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Acute intoxication in prehospital emergency care
KUTLÁK, Ondřej
This bachelor thesis on Acute Intoxication in Pre-hospital Emergency Care is divided into twoparts: theoretical and research. The theoretical part is initially focused on the causes of acute intoxications and effects on the human organism. Most of the space is devoted to selected types of intoxication and their therapy. For the research part, Objective 1 has been set: To map the level of the theoretical knowledge of medical rescuers in connection with the providing of pre-hospital emergency care in the case of intoxicated persons. Two research questions were identified on the basis of this objective. The research question 1 is: How do the health rescuers in the care of the intoxicated patient progress from the point of view of differential diagnosis? Research Question 2: How do medical rescuers approach the treatment of the intoxicated patient from the point of view of therapy? The qualitative research method was used in the form of semi-structured interviews with 8 medical rescuers performing their profession at the Medical Rescue Service in Písek and Český Krumlov. The data obtained was divided into 12 categories. The summary of the research showed a sufficient knowledge of the clinical manifestations of selected acute intoxications presented in the practical part of this work. The other group studied was the therapy of selected acute intoxications presented in the practical part of this work. The research has shown that the knowledge of acute intoxication therapy is average. Since the appropriate knowledge of medical rescuers is necessary to manage this profession, I consider it important to examine them periodically.
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The qualifications of paramedics in the emregency medical service
HAVEL, David
The topic of this bachelor thesis is The Qualifications of Paramedics in the Emergency Medical Service. The theoretical part of the thesis describes the characteristics of the emergency medical services, with the focus on paramedics, the urgency levels of emergency calls and the integrated emergency system as a whole. Furthermore, this part explores the issue concerning the legislation of paramedics; primarily, the acquisition of required professional competences in comparison with the Slovak Republic. Lastly, the thesis summarizes the qualifications of paramedics, as well as of the paramedics who have already reached the level of professional expertise needed for the practice of emergency medicine. In the practical part of the thesis, two goals were selected. The first goal was to map the knowledge of qualifications of paramedics working for the South Bohemian emergency medical services (Zdravotnické záchranné služby Jihočeského kraje). The second goal then was to examine to which extent those qualifications were being followed. The qualitative method of data collection was used for the execution of this research. It was carried out in form of half-structured interviews that comprised of 20 questions. The sampled group consisted of 8 paramedics from the South Bohemian emergency medical services (Zdravotnické záchranné služby Jihočeského kraje). The outcome of this bachelor thesis is the overview of the knowledge of qualifications of paramedics working for the South Bohemian emergency medical services. It points out their minor lacks in education and awareness. The thesis could potentially be used as a source for the teaching of paramedics.
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An Algorithm of the Pre-hospital and the Acute Hospital Care when Treating Electrical Injuries
BUCHTELE, David
We come into contact with the electric current on daily basis. Not following the safety instructions or some unexpected situation can result in injuries that can even endanger one´s life. These situations arise primarily due to the lack of awareness of the risks of the electric current. In such conditions, it is important to provide high-quality pre-hospital emergency care followed by an acute hospital care. The effects of electrical current depend on a number of factors which are mentioned in this bachelor thesis. These include primarily the strength and type of the current or resistance, the frequency, the impact track and the duration of its action. The injuries include mostly burns of various degrees. These are caused mainly by a high voltage. Another manifestation may be heart rhythm disorders (the monitoring should not be underestimated during the acute care). In addition, they can cause brain damage - which is manifested by the loss of consciousness, - renal failure, and secondary damage as a consequence of the fall. However, we cannot forget the positive effects of the electric current, which are an essential part of the modern medicine. The topic of the electric injury protection deals with the safety measures focusing primarily on the job and household injury prevention. Part of the bachelor thesis is dedicated to the lightning strike - a strong, natural discharge - injuries, which can cause a number of complications: burns, cardiac disorders, eyesight and hearing damage. Sudden death may also occur. The main topic of this thesis is the pre-hospital emergency care and the acute hospital care. When treating such a severe trauma, it is necessary to intervene immediately and adequately. The seriousness of the health-consequences depends on the quality of the pre-hospital emergency care and the follow-up acute hospital care. The aim of this bachelor thesis was to provide a brief overview of electrical injuries based on a sufficient amount of current information and to compile a brief algorithm of pre-hospital emergency care and the acute intensive care. The algorithm describes a simplified procedure for dealing with these serious injuries. Relevant Czech and foreign sources available were used in this bachelor's thesis with the title An Algorithm of the Pre-hospital and Acute Hospital Care when Treating Electrical Injuries. In order to obtain a sufficient amount of information, a number of foreign and Czech professional journals, case reports and foreign professional internet articles written by registered professionals had to be read. The intended goal would be fulfilled when a healthcare specialist or a normal person encounters an electric injury and successfully deals with the situation based on the knowledge gained from this bachelor thesis.
