate that surgical treatment and careful postoperative rehabilitation is of great importance among badminton players of any age or sports level with Achilles tendon rupture.

Injuries to the elderly in the traffic environment.

Two hundred ninety-seven persons, all aged 60 or over (180 women, 117 men), injured in the traffic environment, and treated at the Regional Hospital in Umeå, over a one-year period, were analysed. Injuries were grouped into three main categories: falls (52%), vehicle-associated events (44%), and "other" injury events (4%). In women, falls were a more common cause of injury than vehicle events, whilst in men there was a tendency for a converse relationship. Two-thirds of the falls involved slipping on ice and snow. Ice- and snow- related injuries (all categories) accounted for 37% of the total cost of all injuries in the elderly in the traffic environment. The main groups in the vehicle-associated injury category were cyclists (48%), car occupants (34%), other occupants (14%), and pedestrians (4%). Vehicle-associated injuries became more common with advancing age, resulted in the most severe and critical [Maximum Abbreviated Injury Scale (MAIS) greater than or equal to 4] injuries and the most fatalities, and cost (total and mean) more than falls. In conclusion, from the injury cost point of view, it is most important to prevent vehicle-associated injuries. However, when total frequencies are considered, falls deserve to be given just as much priority in injury prevention programs as vehicle-associated injuries, to make the traffic environment safer for this growing population.

Unintentional injuries among elderly people: incidence, causes, severity, and costs.

People aged 60 years or older (1,313 injured) treated for unintentional injuries at the emergency department of the Regional Hospital in Umeå, Sweden, over a period of one year were included in the material. The injury, fracture, and mortality rates per 1,000 persons aged 60 years or over were 57, 31, and 0.6, respectively. The causes of injuries were falls (70%), vehicle accidents (10%), and other (20%). Injury incidence, severity of injuries, proportion of injuries that were fractures, femur neck fracture frequency, duration of hospitalization, and mean costs of medical care increased with age of patients. Women had a higher injury rate, more severe injuries, longer duration in hospital, and higher cost of medical care than men. The cost of medical care of this group of elderly, making up 15% of all injured in the primary admission area, was SEK* 14 million; this being almost half the cost for all injured. Since the elderly population, especially the very old, is expected to increase in the future, prevention of falls (taking up 80% of total treatment costs) and vehicle accidents (causing the most critical injuries) is of utmost importance.

Persistent medical problems and permanent impairment: injuries associated with work, vehicles, and sports.

Among injuries treated in one year at the University Hospital in Umeå, Sweden, work- and sports-related accidents caused 16% each and vehicle-related accidents caused 12% of all injuries treated. Most fatalities and severe injuries were associated with vehicles. The proportion of victims with permanent medical impairment was highest among vehicle- and work-related injuries-6%. The proportion of persons who reported some form of persistent medical problem five years after the accident was similar in the three groups--between 21% and 24%. Among those injured in work- and vehicle-related accidents, one percent had been retired early or were on long-term sick leave. In all three groups, between 1% and 3% had changed jobs because of the injury, and between 3% and 6% had changed their leisure time activities to a large degree. Twelve percent of the work-related injuries and 8% of the vehicle-related injuries, but only 3% of the sports-related injuries, were claimed under some sort of insurance scheme. Pain was the most common persistent medical problem. Pain, together with serious brain and spinal injuries, is rather poorly defined in the impairment classification presently used by Swedish insurers to determine degree of permanent medical impairment. Improved and clarified criteria would be of great value.

Gender patterns in minor head and neck injuries: an analysis of casualty register data.

