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Level of legal defence of a paramedic in practice
CUPER, Tomáš
Members of the ambulance teams of Emergency Medical Services are increasingly becoming victims of assaults by patients, their close relatives or passers-by. Many of them does not end with only verbal threat or insult, but also with direct physical confrontations that affect not only the quality of pre-hospital care provided, but also the physical and psychological state of the crew members. On the contemporary risk of reprisal attacks aren't members of the Emergency Medical Service adequately prepared, equipped and mainly protected by law. Emergency Medical Service occupies a specific position with respect to powers and duties, which means to the level of legal protection in the same position as the basic components of the integrated rescue system. The theoretical part deals with the current level of legal protection of paramedic in practice. The beginning of work briefly defines and characterizes pre-hospital emergency care, which is the subject of daily activities of Emergency Medical Services. The analysis of laws listed the competencies of paramedic, then analysis of rights and obligations during the provision of pre-hospital care, but also offered a view of the recent changes in the legal protection or outlined the legal inequalities in Integrated Rescue System. The work also defined the risks of field emergency work and causes of aggression, which is causing attacks. The theoretical part is closed by chapter dealing with the consequences of the attacks themselves, which are taking their toll on the quality of pre-hospital care and the physical and mental state of paramedics. Introduction of practical part is dedicated to the processed statistical surveys. For the verification of research questions and for meeting the objective of this thesis was done supporting statistical surveys in order to determine the frequency of attack of paramedics in the individual regional emergency medical services in the period from 2010 to 2014, i.e. since amendment of the Criminal Code, which changed legal protection of paramedics. The aim is to evaluate the legal protection of paramedics in providing pre-hospital care and propose measures to improve its protection. The chosen research question determines what resources can be used to enhance the protection of paramedics For the practical part of the work was used the Region of South Bohemian, which was used for the qualitative method of data collection using structured interviews and subsequent analysis of data. Data collection was done through structured interviews and the sample consisted of 10-attackedparamedics in all regional centres of Emergency Medical Services in Region of South Bohemia in České Budějovice, Český Krumlov, Jindřichův Hradec, Písek, Prachatice, Strakonice and Tábor. As the respondents' answers fixation method was used audio recording, followed by transcription of the audio into written form. By summarizing data obtained from structured interviews was carried The SWOT analysis based on the comparison of the internal and external environment in order to evaluate the legal protection in practice. From the percentages of the individual areas of the SWOT analysis has been chosen, for the needs of the work, WO strategy, which is aimed at eliminating weaknesses using the opportunities. From the apparent results of the level of legal protection, which is also demonstrated by the worsening prognosis of processed survey in the practical part from which is monitored an increase of attacks were in response suggested means to increase the legal protection of paramedics, which aim to minimize attacks on outreach EMS crew.
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Invasive monitoring in intensive care
CUPER, Tomáš
Invasive monitoring is a repetitive, durative observation of physiological functions of a patient and functioning of apparatuses which serve as support of these functions. It is thus an active, repetitive and continuous process when both the patient and the medical apparatuses are regarded. The human factor is thus essential and vital. The reason for application of the invasive monitoring during an intensive hospital care is above all the ability to support physiological functions of a patient, at the same time, it serves to timely detect divergences in physiological values; it very often effectively helps in further decision-making of medical interventions, and clarifies the effectiveness of patient´s treatment. The theoretical part of this bachelor thesis deals with the issue of invasive monitoring in intensive hospital care. The beginning of the thesis provides an explanation what actually the invasive monitoring means, and clarifies and characterises intensive medicine and monitoring in general. The individual types of invasive monitoring are divided according to areas of basic living functions in cardiovascular, respiratory, and central nervous system. With every type of invasive monitoring comes an explanation and clarification of it, further, generally indicated and contraindicated statuses are provided, along with instruments and the way monitoring is applied. The theoretical part is concluded by a chapter that deals with general nursing care. The practical part focuses on mapping of the most often used types of invasive monitoring given critically ill patients in Anaesthesiology and Resuscitation wards, and Urgent Admittance wards in hospitals of the area of South Bohemia, and the region of Carlsbad, and mapping of knowledge of staff of Anaesthesiology and Resuscitation and Urgent Admittance in the particular regions given invasive monitoring. The research was implemented by a quantitative method using a printed standardised questionnaire. The amount of data was collected in March 2014. The target group of the research was a team of general nurses and paramedics, who work in Anaesthesiology and Resuscitation wards and Urgent Admittance wards. The anonymous questionnaire was handed out 100 exemplars for hospitals in South Bohemia, and 100 exemplars for hospitals in the region of Carlsbad. In South Bohemia, there were picked the hospitals in České Budějovice, Jindřichův Hradec, Písek, Prachatice, and Tábor, there. In the region of Carlsbad, there were picked the hospitals in Cheb, Carlsbad, and Sokolov, there, to fill in the questionnaire. There took part 141 respondents in the research. The total amount of responses out of 200 exemplars (100%) of the questionnaire thus reached 70, 5%. The questionnaire contained the total of 28 questions, out of which the opening 4 were stratification-like, question nr. 5 was closed, question nr. 6 were half-open and the remaining 22 questions were dealing with knowledge of respondents in the issue of invasive monitoring in intensive care. The results were progressed by the statistic programme SPSS into well arranged tables, and the set hypotheses were statistically evaluated with help of X2 square test. The goal of this bachelor thesis was to map the most often used types of invasive monitoring with critically ill patients in Anaesthesiology and Resuscitation wards, and Urgent Admittance wards in hospitals of South Bohemia, and in region of Carlsbad. This goal was fulfilled. The next goal was to map knowledge of invasive monitoring given staff of Anaesthesiology and Resuscitation wards, and Urgent Admittance wards in hospitals of South Bohemia, and in region of Carlsbad. This goal was fulfilled too. Statistically evaluated questionnaire proved that the workers have the knowledge in the area of treatment, hemodynamic values, as well as techniques in taking care of critically ill patients in Intensive Care wards.
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