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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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Dying and death from the perspective of emergency medical personnel
MALČICOVÁ, Jana
This bachelor thesis deals with the perception of dying and death by emergency medical personnel. The theoretical part includes not only issues of dying and death, but also the ethics of pre-hospital emergency care. The activities of emergency medical services and some methods of psychological intervention are also described here in detail. The theoretical part is amended by a chapter about stress and the related post-traumatic stress disorder and burnout. The practical part of this thesis is a qualitative research carried out by semi-structured interview with 8 emergency medical workers. The respondents were selected from the South Bohemian, the Central Bohemian and the South Moravian Region; one respondent is employed by emergency medical services abroad (Austria). The research objective was to determine how the medical personnel of emergency services copes with critical situations such as dying and death of a patient, to what extent they are influenced by their profession and to determine the level of readiness of future emergency medical personnel for this occupation. The purpose of this bachelor thesis was to point out the need for psychological intervention for emergency medical services personnel, which is still insufficient in the Czech Republic.
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Crush syndrom in prehospital care
JENDŘEJASOVÁ, Tereza
The issue of the Crush syndrome in pre-hospital care is not a topic into which new findings are often brought by science workers. All the currently known and available knowledge about the Crush syndrome has not changed for decades. In part this is caused by the difficulty in pre-hospital emergency care to determine whether the condition signifies the Crush syndrome or also a hypovolemic shock resulting in kidney damage. In the Czech Republic there are neither big earthquakes, fortunately nor major landslides, and yet from time to time such an event occurs. That is why today it is more and more desirable that paramedics should be theoretically well prepared for such interventions. The purpose of this study was to survey and compare theoretical knowledge of paramedics working at the Emergency Medical Service of the South Bohemian and the Central Bohemian regions, including the ability to utilize this knowledge in practice. In the study quantitative and qualitative research was used. The quantitative part of the research mapped, using anonymous structured questionnaires, the theoretical knowledge of paramedics working at the Emergency Medical Service of the South Bohemian and the Central Bohemian regions in terms of the Crush syndrome issue. The results of the quantitative research have proved very good knowledge of the Crush syndrome issue in both regions and thus the hypothesis has been verified. The qualitative part of the research identified, through structured interviews with three respondents from the Central Bohemian region and three respondents from the South Bohemian region, the practical connection of theoretical knowledge directly in the field in a client with developing Crush syndrome. The knowledge was assessed as sufficient to provide quality pre-hospital emergency care. The results of this study have shown that paramedics in the South Bohemian as well as the Central Bohemian regions are well familiar with the theory for providing high-quality pre-hospital care for clients with developing Crush syndrome.
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The Approach of Medical Rescue Service to Treatment of Clients from Different Cultures
TREŠLOVÁ, Zuzana
At the present time a varied ethnic population lives in the Czech Republic and foreigners are found in all medical institutions, from general practitioners to hospitals. This bachelor thesis briefly resumes the theory of multicultural nursing and the special characteristics of treating selected groups of foreigners. The aim of the thesis is both to map out the frequency of departures of the Medical Rescue Service of South Bohemia to patients/clients from different cultures, and to find out how the paramedics from the Medical Rescue Service of South Bohemia approach these patients/clients. The theoretical part contains characterization of rescue service, describes the profession of the paramedic and their competence. In the following part the thesis deals with multicultural health care. At first multicultural health care is described and the terms connected with this subject are explained. Then multicultural communication and its forms are discussed, the special characteristics of health care for foreign patients (in this particular case Romany, Vietnamese and Ukrainian inhabitants) are analysed. Finally the system of health care for foreign patients and the state of health of migrants in the Czech Republic are briefly mentioned. Part two, which is practical, is devoted to research, which used the quantitative method in the form of questionnaires. The findings suggest that the paramedics from the Medical Rescue Service of South Bohemia are well informed about the basic differences in distinct cultures, which means that the first hypothesis was confirmed. According to research paramedics are able to communicate adequately in English or German but at the same time they say that the language barrier is a frequent problem when treating a foreign client. However, this claim never exceded fifty per cent of the results, therefore I can neither confirm nor refute this hypothesis. Paramedics working for the medical rescue service do not need to know multicultural health care in depth. It is important to know at least one world language and, if possible, to have a car equipped with communication cards.
