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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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Specifics of crisis situations with a large number of patients with thermal injury.
MADĚRÁNKOVÁ, Adéla
This thesis deals with an emergency incident in which a burn trauma occurred in a large number of people. The theoretical part of the thesis describes both the legal framework of emergencies and especially the recommended procedures of the components of the Integrated Rescue System for dealing with this type of emergency. A large part of the theoretical part of the thesis and the whole practical part is focused on the procedure of the emergency medical service. The document shows how burns are treated from the point of view of emergency medicine, but also from the point of view of disaster medicine. The practical part of the work responds to the Concept of dealing with an emergency with a large number of patients with thermal injuries in the Czech Republic, published by the Ministry of Health in 2020. I focused on how paramedics know it. Does their knowledge affect the length of practice or the level of their acquaintance with the Concept? I found out using questionnaires filled out by 42 rescuers from different regions.
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Poison by the carbon monoxide in Sounth Bohemia, patients triage
JIRSOVÁ, Monika
This bachelor's thesis on the topic of CO Intoxication in the South Bohemian Region and Triage of Patients is divided into two parts. A theoretical part and a research part. The theoretical part is focused on the creation of carbon monoxide (hereinafter referred to as CO), its effect on the body, care for intoxicated people, triage of these people and options for prevention of this type of intoxication. Objective 1 was determined for the research part: Map awareness among the inhabitants of the South Bohemian Region regarding carbon monoxide poisoning and awareness regarding possibilities for prevention of this type of poisoning. Two research questions were determined on the basis of this objective. Research question 1 is: What is the level of awareness among the inhabitants of the South Bohemian Region regarding CO poisoning? Research question 2 is: Are the inhabitants of the South Bohemian Region aware of the possibilities for prevention of CO poisoning? Research was further extended to include question 3, which is: Do workers of the emergency services in the South Bohemian Region know what the procedure is for treatment of a patient suspected of having suffered CO poisoning? A qualitative research method was used to gain the required data, this being in the form of semi-structured interviews with 16 inhabitants of the South Bohemian Region, divided into 4 groups according to their level of education. The data gained was divided into 12 parts. Summary of the research pointed to a lack of awareness among the inhabitants of the South Bohemian Region regarding CO intoxication. In view of the fact that this is the most frequent type of accidental intoxication, I regard it as important that the population's awareness of this issue be raised. On the basis of this, I designed an information leaflet which could be disseminated, for example via social networks. Another group investigated concerned procedure followed when treating a patient suspected of having suffered CO poisoning. This related to only four participants - paramedics who work for the Emergency Medical Services of the South Bohemian Region. Research pointed to them having sufficient knowledge of therapy for this type of intoxication and triage of those affected.
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Readiness of healt care providers to mass disasters
Opltová, Kateřina ; Prošková, Eva (advisor) ; Hošťálková, Monika (referee)
Reception of a large number of the injured to a medical facility as a result of a mass disaster or a catastrophe puts high demands on health care. Such situations can not be dealt with the mere improvisation; it is necessary to create unified organizational procedures defining the composition of medical teams and their activities during the multiple reception of the injured to a medical facility. The theoretical part of this thesis provides a comprehensive overview of the current state of emergency preparedness in healthcare facilities. In the empirical part, I analyzed the readiness of health facilities for a mass disaster in the capital city of Prague. A structured interview with open questions was chosen as a method of data collection. Based on the survey, I concluded that the readiness of health facilities in the capital city of Prague differs. I recommend setting up a phone line while receiving patients as a result of a mass disaster in order to improve the situation in Prague. The sole purpose of such a line would be reporting emergencies. I also recommend health care facilities participate actively in exercises within the integrated rescue system and clearly identify and determine facilities where the reception of the injured takes place if a mass disaster occurs. Keywords: mass disaster,...