This study was designed to determine the age- and gender-specific incidences of moderate and minor head and neck injuries from emergency room casualty registers in two cities in northern Sweden. By contrast with findings in most studies on injuries, the incidence of minor and moderate head and neck injuries was higher among women than men in the 15-17- and the 39-53-year-old age group, and the incidence of neck injuries as high among women as among men in the 15-65-year-old age group. As compared to men, women more often sustained their head and neck injuries as pedestrians and as car passengers, and in rear-end and side collisions. Men were more often injured as motor vehicle drivers, in single-vehicle accidents and head-on collisions. Sports-related impact injuries were twice as common as fall injuries among men, the reverse being true of women. The determinants of gender-specific differences, and the relatively high incidence of minor head and neck injuries among women are discussed in relation to exposure, physical differences, as well as behaviour and lifestyle. It is recommended that greater detail is required in injury registrations, and that neck injury prevention be improved taking into consideration women's greater vulnerability to such injuries.

Fatalities caused by nonvenomous animals: a ten-year summary from Sweden.

All 58 deaths caused by nonvenomous animals in Sweden 1975-1984 were scrutinized. In 38 cases horses were involved, in 16 cattle and in one case each a moose, a lion, a dog and a ram. In the horse-related fatalities, the most common cause of accident was that the horse bolted or reared, causing the rider to fall off the horse or the cart or sulky. Falls were thus associated with 22 horse-related deaths. In cattle-related accidents, all fatalities where the cause of accident was known occurred due to aggressive behaviour of the animal. In horse-related accidents, head injuries dominated, while in cattle-related accidents head and chest injuries were equally common. It is suggested that wearing a proper helmet is the most important safety measure in horse-related activities. In cattle-related activities, the herding of untethered bulls together with cows is particularly dangerous and should be avoided.

Slipping on ice and snow--elderly women and young men are typical victims.

Slipping on ice or snow during winter caused 3.5 injuries per 1000 inhabitants per year in the Umeå health district; the injury rate was highest among the elderly. Most injured were elderly women, but also many young men in the age group 20-29 years were injured. Half of all injuries were fractures; for women 50 years and over two-thirds were fractures, mostly of an upper extremity. The 'cost' of medical care of these slipping injuries was almost the same as the 'cost' of all traffic injuries in the area during the same time. Injury reducing measures, such as more effective snow clearing, sand and salt spreading in strategic areas, better slip preventive aids on shoes, and 'padding' of older women, would reduce the injuries and their consequences.

Trams--a risk factor for pedestrians.

In Gothenburg tram injuries were identified to be an important cause of traffic injuries and fatalities (48%) among pedestrians. During the summer middle-aged men, often under the influence of alcohol, were often severely injured and the injury rate was also high during the autumn. A majority (60%) of those fatally injured were under the influence of alcohol. Most injury events happened at or near a tram stop. The most serious injuries arose when the victim landed under a tram. In 1992, a runaway tram caused a major disaster, killing 10 pedestrians and injuring 30. The injury reducing measures the tram company has now started to introduce include safety railings at tram stops, side barriers on the tramcars to prevent people from falling under the tram and lower speeds near tram stops.

Elderly in the traffic environment: analysis of fatal crashes in northern Sweden.

Fatal crashes of the elderly (> or = 60 years; N = 379) in northern Sweden in the traffic environment, between 1977 and 1986, were investigated using autopsy and police reports. Males had double the death rate of females. The car occupants made up the largest category (43%) followed by pedestrians, pedalcyclists, and two-wheel-motorvehicle (TWMV) riders, but the risk of fatal injury per unit distance travelled was highest for pedestrians and pedalcyclists. Most car occupants were killed in vehicle-vehicle crashes, mostly in the daylight and at intersections or straight roads. Ice and/or snow (31%) was the major precrash factor. In two-thirds of single car crashes, roadside hazards such as trees were involved. Most elderly fatally injured car drivers were responsible for the crash, and they were commonly involved in collisions with oncoming vehicles. Only 4% of the fatally injured car drivers were driving under the influence of alcohol. Head injuries appeared to be more common in side impact than in frontal impacts. Serious chest injuries were more common than head injuries in car crashes. One-quarter of the pedestrians were injured at pedestrian crossings and about half during darkness. One in six pedestrians were under the influence of alcohol. All pedalcyclists were injured in collisions with motor vehicles and most were injured at intersections. Pedestrians, pedalcyclists, and TWMV riders had more serious head injuries than chest injuries.

