Forskning på Kunskapscentrum för global katastrofmedicin
En katastrof kännetecknas av en brist på resurser - på personal, brist på förmågor, brist på material och brist på tid. Vår forskning handlar om utmaningen i hur vi, trots resursbristen, tillhandahåller bästa möjliga hälso och sjukvård. För närvarande bedriver vi forskning inom fyra områden: behovsbedömning, moralisk stress, handhavande av konflikskador, och hälso- och sjukvårdssystemets motståndskraft. Professor Johan von Schreeb är huvudansvarig för vår forskning.
Ett urval av våra senaste artiklar:
- Martina E Gustavsson, Nicklas Juth, Johan von Schreeb, Filip K Arnberg. Moral Stress among Swedish Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study. Scandinavian Journal of Work and Organizational Psychology, 2023 8(1): 2, 1–13.
- Nieves Amat Camacho, Johan von Schreeb, Francesco Della Corte 2, Ourania Kolokotroni. Interventions to support the re-establishment of breastfeeding and their application in humanitarian settings: A systematic review. Maternal & Child Nutrition. 2023 Jan;19(1):e13440
- Yohan Robinson, Luca Ragazzoni, Francesco Della Corte, Johan von Schreeb. Teaching extent and military service improve undergraduate self-assessed knowledge in disaster medicine: An online survey study among Swedish medical and nursing students, accepted in Frontiers in Public Health 2023
Needs assessments in disasters:
To plan relief activities following a disaster the following needs assessment information is needed: The context in which the disaster struck: What was the socioeconomic situation before the disaster? What resources are available and how was the pre-disaster situation for the population?
Our previous research findings highlight the lack of a “system” among disaster response agencies to make use of needs assessment data. Relief is sent based on “experience” and “feeling” rather than on objective needs assessment. Our focus has changed towards developing methods and approaches of estimating needs and risk following disasters, rather than how to collect the data on ground. We have created and tested a model to estimate and compare the severity of disasters, and our work now focuses on predicting the severity of disasters using the model of indicators we developed earlier.
- To map existing models of severity assessment models used in complex disasters and earthquakes.
- To evaluate the extent to which the mapped severity models can estimate the number of people affected and killed by earthquakes and floods.
- Based on objectives the first objectives, to define a model for estimating the severity and level of needs in different types of disasters.
- Moreover, to explore contextual and conceptual aspects of needs assessments and how their results may influence the international humanitarian health assistance response in disaster situations
Moral stress and ethical challenges in disasters:
The resource scarcity that defines disasters brings with it moral challenges beyond those in normal healthcare settings. In disaster response situations, healthcare staff will be in new, often threatening, situations where they will need to make difficult decisions to prioritise among overwhelming needs. Available professional ethical guidelines are of limited use as they do not sufficiently capture the complexity of disasters and the pressure responders are working under.
Our research aims to better understand what determinants are crucial to moral stress and what can be done to prevent illness and suffering.
- To identify and categorise moral challenges in disaster response.
- To explore how and to what extent these challenges affect wellbeing among responders.
- To systematically develop education materials to prepare responders.
- To assess the extent that a preparatory education improves the preparedness and the capacity of responders to handle moral stress.
Societies at risk:
Armed conflict is human development in reverse. The full scale of conflicts’ impacts remains unknown, and fragmentation of research into multiple academic fields limits our understanding, that is why we are part of the Societies at Risk project.
Societies at risk - anticipating the impact of armed conflict, is an inter-disciplinary research project that looks at the impact of armed conflict as an hazard, exposure and vulnerability. It considers the macro and micro effects on economies, health, water security, political institutions, human rights, gender equality and forced migration.
The Centre for Research on Health Care in Disasters forms part of the project along with Uppsala University, Universitat Autònoma de Barcelona, the International Security and Development Center (ISDC), Stockholm University, Johns Hopkins University, University of Pittsburgh, and V-Dem at University of Gothenburg. The project seeks to provide a a comprehensive, multidisciplinary and forward-looking assessment that may provide for a well-informed decision-making and anticipatory action. The aim is to develop a comprehensive risk-based framework for empirically assessing the expected impact of armed conflict on human development
The Centre for Research on the Health Care in Disasters will contribute to the cross-cutting themes and to the work package on health impacts of armed conflict.
- To assess the impact of armed conflict on a population of a given combination of hazard, exposure, and vulnerability across a set of outcome metrics, such as mortality, malnutrition, and economic growth, explicitly taking how these effects interact and reinforce each other into account.
- To estimate the hazard of conflict by applying the insights of research on the causes of war.
- To research the extent to which populations are exposed to conflict as a function of distance to it in terms of time and space.
- To assess the vulnerability of exposed populations to adverse impacts, conflict and climate-related and natural disasters.
- To formulate scenario simulations and cost-benefit analyses based on the results of the research. This will make use of a forward-looking, live, risk-assessment system that will produce regularly updated evaluations of expected impacts globally across locations.
- To produce free-standing estimates of conflict exposure and an index of vulnerability to shocks.
Management of conflict injuries:
Local negative pressure therapy for gunshot and explosion wounds
Wounds caused by gunshots and explosions often have difficulty healing because of extensive tissue damage and contamination. Current management practices are based on experience treating military personnel, but these skills may not necessarily transferable to a civilian context. Research is needed to enable evidence-based management of traumatic injuries and evaluate the use of new therapies.
Our research concerns local negative pressure therapy is a relatively new technology that primarily aims to reduce infections and shorten healing time. We performed a randomised controlled study in close vicinity to active conflicts to evaluate if the Vaccum Assisted Closure (VAC) treatment improved wound healing and reduced infection complications of limb injuries. The results of this study showed no significant benefit, which provides support for evidence-based management of patients with traumatic injuries. More studies regarding improved management of conflict injuries are underway
- To assess pre-hospital trauma mortality in conflict situations and examine to what extent it is possible to reduce this.
- To evaluate the efficacy and safety of local negative pressure treatment of explosion and gunshot wounds.
Epidemiology of conflict-related trauma in contemporary armed conflicts
Armed conflicts constitute a significant public health problem, and the advent of asymmetric warfare tactics creates unique and new challenges to healthcare organisations providing trauma care in conflicts.
Our retrospective studies analyses the epidemiology of presentations to civilian hospital close to ongoing conflicts in Afghanistan and Iraq and assess different aspects of their management
Emergency Medical Teams (EMT) and Surge Capacity:
Emergency Medical Teams (EMTs) are teams of health professionals (doctors, nurses, physiotherapists, paramedics, etc.) that provide direct clinical care to people affected by emergencies and disasters, and support local health systems. The structure is set up within the WHO and the director of our centre, Johan von Schreeb, as been involved with the initiative since the start.
In our role as WHO collaborating centre, we conduct research and training in healthcare and public health in disasters. We also support the WHO in their global health initiative, collaborate on developing standards for EMTs in conflict situations and complex emergencies, and much more.
At present members of our team are also looking particularly at the issue of surge capacity in disasters and in the field of disaster medicine.