title: Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study.
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.
  
  
  CONCLUSIONS
  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. Doohan I , Björnstig U , Östlund U , Saveman BI . Exploring injury panorama, consequences, and recovery among bus crash survivors: a mixed-methods research study. Prehosp Disaster Med. 2017;32(2):165-174.
authors.affiliation: 1Department of Surgical and Perioperative Sciences,Section of Surgery - Centre for Research and Development in Disaster Medicine,Umeå University,Umeå,Sweden.
authors.forename: Isabelle
authors.identifier: http://orcid.org/0000-0001-9387-3174
authors.initials: I
authors.lastname: Doohan
authors.affiliation: 1Department of Surgical and Perioperative Sciences,Section of Surgery - Centre for Research and Development in Disaster Medicine,Umeå University,Umeå,Sweden.
authors.forename: Ulf
authors.identifier: http://orcid.org/0000-0001-6827-6116
authors.initials: U
authors.lastname: Björnstig
authors.affiliation: 4Center for Collaborative Palliative Care,Linnaeus University,Kalmar/Växjö,Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Östlund
authors.affiliation: 2Department of Nursing,Umeå University,Umeå,Sweden.
authors.forename: Britt-Inger
authors.identifier: http://orcid.org/0000-0003-3716-6445
authors.initials: BI
authors.lastname: Saveman
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D013313:Stress Disorders, Post-Traumatic; D013548:Sweden; D014947:Wounds and Injuries / Q000523:psychology* / Q000534:rehabilitation; D055815:Young Adult
keywords:  AIS Abbreviated Injury Scale;  MAIS Maximum Abbreviated Injury Scale;  MCI mass-casualty incident;  PTSD posttraumatic stress disorder;  RSA road safety audits;  SAIA Swedish Accident Investigation Authority;  TSQ Trauma Screening Questionnaire; Emergency Medical Services; injuries; mass-casualty incident; survivors