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Pulmonary embolism in the practice of paramedic
KAHOUNOVÁ, Šárka
The bachelor thesis discusses the issue of states of dyspnoea, specifically pulmonary embolism from the perspective of a paramedic working in the area of pre-hospital emergency care. In the theoretical part, a brief characteristic of pre-hospital emergency care is given, the paramedic branch is briefly defined and further on, the basic anatomy and the physiology of the circulatory and respiratory systems is given. Dyspnoea is defined from a general perspective, its causes, diagnosis and risk factors are mentioned. Diagnostically and therapeutically, the thesis is focused on specific characteristics of dyspnoea within pulmonary embolism, including the main causes of their origin. The research part of the thesis was implemented based on semi-structured, anonymously processed interviews. The research file was made of randomly chosen paramedics of the Ambulance in South Bohemia and Central Bohemia. The analysis of the obtained data was focused on the awareness of the paramedics themselves concerning the given issue of dyspnoea, including the presentation of their perspective on the implementation of professional preparation in the dyspnoea issue from their employer´s side. Further on, the procedures of differential diagnosis and pulmonary embolism treatment in pre-hospital emergency care were evaluated. The implemented research has found out that the paramedics from South Bohemia are not sufficiently educated in the issue of dyspnoea, including pulmonary embolism. The paramedics from Central Bohemia are, compared to that, educated by the relevant educational and training centre, educated enough concerning states of dyspnoea. Based on the findings, the thesis results might be presented to the educational and training centre of the South-Bohemian and Central-Bohemian Ambulances to perhaps consider the future aiming of educational and training programmes concerning dyspnoea issues, including the specific aiming at the awareness about pulmonary embolism diagnosis and therapy.
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Forms of provision of pre-hospital emergency care applied to the foreign missions by the Army of the Czech Republic
SMUTNÁ, Jana
The thesis deals with the forms of provision of pre-hospital emergency care (PEC) by paramedics of the Army of the Czech Republic (ACR) and this means above all those forms of PEC which are provided by Combat Medic and Combat Lifesaver (a Combat Lifesaver trained soldier). With regard to the terminology and conception of the thesis comprising the areas of providing PEC, the thesis deals with the levels 1 3 outfeed chain, consequently with the care of the patient to the relevant Role 1 including. The aim of the thesis was to show the basic differences in providing PEC by the Army of the Czech Republic in comparison with the system of emergency medical services of the Czech Republic and then to find out what the specific qualifications for a paramedic´s profession are. I tried to demonstrate this knowledge both by the practical part of the thesis and by its theoretical part.The theoretical part deals with the problems of reaching the paramedic post of the ACR either the Combat Medic or Combat Lifesaver, by required education and necessary courses. Then the thesis deals with providing PEC in the battlefield, up to Role 1, when the wounded person is given the first aid by paramedics. The practical part meant the qualitative research in the form of semi-structured interview and research questions. There I managed to achieve particular aims of the thesis thanks to the interviews with the respondents of the medical personnel of the ACR and the respondents of emergency medical services. All the inverviewed medical personnel of the ACR had to participate in at least one foreign mission. Among the respondents were both the CLS trained soldiers, Combat Medics, and even one medical corps doctor. The thesis is a contribution to the paramedics of the ACR and paramedics in general who could learn more about the problems of providing PEC in extreme circumstances or possibly consolidate the knowledge they have. The research showed that the basic differences in providing PEC between the interviewed groups (it means the military paramedics and paramedics) are above all external factors, the terrain, and material or even the kind of wound or the hierarchy of the medical personnel of the foreign mission. The research also outlines the specifics necessary for exercising an ACR paramedic´s profession, and those are the courses they take before a foreign mission.