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Large-scale disasters and their management
Černá, Jana ; Šamánková, Marie (advisor) ; Špunda, Jan (referee)
Bachelor thesis "Mass accident and their management" deals with the problem with management extraordinary events. The aim of this study is to resume the basic information and pieces of knowledge concerned the theme of the mass accidents. It is a theoretical study with practical instructions. By the processing of this work is gone from the specialized literature and from the up-to- date thesis relating to different kinds of catastrophes and mass accidents. At the beginning of the thesis there is described what the medicine of catastrophe is and a little bit of the history of this medicine branch. Next part of the study deals with classification of the catastrophes. Some catastrophes, which destroy our earth, for example tsunami in Asia in 2004 and floods in the Czech Republic in 1997 and 2002 are mentioned. The study introduces integrated rescue system and organization in place of the extraordinary event. More closely my study devotes the classification of the wounded. In this part there are the charts, which are used to classification. Finally there are the basics of first aid of some injuries introduced in this work. The study mentions the contagious diseases, epidemic hazards and psychological effects of mass accidents. In study there is the case reports and the manual "What do when the siren sounds"....
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Problems of triage during an emergency involving disabled people
HAVRDOVÁ, Jitka
Mass casualty incidents and their occurrence are a real threat not only to the society as a whole but also to emergency medical service providers, who, at the moment of the occurrence of a mass casualty incident, must completely change their approach to providing care and switch into the emergency regime. At that moment, high demands are placed on the entire integrated rescue system, both with regard to ensuring safety, preventive measures and organizing activities at the site of the mass casualty incident, andto providing quick and expert assistance. This bachelor thesis concerns mainly providers of emergency medical services during mass casualty incidents and problems of sorting of casualties. In case of a mass casualty incident, the situation requires a completely different approach to the treatment of the casualties than everyday work. In this situation, the individual medicine model when the emergency medical crew provides care to one patient only, from the initial contact to the transfer of the patient to a medical facility, does not apply. In a regime of mass casualty incident, it is necessary to set priorities for treatment, to carry out such treatment and transport the patient to a medical facility. The priority in such a situation is not to save everyone's life, but to eliminate the extent of injuries of the people to the minimum. The treatment of casualties at the site of a mass casualty incident is complicated by many factors that negatively affect the situation. In particular, there is a lack of time for decision-making and treatment, chaos, stress, panic, and in the initial phase also a lack of resources and forces, concerning not only the providers of emergency medical services, but the entire integrated rescue system. Since the on-site situation is optimized within thirty and sixty minutes of the start of operations, it is crucial in the initial phase to focus on the organization and management of the integrated rescue system units. The bachelor thesis is devoted to the issue of classification of the casualties on the site of amass casualty incident. The theoretical part deals with the topics of disaster medicine, the integrated rescue system and in the last part it is devoted to the classification itself. The theoretical part is based on expert literature and current legislation. In the part focused on the classification of the casualties, the individual methods for classification of casualties and scoring systems are analysed in detail, especially the START method and classification identification card, which dominate in our country. The practical part of the thesis is done in the form of qualitative research and compares the answers obtained by a semi-structured interview with two groups of respondents. Respondents were non-doctor medical personnel of the emergency medical service, one group from the Vysočina Region and the other from the South Bohemian Region. The content of the interview was divided into four categories, each focusing on a particular area of casualty incidents. The individual categories dealt with general and specific procedures at the site of a mass casualty incident, cooperation of the integrated rescue system and the issue of classification of patients. The aim of this thesis was to find out how the rescue workers are prepared for a mass casualty incident both theoretically and practically, how they evaluate the cooperation within the whole integrated rescue system. The aim of the thesis was also to verify the theoretical knowledge of the respondents concerning this area of interest and the procedures. The results obtained by the interview and their analysis are included in the chapter Vyhodnocení rozhovorů. The research questions and their results are discussed in the chapter Diskuze. The overall conclusion is included in the chapter Závěr.
