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The influence of the proper triage choice on the early identification of life-threating conditions in tactical environment
DUCHOŇ, Jaroslav
The tactical environment is very unfriendly for trauma patients and the rescuers, themsel- ves. From the point of view of providing pre-hospital emergency care on a larger scale, which we are used to in a civilian environment, it is a very austere environment. With the deteriorating security situation in the world and, at the same time, on the European continent, the issue of tactical and combat medicine is increasingly coming to the foref- ront. It is no longer just a question of professional elements from the area of armed forces or armed security forces. The issue of triage of the patients in scenarios with mass casualty incidents connected not only with the most frequently rehearsed topic of an active shooter, but also bomb attacks of various natures, is increasingly coming to the forefront and is being sought by the professional public. However, thanks to historically ingrained dogmas, in our territory, unlike abroad, which faces more and more waves of terrorist attacks, it is not possible to break the barrier of prejudices regarding the tactical sorting systems that are already commonly used in the world. These include, for example, MASS, designed for security forces in the USA im- mediately after the September 1st terrorist attacks on the World Trade Center, or the TCCC Triage algorithm, used as a standard for combat conditions. This regressive thin- king still favors S.T.A.R.T as the only suitable candidate for all types of mass casualty incidents, regardless of the safety of the incident itself and the level of threat to the rescuers. What is neglected is that the first responders in these completely asymmetrical incidents will not be professional rescuers from the ranks of EMS, but only minimally educated armed forces or even the civilian population arriving at the scene of the incident itself. The aim of this diploma thesis was to compare the effectiveness of the three most widely used civilian and tactical triage sieves, where three criteria were compared during eight TECC (Tactical Emergency Casualty Care) and TCCC (Tactical Combat Casualty Care), tactical and combat medicine courses. Effectiveness: speed, accuracy and ability to re- member sorting algorithm without the need to use an auxiliary card for groups of profes- sional as well as lay rescuers. Students were always trained in a pre-determined time window and with the necessary equipment completed model scenarios in a simulated tactical environment with different climatic and lighting conditions, determining the ap- propriate sorting categories for each of the ten trauma patients. The data of the individual triage systems differed greatly during the subsequent compari- son not only in the area of memorability, but, also, in the speed of performing the primary triage. S.T.A.R.T demonstrated the worst results in comparison with the two other com- peting tactical systems MASS and TCCC Triage algorithm with values (average time for sorting ten of the injured was 3 minutes and 50 seconds, and an average of 35% of stu- dents demonstrated the ability to remember the classification scheme, n = 80). MASS, which with its resulting values of 100% memorability rate, average time of 2 minutes and 55 seconds and accuracy in determining the sorting category of 95.5%, n=80, finished second in the ranking. However, the best triage efficiency values with a 100% recall rate, 99.4% agreement and an average time of 1 minute and 59 seconds, n=80, were achieved by the TCCC Triage algorithm designed for the combat environment. Here, participants clearly demonstrated the easier usability of tactical sorting sieves from the point of view of primary triage not only for professional rescuers, but also for minimally trained mem- bers of the armed security forces and the general public.
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The readiness of the Czech army members to provide first aid in a dangerous environment.
JOHÁNEK, Jakub
This master thesis is focused on the issue of providing first aid in combat conditions according to the principles of Tactical Combat Casualty Care. The centerpiece is a chapter on the TCCC program, which is supposed to provide medical training for all soldiers and medical personnel. The TCCC program is designed to be simple and effective for all staff to use. Every member of the army should thus be able, even with limited material resources, to keep a soldier alive even in his most demanding conditions at least for the necessary time. The aim of this thesis was to map how the members of the Czech Army are prepared to provide first aid in a dangerous environment. The second objective was to map their knowledge in providing first aid in a dangerous environment, reflecting the effectiveness and efficiency of medical training of members of the Czech Army. Qualitative methods were used to achieve the objectives. The research part consisted of non-standardized questionnaires, which served to evaluate the medical training and to verify the knowledge of the Czech Army members in providing first aid according to the TCCC principles. The second part of the research was supplemented by semi-structured interviews with non-medical medical staff of the units. The results show that medical training does not fully comply with the current concept of training of units of the Czech Army and other documents. It is also evident from the research that members of the Czech Army should be educated more on the theoretical level in relation to the provision of first aid according to the TCCC principles, as the awareness of this issue appeared to be minimal. The obtained knowledge will be used both by unit medics leading medical training and by unit commanders who organise medical training and can thus avoid the mentioned deficiencies. Furthermore, the findings can also be used by all other members of the Army of the Czech Republic who are interested in the issue in question and want to find a comprehensive and up-to-date overview of information.
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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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Possibilities of Providing First Aid by Trained Members of the Army of the Czech Republic in Foreign Missions
HLOBILOVÁ, Petra
This Bachelor thesis deals with possibilities that trained members of the Army of the Czech Republic have when giving first aid on their foreign missions. It deals with the soldiers who have passed through a special Combat Lifesaver Course (later just CLS), the activity of doctors and middle medical staff in medical centres is not involved. The work is divided in two parts ? theoretical and practical. In the theoretical part I summarized the specifics of giving first aid in field conditions and the basic principles that military medical staff follow. There are into detail described actions that a Combat Lifesaver performs in case a fellow fighter is injured, to ensure their vital signs immediately after the injury and to transport them to a higher level medical facility. The aim of this work is to provide an idea of giving first aid in the tactical environment of experts and to point out numerous peculiarities which differentiate it from the first aid we know from the civil life. That´s because combat conditions bring lots of restrictions and risks for the injured as well as for the medical staff providing urgent care. The method selected for the qualitative research in the practical part is semi directive interview. The interviews were held with four members of the Army of the Czech Republic, who have attended the above mentioned course and have taken part in a foreign mission with that specialization, and with two instructors of the CLS course. The questions were about the way of selecting soldiers for the CLS course, their training and preparation before their departure to a foreign mission. There were also analysed the competences and obligations of a Combat Lifesaver in case of injury of a fellow fighter. The research has demonstrated that soldiers are selected for the Combat Lifesaver course mainly according to the requirements for the foreign missions. The aim of the selection is the presence of at least one soldier with medical training in each crew. The only requirement on the soldiers that must be fulfilled before departing to a foreign mission is completion of the cited course. Other activities, like training other members of the crew and rounding off their knowledge are up to their consideration. It´s been proved that a Combat Lifesaver fulfils their tasks at a foreign mission in the same way as any other soldier and their specialization is applied only in case of injury of a fellow fighter. They most often deal with gunshot and fragment wounds.
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