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Providing Special Care for Motorcycle Trauma in Prehospital Emergency Care
HAVLŮ, Monika
This thesis deals with providing special care for motorcycle trauma in pre-hospital emergency care. The work has set three goals. The first goal is to map the processes of providing specialized care for trauma bikers both by paramedics and general nurses. The second goal is to map paramedics and nurses' knowledge about the nature of trauma in view of urgent transport to a higher catchment area. The third objective is to map the specifics of bikers from the perspective of paramedics and nurses. To those objectives were to answer three research questions. The research part of the thesis was carried out by a qualitative research. A combination of semi-standardized interview, which consisted of 13 questions, was used for a data collection. There was used the knowledge test, too, which consisted of 21 questions. Semi-structured interviews and knowledge tests were conducted with randomly selected paramedics and nurses working in Emergency Medical Services in Vysocina Region and South- Bohemia Region. The results of the knowledge tests were arranged into tables. Semi-structured interviews were transcribed and processed into tables. There is the list of semi-standardized interview questions and a knowledge test in the attachment. The research showed that knowledge of paramedics and nurses working in Emergency Medical Services in Vysocina region are more optimal than in the South Bohemia Region. However, the differences are minimal. Only one question, number 9, which is related to the knowledge of neurogenic shock, showed insufficient knowledge, when only 8 out of 40 respondents answered correctly. Other mapped knowledge is good, in some areas is excellent. In conclusion I would like to say that despite excellent knowledge of paramedics and nurses working in emergency medical services there is still some space left for further training, especially in specific injuries and complications of injuries, which may occur at motorcyclists. I think it is important to be knowledgeable and educated in this issue because a good training practice of pre-hospital emergency care is crucial for the further development of the patient's condition. This issue could be supported by this thesis, which tries to be a comprehensive overview of the problem of motorcyclists and procedures providing special care for motorcycle trauma in pre-hospital emergency care.
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The importance and methods of measuring hematocrit and hemoglobin in pre-hospital emergency care
PEŠL, Stanislav
This bachelor thesis is called: "The importance and methods of measuring hematocrit and hemoglobin in pre-hospital emergency care". There has been recent progress in technologies which allows to measure various laboratory values by small portable systems. These values can be Hb and Ht, measuring of these values is not standard in pre-hospital medical care in Czech Republic. It is the reason why this thesis deals with possibility of its implementation. The theoretical part deals with composition and physiology of hemoglobin and associated diseases such as anemia and polyglobulia. It also contains the issue of diagnostics, guidelines of physical examination procedures as well as description of what should be focus on when one is gathering case history. There are also provided facts and information about portable measuring systems, their measuring methods and overview of systems which are available in Czech Republic. There was conducted a qualitative research and was presented in practical part of this bachelor thesis. Collection of data was based on technique of standardized anonymous questionnaire which included only structured answers. The paramedics of Emergency medical services of South Bohemia region were the respondents. The research took place in March 2014 and 54 respondents anticipated in it. There were stated two aims in this bachelor thesis. The heart of first aim was to find out whether the paramedics are able to use values of hematocrit and hemoglobin to diagnose a patient. The second aim was to map paramedics' attitude to measuring values of hematocrit and hemoglobin within emergency medical service. There were also stated hypothesis which expressed the expectations that paramedic are able to use values of hematocrit and hemoglobin and they are interested in and enthusiastic about measuring hematocrit and hemoglobin within pre-hospital emergency care. From data, which were collected and analyzed in the practical part, it is obvious, that paramedics do have satisfactory amount of skills and knowledge which are absolutely necessary for diagnosing a patient by using values of hemoglobin and hematocrit. Contrary to the fact that paramedics have certain knowledge about benefits which would measuring values of hemoglobin and hematocrit brought they do not believe that portable measuring systems would be efficient in pre-hospital emergency care and they are not interested in using them.
