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Assessment of diagnosis by paramedic in pre-hospital emergency care
BINKOVÁ, Kristýna
Proper diagnosis is difficult even for many years experienced physician. It requires a carefully collected anamnesis and ability to listen and perception of the patient. Paramedics in prehospital emergency care do not determine suspected diagnosis. They determine only rough description. Based on previous anamnesis, physical examination and premedical knowledge together with suspected diagnosis they send patient to appropriate department. Here he is taken by medical worker and examination is done again. The aim of this bachelor thesis is to describe procedure and find out most common mistakes which paramedics commit when they determine diagnosis during prehospital emergency care. The thesis is divided into theoretical and research section. Theoretical section is about general terms as anamnesis, laws, diagnosis and differential diagnosis of the most common diseases. Research in this thesis was done by qualitative method, data were collected by standardized interviews with paramedics from South Bohemia and Vysocina Region. The aim of this bachelor thesis is to describe procedure and find out most common mistakes which paramedics commit when they determine diagnosis during prehospital emergency care. Research showed that paramedics determine descriptive diagnosis several times a day and they know how to proceed correctly. They have a possibility from the employer to have special training regarding this issue, however they are missing feedback from hospital to verify correctness of determining the descriptive diagnosis. Participants would like to have this feedbacks it would be a confirmation of correctness of their prehospital care. The results of this thesis give the reader information on the issue and legislation in the theoretical part. The main benefit of this thesis should be the experiences and practices of paramedics from the Vysocina Region and the South Bohemian Region in determining descriptive diagnosis in prehospital emergency care.
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Managing transformation of asset management using bar codes at the Emergency Medical Service
Spurný, Martin ; Hradcová, Dana (advisor) ; Mathauser, Radek (referee)
1 ABSTRACT As the capital of Prague gradually expanded, both in population and area, Emergency Medical Service of Prague (EMSP) had to grow accordingly. Rescue Teams of EMSP are currently located in 18 stations throughout the territory of Prague. The high number of Rescue Teams groups poses a major challenge to technical - physical operation. One of the areas where the need for changes has been identified, is the asset management. The current system is inadequate and unable to respond flexibly to frequent changes in the asset register. Large number of emergency stations, which are located over a large area and include ambulance cars, triggered the need for rapid search and registration of fixed assets, so the whole process would be as efficient as possible and would not hinder the operation of Rescue Teams. Therefore the registration of property by means of barcodes was launched. During inspections and changes in records or registration of new assets, the operation in records is carried out quickly and efficiently using mobile terminals with a bar code reader, which is actually a small computer. The aim of this paper is to describe management of changes in property records using bar codes at the Medical Emergency Service of Prague. This change in the process of property registration will reduce the time,...
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Asthma mixtum in prehospital emergency care
ZEZULÁKOVÁ, Michaela Anastázie
The theme of my bachelor thesis is Asthma mixtum in prehospital emergency care. In the theoretical part there is described the anatomy and physiology of the heart as well as anatomy and physiology of the air passages, so it is helpful for better understanding the issues of Asthma mixtum. Further chapters are focused on the definition of Emergency Medical Services, on the outgoing sections and their composition as well as on the rescuer worker and his necessary education and skills. Following chapter describes the clinical feature and pathophysiology Cardiac asthma, its causes and diagnosis, first aid, treatment and complications of the disease in the prehospital emergency care. In the next chapter, it is described asthma, clinical scene and pathophysiology of this disease. It is followed by its diagnosis, symptoms, first aid, treatment and complications in the prehospital emergency care. The last chapter of the theoretical part is concentrated on the mixtum asthma, the clinical features, diagnosis and treatment in the prehospital emergency care. The practical part was conducted by using qualitative research. There were used structured direct interviews with rescuer workers and nurses working at the Emergency Medical Services of the South Region. The interviews consisted 17 questions, which were focused on knowledge from the field of asthma mixtum. The interviews are transcribed in the practical part and the answers are prepared for clarity in the chartes. It was showed in the survey that rescuer workers and nurses working at the Medical Rescue Service of the South Bohemian Region have theoretical knowledge from the field of asthma mixtum and that they know how to proceed with this disease at the point of action.