Teenager injury panorama in northern Sweden.

OBJECTIVES: To study non-fatal unintentional injuries among teenagers and to suggest preventive measures. SETTING: The emergency care unit of the University Hospital, Umeå, Sweden. METHODS: 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 records were examined. Data were coded according to the Nordic Medico-Statistical Committees Classification for Accident Monitoring, NOMESCO, and to the Abbreviated Injury Scale, AIS. RESULTS: 1,043 teenagers were treated with sports and transportation related injuries as the most common ones. Most injuries were minor (AIS 1), transportation related injuries had the highest proportion of non-minor injuries (AIS > or = 2), 139 teenagers were admitted for in-patient care. Most injuries occurred during leisure/school time. CONCLUSIONS: Sports and transportation related injuries were most frequent. Body weight and length differs among teenagers, we suggest that teenagers should exercise and play together, not only by age, but also to some extent, to height and weight. Curfew laws, a compulsory bicycle helmet law are other injury reducing measures suggested.

Use of seat belts in cars with different seat belt reminder systems. A study of injured car drivers.

The use of seat belts in cars with different seat belt reminder systems was analyzed in a population of 477 injured car drivers, transported by ambulance to Umeå University Hospital after car crashes. The ambulance personnel acted as independent observers regarding the use of seat belts. In this population the non-users were significantly (multivariate logistic regression) fewer (12%) in cars with a combined light and sound reminder, compared to cars without reminder (23%). In cars with only a light signal the proportion of non-users was the same as in cars without any reminder at all. An introduction of more effective reminders, at least in new cars, might be an effective way to increase seat belt usage rates in the long-term.

[Inline skating--high fracture risk. Two of three injured are boys and young men. Wrist fractures are most common]. / Aka inlines--stor frakturrisk. Två av tre skadade är pojkar och unga män. Handledsfraktur mest typisk.

In-line skating injuries have increased in recent years. Hospital based data from Umeå concerning 135 persons injured in in line skating collisions were analyzed. The highest yearly incidence of injury was found in males 10-19 years of age, at 1.7 per 1,000 inhabitants; the corresponding figure for females was 0.5. Two-thirds of incidents were caused by falls due to balance problems without the influence of any "external factor" such as rough road surfaces. No collisions with motor vehicles or other road users were registered. Nearly half of the injuries were fractures or dislocation injuries, most frequently of the upper extremities. Non-minor head injuries were rare. Protective gear for wrist and elbow may have the potential to reduce these injuries.

[All traffic related deaths are not "fatalities"--analysis of the official Swedish statistics of traffic accident fatalities in 1999]. / Alla dödsfall i trafiken är inte "dödsolyckor"--en analys av officiell statistik över dödsfall i svensk vägtrafik år 1999.

In 1997 the Swedish Parliament decided, in accordance with the so-called Vision Zero, that one official goal for the national traffic safety effort is that the number of traffic fatalities in the year 2007 must not exceed 270. In order to monitor efforts toward this hard-won goal, it is of course of utmost importance that official statistics on traffic deaths are reliable. In a meticulous analysis of all 580 officially registered traffic deaths in Sweden in 1999, we found that 490 were true accidental deaths, while 18 were suicides, 12 were deaths due to indeterminate causes, 59 were natural deaths and 1 case was not possible to evaluate due to missing data. Thus, only 84% of the officially registered "accidental traffic deaths" were bona fide accidents. In order to enhance the reliability of the official statistics, we suggest that regulations concerning police investigation and medicolegal autopsy of all unnatural deaths be adhered to all deaths reported to the Swedish National Road Administration should be checked in the database of autopsied cases in the National Board of Forensic Medicine in order to exclude natural deaths the time delay (1.5 years) to complete the official Cause-of-Death Register be shortened criteria for the classification of manner of death in "borderline" cases be suggested for international acceptance.