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Patient's status and rights during emergency medical services
ZRŮSTOVÁ, Simona
It is necessary to consider each patient to be a unique entity and respect his or her rights. This position requires an individual approach of paramedics. They should give the client a sense of security, certainty of assistance and take into account the fact that the patient is exposed to stress, which can change his behaviour. The paramedic must cope with these facts, he cannot be influenced, he must know how to prevent conflicts and behave according to the rules of medical ethics. The aims of this thesis was to map out the level of knowledge of patients in the area of their rights, and to find out their views on the attitude and behaviour of the paramedics during an intervention of a medical rescue service. The third part of this bachelor thesis deals with the knowledge of paramedics in the area of the patients' rights and their observance of these rights. Three research questions were set up. Whether the legal awareness among patients regarding the intervention of medical rescue services is sufficient and how patients evaluate the attitude and behaviour of paramedics during the intervention. A research question was also set up for the third aim of this thesis: what is the point of view of paramedics on respecting the patients' rights during pre-hospital emergency care. In the theoretical part I focused on explaining of the basic concepts of the medical ethics issues, its history and development. The most important part of the thesis is the ethic of emergency medicine and the issues of the rights of patients during prehospital emergency care. The thesis also discusses the ethical dilemmas that paramedics deals with during their responses and an equally important area is focused on different patients' rights, including legal standards that modify them. The research part consists of interviews with two groups of respondents: eight paramedics of the Ambulance Service of Pardubice Region and eight patients who used their services. The research showed that the legal awareness of patients is inadequate. At first glance, all patients were satisfied with the intervention of the medical rescue service and had no objections. After targeted questions targeted on the compliance of individual patient's rights, I concluded that in some cases the right to privacy and dignity of the patient was not respected. The patients were not sufficiently informed about their health and procedures that paramedics performed. None of the interviewed paramedics complied the patient's right to know the name of the medical staff member who treated him. The paramedics themselves commented on the issue of the rights of patients during the pre-hospital emergency care in the sense that they try to comply these rights, but they had problems with is not always possible. They are aware of the ethical code of the rights of patients, but they had problems with telling its content. The most frequent reason for non-compliance of the rights of patients was reported in connection with responses to people under the influence of alcohol, drugs or to patients with disorders of consciousness. The surprising result of the research was the finding that half of the responding paramedics have used violence against a patient during their practice. Among the groups of patients, to whom the responding paramedics do not like to drive, are mostly Romani people, homeless people and repeatedly calling patients. This bachelor thesis will contribute to a better awareness of paramedics and the general public about the respecting the rights of patients. Paramedics can use the observations of patients and by that remove the deficiencies they have been committing during their responses.
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Premedical care for patients with methanol intoxication
KŘENEK, Jan
Intoxication through methanol is a relatively less frequent type of poisoning, which can lead even to a serious damage to the human body; can cause loss of vision as well as permanent infliction of the central nervous system. And also the death of the afflicted person is possible with late treated conditions. The methanol metabolites are quilted for the damage of the human body - mainly formic acid that is why the therapy of this health and life-threatening condition is mostly focused on the metabolism of methanol. The theoretical part deals with pre-medical that is pre-hospital emergency care of patients with a methanol intoxication. The first chapter deals with the pre-hospital emergency care, a medical rescuer and his competencies, and the ambulance crew is listed here as well. Furthermore, the theoretical part of the thesis deals with the acid-base balance, metabolic acidosis, but also involves the Toxicological Information Centre. The next chapter explore methanol and its characteristics and the history of methanol in the course of the human civilisation. It explains the metabolism of methanol and highlights the symptoms of acute and chronic methanol intoxications. The last chapter is directly focused on first aid in this state provided by a layman; and on the treat methanol intoxication in terms of pre-hospital emergency. Last but not least, it is also concerned with the effects of the methanol intoxication. The practical part of the thesis is focused on mapping the activities of a paramedic in a pre-medical care of a patient with a methanol intoxication and on determination the level of awareness of laity as well as the clients of the