KcKM at the Centre for Disaster Medicine

The project aims to investigate how artificial intelligence (AI), particularly large language models (LLMs), and computer-based language analytical methods (NLP tools) can be used to strengthen training, practice and research in disaster medicine. The goal is to develop methods that streamline analysis of communication and team dynamics, which is crucial for learning and improved preparedness during complex events.

The project is divided into several sub-studies. The first sub-study, AI-Enhanced Team Debriefing, focuses on developing a model and software that supports team debriefing with the help of AI and complexity analysis. By collecting time series data, such as physiological parameters and communication data from exercises, a pipeline for AI-supported analysis is created. This includes automatic transcription and coding of communication to provide a data-driven basis that strengthens learning about non-technical skills. During 2026, development and testing of pilot software in simulation exercises is planned.

The second sub-study, Language Technology Analyses of Communication During Major Exercises, aims to automate analysis of communication data from complex exercises. Through NLP and complexity methods such as recurrence quantification analysis and phase space analysis, it investigates how collaboration changes over time. The goal is to identify metrics that can be applied to communication data and largely automated, enabling evaluation of larger disaster medicine exercises. The third sub-study, NLP Tools for Analysis of Large-Scale Disasters, is exploratory and focuses on how NLP can be used to analyze inter-organizational collaboration during major crises. By extracting and analyzing text data from exercises and real incidents, new insights into communication patterns and coordination are created.

The project plans collaboration with the Institute for Analytical Sociology at Linköping University to develop this approach. During 2026, the project is expected to produce a first set of AI- and NLP-based methods for analyzing team dynamics and communication during disaster medicine operations, including pilot software, automated analysis models and a manuscript for scientific publication. The project addresses a central knowledge gap and has the potential to create more resource-efficient interventions and strengthened preparedness in the Swedish crisis management system.

Co-investigators: Wilhelm Brodin, Carl-Oscar Jonson

Mass casualty incidents are often characterized by injury patterns similar to those seen in military combat, placing high demands on surgical competence, experience, and preparedness. In Sweden, exposure to severe trauma is low in peacetime, limiting opportunities for surgeons to maintain practical experience with such injuries. At the same time, there is currently no systematic and quantitative way to assess surgeons’ actual preparedness to manage mass casualty incidents.

The aim of the project is to apply and further develop the American KSA metric (Knowledge, Skills, and Abilities) in a Swedish context to analyze surgical preparedness for mass casualty incidents. The objective is to map operative experience in trauma surgery, identify competency gaps, and analyze how preparedness varies across different levels of the healthcare system.

Within the project, a Swedish version of the KSA system has been developed by matching American CPT codes to Swedish KVÅ codes. This enables scoring of surgical procedures performed in Sweden and provides a quantitative estimate of surgical experience. In the next phase, operative data from the Swedish Perioperative Register (SPOR) will be analyzed to map variations in preparedness based on professional level, surgical specialty, and hospital type.

During 2026, the full application of the Swedish KSA model to national operative data will be carried out. The work includes data collection and processing, calculation of annual KSA scores, and comparative analyses across hospital levels and levels of surgical experience. The project will conclude with the compilation of results for scientific publication and presentation in national contexts.

By applying the KSA system to Swedish surgical practice, the project establishes the first Swedish KSA-based method for quantitative assessment of surgical preparedness for mass casualty incidents. The results are expected to provide a systematic basis for evaluating whether current surgical capacity is sufficient to meet the demands of major incidents and crises. The methodology may also be integrated into existing registers, enabling long-term monitoring of surgical preparedness at both regional and national levels.

Co-investigators: Laura Pompermaier

Burn care in the Nordic countries is highly centralized to a limited number of specialized units. During a Mass Burn Casualty Incident (MBCI), this concentration risks rapidly overwhelming available capacity. MBCIs are among the most resource-intensive types of disaster in healthcare, placing high demands on planning, coordination and the ability to rapidly expand capacity at both national and regional levels.

The aim of the project is to map preparedness, capacity and operational capability within Nordic burn care systems to manage an MBCI. The objective is to identify structural strengths and weaknesses and analyze opportunities to strengthen collaboration, triage processes and surge capacity within and between countries.

The project begins with a systematic literature review and preparations for ethical review. This is followed by a quantitative survey, based on a validated European instrument, targeting all Nordic burn centers, trauma centers and a selection of representative Swedish county hospitals. The survey covers key areas such as preparedness planning, communication pathways, triage, resource availability and opportunities for rapid capacity expansion during an MBCI.