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The possibility of pain management in prehospital emergency care
GUIDA, Mario
I chose the topic Possibilities of pain management in pre-hospital emergency care for my bachelor thesis as pain belongs to the most frequent symptoms of patients in the care of the Emergency Medical Service. The goal was to map the possibilities of pain management in pre-hospital emergency care in South Bohemian Region. The second goal was to map the awareness of pain management in pre-hospital emergency care among South Bohemian medical rescuers. The theoretical part deals with the present situation of the Emergency Medical Service, education and competences of rescuers. In the next part I focused on various types of pain, assessment and subsequent treatment of pain. The last, theoretical part describes the caring process in pre-hospital emergency care for a patient in pain. The research was performed by means of quantitative method in the form of a questionnaire with semi open and closed questions. The questionnaires were distributed at Emergency Medical Service regional centres of South Bohemia. The results show that pain is sufficiently managed in pre-hospital care. Another fact was confirmed, that rescuers are familiar with the pain management possibilities and prefer pharmacological methods of pain management. We also found out that non pharmacological interventions were used less frequently than they could be. One of the hypotheses was refuted, two were confirmed. The quantitative research results show that there is still a relatively large reserve in using non pharmacological methods. Rescuers might use them more, particularly the quick emergency crews, or they might be applied in situations not requiring immediate pharmacological treatment. Educational seminars at the individual workplaces might improve the awareness of non pharmacological intervention techniques. A patient in pre hospital emergency care suffering from pain of various intensity should be given primary professional care from qualified rescuers.
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The Problem of Distal Cannulation by Medical Rescuer in Pre-Hospitalization Care
BRATRÁNEK, Pavel
At present, an absolute necessity for health workers is knowledge of the way how to access the bloodstream both in an area of the pre-hospital care and in an area of the health care. The bloodstream is an ideal choice in cases when times plays a major role in the onset of a drug. In my bachelor thesis I focused on issues regarding an assurance of the peripheral bloodstream by a medical rescue worker in the pre-hospital emergency care. I concentrated on the assurance of an intravenous access and at present more and more discussed intraosseous entry. Nowadays, when a lot of medical rescue workers yearn for raising their competences, it is necessary to think if they really know and apply these basic skills while assuring the peripheral bloodstream. An aim of the thesis was to determine if medical rescue workers have an appropriate theoretic preparation and if they know principles of the assurance of the peripheral bloodstream, if they follow these procedures in practice and if there are any differences in the issues of the assurance of the peripheral bloodstream at chosen regional centres of Medical Rescue Service of the South Bohemian Region given by a different driving distance to a hospital facility. A quantitative research was selected as a method applied. An anonymous questionnaire was used as a technique of the data collection. It was distributed to medical rescue workers operating at Medical Rescue Service of the South Bohemian Region. The results of the research showed that medical rescue workers did not have very deep knowledge in case of the intravenous entry but on the contrary they had good knowledge of the intraosseous access. It was also proved that medical rescue workers did not follow prescribed procedures during the intravenous cannulation and not all of them used safety devices. Another result of the research is a fact that medical rescue workers have theoretic knowledge of the intraosseous cannulation but they do not have enough practical experience with it. The last of the most important results of the research was the finding that medical rescue workers in České Budějovice cannulate with a lower frequency than medical rescue workers from other regional centres where there are not so noticeable differences. On the grounds of the data obtained I think that the results of the research included in the bachelor thesis could be used to deepen theoretical knowledge of medical rescue workers in the area of cannulation issues of the peripheral bloodstream.
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Children´s drowning from the perspective of pre-hospital emergency care
SEDLÁČEK, David
Drowning, especially in children, is a relatively frequent cause of death. Statistics speak clearly. Children´s drowning is the second most frequent cause of death of children in industrialized countries. Good knowledge of the issue of drowning in children, therefore, seems to be the best way how to at least partially minimize the unfavorable statistics. But it is necessary to be aware of the child drowning specificity due to the child age. And the nursing care specifics are the subject of the thesis. The main objective was to survey the knowledge of prevention and first aid for children in the context or drowning and near-drowning on the part of adult and child public and also in the Emergency Medical Rescue Service workers. The quantitative research method through anonymous questionnaires was chosen. The research sample representing the general public was composed of staff members and pupils and students of several primary and secondary schools in České Budějovice. The research was conducted with the Emergency Medical Rescue Service workers in the regional centers of the Emergency Medical Rescue Service of the South Bohemia region. The questionnaire addressed to the general public contained a set of 25 questions, the questionnaire for the Emergency Medical Rescue Service workers comprised a set of 20 questions. The research has confirmed that the general public knows the first aid basics, but does not have enough knowledge about prevention and first aid for child drowning and near-drowning. The outcomes have mainly proved unfamiliarity with principles of resuscitation for children. The research has also shown that in children in general the knowledge of prevention and first-aid provision for near-drowning or drowning only minimally depends on their age. According to the research results the Emergency Medical Rescue Service workers have adequate knowledge about prevention and first aid for drowning or near-drowning children. The obtained results suggest the need to increase training and education in issues relating to the near-drowning of children in the general public of all ages. In a limited range it would be useful to organize training on issues related to pre-hospital emergency care also for the Emergency Medical Rescue Service workers. The need of the knowledge of prevention and first aid for drowning or near-drowning is confirmed by the fact that even among the public, with which the research was conducted, several persons who had already met this problem were found.