sobering-up station for this type of poisoning. As well as a laity with help of anonymous questionnaires. The research survey was conducted through the quantitative method among the paramedics. The amount of the data was collected during the March 2015. The research group were the randomly choired laymen and clients of the sobering-up station and the paramedics working in the Emergency Medical Services of South Bohemia Region at the regional centres of Strakonice, Písek, Prachatice, Český Krumlov and Jindřichův Hradec. The anonymous questionnaire was distributed to the above stated regional centres in the number of 100 pieces, for the laity in the same number and 10 pieces for the sobering-up station in České Budějovice. The questionnaire for the paramedics contained a total of 18 questions. The first four questions were the ones of stratification, the questions no 5 to 18 were closed and directly addressed the issues concerning the provision of pre-hospital emergency care in methanol intoxication, whereas the hypothesis no. 1 was confirmed. The questionnaire for the laity in itself contained a total of 14 questions. The first three questions were of socio demographic character. The fourth question was closed and crucial to the continued questionnaire. The question no. 5 was semi-open and remaining questions no. 6 to 14 related to determine the level of awareness among the laity methanol intoxication. The results are processed into clear graphs and the related hypothesis no. 2 was also confirmed. The first goal was to map the activity of a paramedic in a pre-medical care of a patient with a methanol intoxication. The second objective was to determine the level of awareness of the laity of this intoxication. Both the objectives have been met. The statistical method of processing a research survey showed that paramedics are knowledgeable in the procedures of pre-medical care for patients with a methanol intoxication and that lay people are informed of this intoxication, but would welcome more active involvement of experts in informing society about this issue. Based on the results of the work an information leaflet was produced for the lay and paramedics in the field of alcohol intoxication.
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Management of difficult intubation in the prehospital emergency care
SKLENKOVÁ, Hana
The thesis deals with the management of difficult intubation in pre-hospital emergency care. In the context of a difficult intubation it tries to solve the issue of difficult airways management when dealing in such arduous situations. Within the interim legislation a paramedic is not qualified to perform the actual endotracheal intubation, by ordinance No. 55/2011 statue book which determines activities of medical staff and other professionals. Except in extreme emergency situations. (29) Despite of this, he is expected to know all the procedures and master these functions mainly in emergency situations when he must assist a doctor. The aim of this work was to set out the possibilities of solving difficult intubation in pre-hospital emergency care with a focus on competence of a paramedic. But during the research process I reached the view that, taking into consideration the interim legislation and the attitude of paramedics to this issue, it will be more suitable to map out the experience and knowledge of paramedics related to the management of a difficult intubation and airways management. In the theoretical part I tried to approach the issue of difficult intubation and with that, of course, airways management. The part of the procedure of solving difficult intubation, which it is not in the competence of paramedic, is also the use of alternative tools that every paramedic should manage. The research was carried using a qualitative method in the form of a structured interview. The interview was conducted with paramedics who were randomly selected in various regional centers of the Emergency Medical Services in South Region. The research group consisted of thirteen respondents of different gender, age and length of service. Respondents were asked 11 questions, which surveyed the attitudes of paramedics to the issue of difficult airways management. The questions concerned the experience of these states, their options and also verified general knowledge of whether paramedics are theoretically prepared to tackle difficult intubation and difficult airways management in pre-hospital emergency care. When processing data from the research I concluded that the approach to the issue of paramedics' difficult airways management is not as responsible as it should. Although paramedics met with difficulty in ensuring the airway, it was usually the doctors who solved these states. In the majority opinion, the paramedics agreed that for the time being using the laryngeal mask is sufficient or, if need be, they call the doctor. But if the doctor was not available, it is not certain whether they would be able to handle the situation themselves, because their theoretical knowledge is not always sufficient. As a positive outcome of my research was finding that most of the paramedics did not object to further practical and theoretical training in this direction and that there are some individuals who are privately educated in this area.The thesis can be beneficial for students in the paramedic field and also specialized healthcare professionals to bring together information on airway management. Part of the thesis is also a DVD-ROM complete with video attachments.
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