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The role of emergency medical services in the incident with mass health disabilities
ZRŮSTOVÁ, Simona
Medical rescue workers are routinely employed in emergency medicine. In emergencies where a large number of people are affected, knowledge of medical disaster practices is necessary. Within a second, the intervening crews should switch to another mode with a different approach to the patients than they use daily. The diploma thesis has set the following goals: to map the level of knowledge of medical rescuers in the field of emergency response with mass health impairment, their personal experience and, last but not least, education and training. Three research questions were asked to reach these objectives. What are the skills of medical rescuers in dealing with emergency health issues with mass health impairment? How do medical rescuers assess incidents with mass health impairment at which they were present and what is their attitude towards training and education in the field of dealing with emergencies with mass health impairment? The research part consists of interviews with two groups of participants: eight medical rescuers of the Medical Rescue Service of the Pardubice Region and the same number of medical rescuers of the Medical Rescue Service of the South Bohemian Region. These interviews supplemented the information provided by the crisis preparedness managers of both medical rescue services. The survey used a qualitative research strategy, conversations were recorded on a dictaphone, then processed into categories, subcategories, tables and evaluated. From the results of the work, a great difference in the knowledge of health rescuers in the field of emergency health problems can be seen. Participants of the South Bohemian Medical Emergency Rescue Service showed shortcomings in both the basic terminology and the solving of extraordinary events in particular, from reporting the situation with a report form to the classification of the disabled. On the contrary, the majority of participants in the Paramedical Rescue Service of the Pardubice Region would be able to file an initial emergency report and categorize and transport patients correctly. On the basis of the evaluated results, this difference in knowledge can be attributed mainly to the frequency and content of the training provided. In the case of South Bohemian participants, we can find the cause in the absence of practical training. The alarming results were noted in the participants' ability to use the START sorting method, from all of the sixteen respondents only one was able to answer there. The elaborated case report of an extraordinary event points to the fact that theoretical shortcomings can subsequently be transferred into practice.
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Readiness of healt care providers to mass disasters
Opltová, Kateřina ; Prošková, Eva (advisor) ; Hošťálková, Monika (referee)
Reception of a large number of the injured to a medical facility as a result of a mass disaster or a catastrophe puts high demands on health care. Such situations can not be dealt with the mere improvisation; it is necessary to create unified organizational procedures defining the composition of medical teams and their activities during the multiple reception of the injured to a medical facility. The theoretical part of this thesis provides a comprehensive overview of the current state of emergency preparedness in healthcare facilities. In the empirical part, I analyzed the readiness of health facilities for a mass disaster in the capital city of Prague. A structured interview with open questions was chosen as a method of data collection. Based on the survey, I concluded that the readiness of health facilities in the capital city of Prague differs. I recommend setting up a phone line while receiving patients as a result of a mass disaster in order to improve the situation in Prague. The sole purpose of such a line would be reporting emergencies. I also recommend health care facilities participate actively in exercises within the integrated rescue system and clearly identify and determine facilities where the reception of the injured takes place if a mass disaster occurs. Keywords: mass disaster,...
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Large-scale disasters and their management
Černá, Jana ; Špunda, Jan (referee) ; Šamánková, Marie (advisor)
Bachelor thesis "Mass accident and their management" deals with the problem with management extraordinary events. The aim of this study is to resume the basic information and pieces of knowledge concerned the theme of the mass accidents. It is a theoretical study with practical instructions. By the processing of this work is gone from the specialized literature and from the up-to- date thesis relating to different kinds of catastrophes and mass accidents. At the beginning of the thesis there is described what the medicine of catastrophe is and a little bit of the history of this medicine branch. Next part of the study deals with classification of the catastrophes. Some catastrophes, which destroy our earth, for example tsunami in Asia in 2004 and floods in the Czech Republic in 1997 and 2002 are mentioned. The study introduces integrated rescue system and organization in place of the extraordinary event. More closely my study devotes the classification of the wounded. In this part there are the charts, which are used to classification. Finally there are the basics of first aid of some injuries introduced in this work. The study mentions the contagious diseases, epidemic hazards and psychological effects of mass accidents. In study there is the case reports and the manual "What do when the siren sounds"....
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Designation members of emergency medical service and station of triage at a place of emergency incidents
ŠIMÁČEK, Petr
This bachelor thesis deals with the changig of identifycation medical members and group at a place of emergency incidents. There were changins in legislative in these identifications in 2012. These changigns influenc work of Emergency Medical Servis and other members of Integrated Rescue System during emergency incidents. The emergency situacions and numbers of persons that are involved on health are graduated. That increase pretension to medical care from individual to urgent. Because all people have their right to medical care. That is why the cooperation of all subjects the Integrated Rescue System has to be effective. One part of this bachelor work is also an analyse of documents that deal with the basics factors of IRS during emergency incidents.
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