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Readiness acute inpatient care providers to receive the bulk admission of disabled people during an emergency
JOHÁNEK, Jakub
The theoretical part is focused on mass accidents involving persons with impairment. Within individual chapters I focused on providers of acute care, as well as on the providers of emergency medical services because those two institutes work closely together in the case of emergency event and contribute together on the solution of consequences. In chapter of basic terms I have mentioned the key terminology in accordance with actual legislation and I have outlined the importance of emergency preparedness in health care. Hereafter I have tried to give a brief overview of the approach of emergency medical services and solutions on site. The summary also included the possibility of sorting of people with impairment. Main topic is a discussion of the subsequent connection between emergency medical services and providers of acute care as well as the actual method of mass income of persons with impairment to a medical facility. The aim of the thesis was to plot preparedness the providers of acute care for a possible mass income of disabled persons, which included existence of preliminary measures, methods, preparation and realization of tactical (or auditing) exercise of organizations etc. The second aim of the thesis was focused on the evaluation of the current state of preparedness of acute inpatient care at mass income of disabled people, reflecting the effectiveness of the adopted precautions. This was mainly mapping clarity of the theoretical background in the cases of emergencies involving high amount of disabled persons from the perspective of an ordinary medical personnel performing their profession in the emergency department. Above-mentioned department serves as contact point of a hospital when an extraordinary event occurs, and its staff is naturally predetermined to act as first choice solution. The research also focused on the medical staff knowledge of approaches to dealing with emergencies and its participation in the auditing and tactical exercises. Qualitative research was used in order to achieve defined goals. Semi structured interviews with emergency department paramedics were used. The research showed that the preparation of providers of acute care for an extraordinary event with mass disabled persons is organized in cooperation with emergency medical services in terms of auditing or tactical exercises. At least two exercises per year are carried out, which is ideal in accordance with the general principles of participation of medical organizations in exercises of the Integrated Rescue System. The results refer to the fact that the participation of medical personnel in seminars should be mandatory and human resources management should take in mind in order to prevent non-uniform level of preparedness of medical staff in case of accident involving persons with impairment. The research also shows that knowledgebase - regarding those emergencies; of medical personnel is insufficient and therefore education at least theoretical level should be done. Acquired knowledge can be used for emergency department personnel but can also be used by other departments participating on emergencies that can involve persons with impairment. Employees could draw mainly from theoretical knowledge in the form of self-education.
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Readiness of the urgent reception to mass disasters
PETRŽELKA, Jan
Readiness of the urgent reception to mass disasters This thesis is dedicated to the readiness of the urgent reception to mass disasters. It deals with the history, evolution and the current state of the urgent reception, both in the Czech Republic in the first place and in the world. Within the scope of this thesis I focus mainly on the work scope of the urgent receptions in dependence to their structure, equipment and their actual preparedness to deal with mass accidents. I focus besides other things on technical equipment of the urgent receptions, which is in frames of the Czech Republic very heterogeneous, but totally crucial to handle possible mass accident. A very import aspect is the matter of education and further training of the medical employees on all levels. It concerns not only medical positions, but also nurses and auxiliary staff. The question of the conditions severity of the admitted patients, their classification according to these conditions and transparent processing of the information about them cannot be passed over. Furthermore the thesis discusses emergency medicine as a discipline and the direction it should, in my opinion, further be heading in order to improve the functioning of the present system of pre-hospital and hospital emergency care. Urgent receptions in the Czech Republic represent a relatively new thing, which results into certain ambivalence of their concept and structure. Each urgent reception is somehow original and adapted to the requirements of the founder and the local situation. There is one thing the urgent receptions have in common, overload with patients who fall into the competence of practitioners. This is associated with the financial loss-making of these departments within the medical facilities. This, especially in the case of the private hospitals, leads to a reluctance of the founder to invest to the urgent reception. In this thesis I mention legal framework, contingency planning in the Czech Republic, contingency plans, their content purpose and type plan with its importance for solving crisis events. Another plan that is resolved in my thesis and that has crucial importance especially, for urgent receptions is the trauma plan of medical facility whose application into practice in the Czech Republic in many health care facilities is very problematic. And the practice of the trauma plan activation itself is, according to my research, the prerogative of only a very small amount of medical facilities.