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Possibilities of artificial pulmonary ventilation in urgent care and anesteziological resuscitation department
BINTEROVÁ, Jana
The aim was to explore the possibilities of mechanical ventilation in prehospital emergency care and Anesthesiology and Intensive Care qualitative research method. The first part of the research was focused on finding out how the use, including the most frequently used modes of ventilation, and frequency of artificial ventilation. Research has found that in pre-hospital care are used methods of invasive and noninvasive ventilation and ventilatory modes most widely used in prehospital care are IPPV, CPAP and SIMV. In the second part of the research focuses on the possibility of mechanical ventilation on Anesthesiology-Intensive Care and neužívanějších detection schemes. They are IPPV, BIPAP, SIMV, APRV, PS and CPAP. The last part of the research deals mainly comparing the possibilities of mechanical ventilation at the base emergency medical services of the Liberec Region and South Region. I ran into very different views on the importance of mechanical ventilation in prehospital emergency care, but the result is the possibility of artificial ventilation in different regions does not differ much.
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The urgent care of the clients suffering from the acute heart stroke provided by the medical rescue service
KALÁŠKOVÁ, Dana
The pre-hospital emergency care for clients with acute myocardial infarction within the medical rescue service The pre-hospital emergency care for clients with acute myocardial infarction within the medical rescue service is the topic that I selected intentionally. On one side, I was guided by my own still fresh experience with my father and on the other side I was guided evenby the fact that interventions of the rescue service at patients with chest pains are still the most frequent indications. This is a really up-to-date subject due to contemporary life style and style of living of most of our inhabitants. The term acute coronary syndrome means all the statuses patho-physiologically connected with an instable plate and related thrombosis in the coronary artery. The main symptoms include chest pains or their equivalent in resting state. The bachelor thesis was processed on the basis of quantity method, using the technique of questionnaires. The research set included employees of the Medical Rescue Service of the South Bohemian Region. The first aim of the work was to make a chart of their opinions regarding use of automatic external defibrillators (AED). The results of the research investigation indicated that the employees of the Medical Rescue Service of the South Bohemian Region are well aware of recommended procedures in pre-hospital care for clients with acute myocardial infarction, which successfully confirmed the first hypothesis. Unfortunately, even the second hypothesis was successfully verified,as the automatic external defibrillators still do not belong to natural part of public locations equipment and that is why their use in practice is minimal. Based on results of this work that will be published in a specialised magazine rescue and Urgent Medicine, I would like to appeal to managing employees of medical rescue services to strengthen promotion of automatic external defibrillators and also to the Ministry of Health to more quickly extend the current stage of AED within legal rules of the Czech Republic, which do not still deal with attitude towards defibrillation, which does not solve the difference between manual and automatic defibrillation.
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Frequency and causes of injuries of children in pre-hospital emergency care
MINAŘÍKOVÁ, Petra
Injuries represent the greatest danger for children and the most frequent cause of their death. A certain dangerous situation precedes every injury and as such it can always be prevented. Emergency rescue teams provide professional urgent pre-hospital care. Based on theoretical knowledge and practical experience of a member of a rescue team providing pre-hospital urgent care, two research objectives were determined. Objective no. 1 was to map out the number of children{\crq}s injuries in the regional centre of České Budějovice between 2004-2008. Objective no. 2 was to analyze the situations in which children of various ages get injured. Three hypotheses were determined. Hypothesis no. 1 ``Children living in towns get injured more frequently than children in villages``, was not confirmed. Hypothesis no. 2 ``Children up to 6 years of age most frequently suffer injuries when they are at home and their parents are not cautious enough``, was confirmed. The last determined hypothesis ``Children between 6 {--} 18 years of age get injured during active sports and traffic accidents most frequently``, was confirmed. It is more efficient to invest in preventative activities that reduce the number and seriousness of injuries in children. If we take measures to prevent injuries, the number of fatalities will go down.
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