In parallel, qualitative interviews are conducted with key personnel at Nordic burn centers to deepen understanding of operational routines, constraints and collaboration needs. The combination of quantitative and qualitative methods enables a broad and in-depth analysis of preparedness levels and organizational conditions.

During 2026, ethical review, data collection and analysis of both quantitative and qualitative data will be carried out. The results will be used to describe preparedness levels, identify structural differences between countries and levels of care, and point to areas where capacity, collaboration and planning need to be strengthened to effectively manage an MBCI.

The project concludes with compilation of results for scientific publication and presentation in national and international contexts. By providing a systematic and comparable basis for burn injury preparedness, the study creates knowledge support for policy development, targeted training initiatives and strengthened Nordic collaboration. The results are expected to have potential to directly contribute to increased national and regional resilience during future mass casualty incidents involving burn injuries.

Co-investigators: Laura Pompermaier

Incendiary weapons, such as napalm and white phosphorus, cause extensive thermal and chemical injuries with high mortality, long-term disability and significant psychosocial consequences. The injury panorama is often complex and includes deep burns combined with inhalation injuries, systemic toxicity and organ failure. These injuries are among the most resource-intensive in disaster medicine and place high demands on both acute management and long-term specialist care.

Over the past 15 years, the use of incendiary weapons has been documented in several armed conflicts, including in Ukraine, Gaza and South Sudan. Despite this, systematic data on injury patterns, care needs and clinical outcomes for incendiary weapon injuries remain largely lacking. This knowledge gap complicates both acute clinical management and long-term planning of crisis and war preparedness in healthcare.

Injuries caused by incendiary weapons are highly relevant from a Swedish preparedness perspective. Sweden may in the future need to manage patients with complex war-related burn injuries through medical evacuations within the EU, reception of civilians and military personnel from conflict areas, and care of refugees with previously sustained injuries. This requires preparation, competence building and access to structured knowledge about these injury patterns.

The aim of the project is to map injury patterns, care needs and resource requirements for incendiary weapon injuries and to identify opportunities to strengthen Swedish crisis and war preparedness. The objective is to develop a knowledge base that can underpin improved clinical management, preparedness planning and international collaboration. A central part of the project is to investigate the conditions for establishing a clinical registry for injuries caused by incendiary weapons, and to promote networking and collaboration with international actors.

During 2026, a systematic mapping of health diplomacy in armed conflicts relevant to incendiary weapon injuries will be carried out. As part of the mapping, key actors, organizations and processes that affect knowledge exchange, care interventions and international collaboration in the field will be identified. The mapping will form the basis for a scientific publication and contribute to increased understanding of how medical knowledge and preparedness develop in conflict-related contexts.

By providing a structured and research-based foundation on incendiary weapon injuries, the project can contribute to strengthened Swedish crisis and war preparedness, improved care capacity when receiving war-injured patients, and increased international coordination within disaster and war medicine.

Co-investigators: Filippa Sennersten, Denise Bäckström

In accidents, acute illness and mass casualty incidents, civilians are often first on scene and initiate life-saving actions before professional resources arrive. In these situations, spontaneous ad hoc teams form, where individuals without prior collaboration or shared training attempt to provide first aid together. How these groups collaborate, establish trust and make decisions can be decisive for the outcome, especially when professional resources are limited or delayed.

The aim of the project is to investigate how individuals collaborate in spontaneously formed ad hoc teams during first aid interventions. The objective is to generate knowledge that can underpin development of training initiatives for laypeople and non-medically trained individuals, with particular focus on collaboration, trust and effective division of labor in acute situations. In a broader perspective, the project aims to strengthen civil preparedness and total defence by increasing the public's ability and willingness to act during crises and mass casualty incidents.

The project builds on previously conducted studies, including an experimental study of collaboration in teams with mixed competence levels (laypeople and experts) and an interview study with people who have participated in joint first aid interventions. The current project phase focuses on the public's understanding of collaboration and trust in first aid, with particular interest in similarities and differences in how such situations are perceived.

Two complementary studies are planned. The first uses the story completion method, where participants are asked to complete stories about how different first aid situations unfold. The story openings vary in severity and thematic focus, for example open action, collaboration and trust, to illuminate different aspects of collaboration dynamics. Up to 120 Swedish-speaking adult laypeople will be recruited via advertising and university channels, and the material will be analyzed thematically to identify common patterns and variations.