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The historical progress of the helicopter emergency service in the Czech Republic
KOTYZA, Michal
The bachelor thesis is focused on historical progress of Helicopter emergency service (HEMS) in Czech Republic. This work is focused especially on comparing of historical and actual progress of HEMS in Vysočina region, including comparing of the airplane technology and accessories extensity of helicopters used for HEMS in Vysočina. The first chapter is focused on leveraging of a helicopter marginally, as a device for saving life in the world, when they were used flatly in M.A.S.H (Mobile Army Surgical Hospital) units especially in the Korea war. It also contains progress of HEMS in Czechoslovakia and study of HEMS historical analysis at territory of the Czech Republic and progress of companies, which were spreading these services since 1987. I have included progress on the Czech Republic territory only in this work. In bachelor thesis are mentioned present national (Armáda CR, Policie CR) and private practitioners (DSA, a.s. and Alfa-Helicopter, spol. s.r.o.) as well, including main practitioners, which were operating here on the beginning (Slov-Air and Bel-Air) and thanks to them it was possible to lay the foundations of HEMS in prehospital emergency care system in the Czech Republic. The second chapter is focused on sequential progress of particular HEMS centres in the Czech Republic. In the face of mutual progress of HEMS at Czechoslovakia territory, is this part focused only on historical progress in the Czech Republic after year 1987. Hereby are only included HEMS centers at Praha (Kryštof 01), Brno (Kryštof 04), Ostrava (Kryštof 05), Hradec Králové (Kryštof 06), Plzeň (Kryštof 07), Olomouc (Kryštof 09), Jihlava (Kryštof 12), České Budějovice (Kryštof 13), Ústí nad Labem (Kryštof 15), Havlíčkův Brod (Kryštof 17) a Liberec (Kryštof 18). In the research part I have focused on examination of people's attitudes, which are interested in HEMS, ambulance services and more people, who are connected with prehospital emergency care system. For achieve results, I have decided to make a research by Brainwriting method, when I requested for completing a questionnaire, by aforementioned group of people, which contains questions focused on this topic. Questions are headed on problems of actual and historical progress of HEMS in the Czech Republic with the link on estimation of this problem on Vysočina. The chapter of discussion is focused on more detailed progress of HEMS in Vysočina region. There is marginally analysed HEMS in Havlíčkův Brod, which existed from the year 1991 to 1994. Considering minimal measure of taken information about it, this passage isn't written more detailed. In the next point I focused on HEMS in Jihlava, which has been working on Vysočina region from 1991. Considering sufficient measure of taken information and very accommodating attitudes of respondents and employees working at HEMS, I have analysed historical progress of this centre more detailed and in some parts, I have made comparing with actual status. I briefly focused on the history of the base, where I involved the most important milestones, which went along with their progress. One of the points, which I focused on, is background of the ambulance outpost where sequential upgrading of the base and its surroundings for employees are analysed. In the next points are foreshadowed differences of used helicopters and its history at HEMS centres, including accessories as a medical material or the other devices used in rescue operations as Toughbook for example. In the last point is foreshadowed structure of the crew in HEMS centre. The end of this work is focused on answers of asked research question, if the helicopter emergency service is necessary and useful branch of emergency service.
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Issue of the Emergency Medical Service help to homeless people.
JANČOVÁ, Monika
This bachelor thesis deal with homeless issue from the view of emergency service worker. The theoretical part deals with the pre-hospital emergency care, with the related ethic and homelessness, as extreme form of social exclusion. Furthermore, the theoretical work is describing the health status of homeless people and their relationship with medical personnel. Practical part of thesis is qualitative research which had been done by semistructured interview of the emergency workers. This research had lasted since december of 2014 untill march of 2015. Interviewee were question by snowball sampling method. There were ten people questioned altogether. The transcription of interview is quoted in practical part. These interview are summarise in different charts partly for better clarity. In suplement part there is a list of questions which interviewee received. The aim of research is explored intervention of emergency service to help to homeless people and in which areas emergency service workers see special treatment to them. From interview have emerged that the most often interventions to homeless people are alcohol intoxication and different kind of injuries. Research has also revealed that emergency service workers are not stressed when they help them but all of those people agree with statement that it is unpleasant especially due to low hygienic standarts. Is also very interesting that emergency service workers meet homeless people at least once a month. The main point of this bachelor thesis is demonstrate the homeless issue which is getting more serious in these days. It has not have solution only in providing social welfare to homeless people. It is necessary to create the complex solution of this phenomenon which would include also health care to these people.
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Paramedics opinions on their competencies
KLÍMA, Dominik
The bachelor's thesis name is: Opinions of paramedics about their competencies. The focus is therefore on problematics of competencies which paramedics at present have, and also their views on possible extension. In theoretical part of the thesis an integrated rescue system, the part of which the emergency medical service also is. The history, activities and also providers of emergency medical service are outlined. Further it deals with distribution and types of rescue groups, and technical and material equipment of vehicles. Finally, competencies are mentioned which at present a paramedic has, and also specialisations in urgent medicine, through which the competencies extend. In practical part of the thesis a qualitative method of research was used. Data collection was performed with help of semi-standardized interviews with eight paramedics, who work at Medical Rescue Service of Southern Bohemia Region. A part of the research maps knowledge of competencies in the field of paramedic and to find out opinions of their prospective extension. Also cooperation with doctor on each ambulance trip is discussed. The research file was subjected to the length of practise which the respondents went through within their occupation. The research question was directed at particular prospects which paramedics would welcome compared to the current state. The aim of the thesis was to determine what the opinion of paramedics on their current competencies within their occupation is. A partial aim then was which opinions they hold on extension of their competencies. It was revealed from the obtained and processed interviews that paramedics are mostly content with their current possibilities. An extension of competencies from their point of view would concern such parts at which the least risk of threat to patient, or incidental complications during treatment in prehospital urgent care are posed. Opinions on extension of competencies leaned mainly on bigger responsibility which in case of extensions supervened.