The second study is a controlled experiment based on vignettes, that is, complete stories about first aid situations. Participants choose the course of action that best matches how they perceive they would act themselves. This enables systematic comparisons of which measures and approaches can most effectively improve collaboration and joint action.

The first sub-study is planned for the first half of 2026 and the second for the second half of 2026, the latter subject to external funding. The project's deliverable for 2026 is a systematic analysis of collaboration dynamics in first aid, including identified areas for improvement and a completed manuscript for scientific publication.

By addressing a central knowledge gap around civil collaboration in acute situations, the project has the potential to contribute to increased preparedness during mass casualty incidents and strengthened total defence, where citizens to a greater extent dare, want and are able to take a first action.

Co-investigators: Wilhelm Brodin, Carl-Oscar Jonson

Globally, trauma is the single largest cause of death among people under 45, with uncontrolled hemorrhage as the most common direct cause of death. In Sweden, approximately 3,000 people die from trauma each year, and a significant proportion of potentially avoidable deaths occur before the patient reaches hospital. Experience from war and armed conflicts over recent decades has clearly shown that early bleeding control is a decisive life-saving measure in environments where access to advanced care is limited or delayed.

For extremity bleeding, a tourniquet is the first-line choice to control catastrophic bleeding. For injuries where a tourniquet cannot be applied, such as in the neck, groin or armpit, wound packing is used, either with standard dressings or hemostatic products. Despite wound packing being a central measure in modern trauma care, standardized tools for training and systematic evaluation of practical skill in the technique are largely lacking.

The aim of the project is to develop tools that enable standardized training and objective evaluation of wound packing technique. The objective is to produce a structured observation protocol that can be used both to assess technical skill and as pedagogical support in training on bleeding control, in civilian as well as military and disaster medicine contexts.

Development of the observation protocol is based on a systematic and theory-grounded methodological approach. Central to the work is translating clinical guidelines and practical expert knowledge into a structured and usable assessment instrument. The protocol is intended to cover the psychomotor skills required for correctly performed wound packing and to enable objective and reproducible observation of practical performance. The instrument is also intended to support formative evaluation and feedback during training sessions.

Validation of the observation protocol will cover several complementary aspects of validity and reliability to ensure the instrument's scientific quality and practical usability. In the validation work, instructors and trainers with long experience of advanced trauma care will be involved, as well as participants with varying degrees of prior experience of wound packing. This enables assessment of the instrument's reliability, discriminatory ability and relevance in training contexts.

The project contributes to addressing an identified knowledge and method gap in bleeding control by creating a standardized basis for training and evaluation of wound packing. The results have the potential to strengthen quality in trauma training, improve practical skill among both professional and civilian actors, and in the longer term contribute to reduced mortality in severe trauma injuries.

Co-investigators: Lukas Arkestål, Marc Friberg, Wilhelm Brodin

Hemostatic dressings contain active substances intended to accelerate the body's hemostasis and thereby facilitate bleeding control during wound packing. These products are used primarily for catastrophic bleeding where a tourniquet cannot be applied, for example for injuries in the groin, neck or armpit. Despite their central role in modern trauma care, the evidence base regarding the effectiveness of various commercially available and newly developed hemostatic dressings is limited and partly unclear.

The aim of the project is to systematically evaluate the effectiveness of hemostatic dressings with regard to their ability to stop catastrophic bleeding. The objective is to generate comparable and evidence-based knowledge that can underpin recommendations on the use of hemostatic products in trauma, disaster and war medicine.

The study is conducted using a standardized in vivo bleeding model, enabling controlled comparisons between different types of dressings. In addition to hemostatic properties, usability and practical handling will also be evaluated, including factors such as applicability, stability and function under realistic conditions.

The project uses the standardized analysis and observation tools developed within Wound Packing, sub-study 1. By using a structured and validated assessment instrument, objective and reproducible evaluation of both effect and usability is ensured, strengthening the study's methodological quality.

By providing a systematic and comparative basis on the effectiveness of hemostatic dressings, the project can contribute to improved bleeding control in severe trauma injuries. The results have the potential to strengthen training, clinical practice and preparedness planning and, in the longer term, reduce mortality from catastrophic bleeding in civilian, military and disaster medicine contexts.

Co-investigators: Lukas Arkestål, Marc Friberg, Wilhelm Brodin