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Differential diagnosis of dyspnoea in the prehospital emergency care
JENÍČEK, Petr
The bachelor work is devoted to the topic of differential diagnostics of dyspnoea in prehospital emergency care. The issue of dyspnoea is still very relevant because of number of diseases causing it. The theoretical part of this bachelor work contains basic information about terms of dyspnoea, differential diagnostics and examination methods with regard to the dyspnoea. The most often incidence of dyspnoea is generally associated with cardiac and pulmonic diseases. There are also described additional diseases caused by other reasons, i.e. the carbon monoxide intoxication, anemia or hyperventilation, which are often occurred in prehospital emergency care and therefore could be difficult to distinguish from the pulmonic dyspnoea. In particular for paramedics, distinguishing the cardiac or pulmonic dyspnoea from the dyspnoea caused by other reason could be difficult. The examination methods in prehospital emergency care currently available for paramedics are very limited, which can make the fieldwork diagnostic of dyspnoea more difficult. The research was realized by the standardized half-structured interviews with the paramedics working at Emergency service of South Bohemian region. The surveyed group was composed of 14 respondents from all regional centers of Emergency service of South Bohemian region. Selected respondents were at all age categories varying in the length of the praxis at the emergency service, educational background and also in the composition of ambulance crew. The respondents answered 20 prepared questions regarding the knowledge and experience with dyspnoea. The research was aimed to the knowledge of paramedics in the field of differential diagnostics of dyspnoea in prehospital care and also to the difficulty of determination of working diagnosis based on examination methods available for paramedics in prehospital emergency care. Results of the research were summed up into the tables and consequent results are included in the discussion. The first goal of the research was to monitor the knowledge of paramedical staff about differential diagnostics of dyspnoea in prehospital emergency care. The second goal is aimed to monitoring the difficulty of working diagnosis assessment of dyspnoea associated with possibilities of diagnostics in prehospital emergency care. Two experimental questions were elected for research. The first question is dealing with the enough knowledge of paramedics for correct differential diagnosis of dyspnoea in patients in prehospital emergency care. The second experimental question is addressed to the dyspnoea, diagnostics possibility in prehospital emergency care for paramedics and whether it is complicated symptom for working diagnosis assessment. Based on interviews results, the insufficient knowledge of paramedics in most cases of dyspnoea are evident. Paramedics with university degree are more educated in this field. The big lack of knowledge related to dyspnoea lies also in the education of paramedics in the Emergency service of South Bohemian region. Respondents also mentioned the absence of primarily focused course on dyspnoea. The theme is obviously discussed during the course of Emergency service of South Bohemian region only in connection with another theme. Therefore, the big lack of necessary information is obvious. Regarding the insufficient education of paramedics the problem of wrong dyspnoea diagnostics in prehospital emergency care could be closely related. Commonly, paramedics treat cardiac and pulmonic dyspnoea. However, research results emphasize the problems with working diagnosis assessment, necessary for subsequent treatment and targeting the patient. Concerning the gravity of some diseases causing dyspnoea, the incorrect diagnostics could be fatal for patient.
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Analysis EKG by paramedic in pre-hospital care
KOLLNEROVÁ, Kateřina
This Bachelor thesis deals with the issue of monitoring and evaluation of electrocardiography (ECG). The monitoring of ECG belongs to the basic diagnostic methods of heartbeat. It is also irreplaceble in prehospital emergency care (PEC). That is why a paramedic must be sure in manipulation with the ECG machine and he or she must faultlessly distinguish typical deviations in ECG curve, especially in case of life-threatening and frequent arrhythmia because a proper treatment in PEC usually has a decisive influence on a patient´s life. In the theoretical part of the thesis I dealt with basic knowledge about the anatomy and physiology of heart. Then I focused on electrocardigraphy as a basic diagnostic method, I mentioned various types of ECG and described ECG machine used in PEC. I also delineated electrodes and downspouts and their classification. I added a procedure of monitoring ECG by means of defibrillation electrodes and by means of downspouts. In the next chapter I dealt with physiological ECG curve, its description and assessment of cardiac rhythm. A considerable part of the theoretical part is devoted to heart rhythm disorders and classification of these disorders. In the last charter I mapped options of heart rhythm disorders treatment pharmacological as well as therapy without drug application. The research part of the thesis is based on qualitative and quantitative form of research. Data were gained by method of interview and by additional knowledge test designated for paramedics from the South Moravian Region. The interviews were carried out with paramedics from the Emergency Medical Service of the South Moravian Region. The additional test consists of 16 open as well as closed questions. Results of the research were processed and depicted by means of bar charts. These express numerical value of the research results. The main aim of the thesis was an analysis of paramedics´ procedure when evaluating ECG curve. The minor aim of the thesis was to map a paramedic´s knowedge in te field of ECG curve evaluation. The theoretical part of the thesis can be used as a study material for paramedic students and also for students of other medically-oriented branches who study the issue of ECG. On the basis of the thesis results a manual was made out which could simplify the evaluation of ECG curves.
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