Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.

This diploma thesis deals with problematic of emergency medical service preparedness in the Czech Republic, in the place of disaster and during this situation especially in bus accident with large number of injuries and casualties. Bus accident can create high risk of forming mass disaster due to many people transported in small area with low safety components. High risk of many injuries and casualties with chaotic first call make hard decision to activate plans to solve this situation for emergency services. Theoretical part of diploma thesis maps transformation of Czech paramedic system organization from districts to regions and new legislations for emergency medical service that solve preparedness, organization and duties during large incidents. Due to this new legislations were formed offices for emergency preparedness which ensure this preparedness. Practical part of diploma thesis is analysis of Czech paramedic preparedness that solve bus accidents as disaster. For this analysis were used data from regional emergency medical service headquarters (EMS HQ) - bus accident reports, drills for staff and special material equipments. But only 3 EMS HQ provided acceptable data and 1 EMS HQ partly acceptable data. Aim of this study is assessment in preparedness change for disaster during examined time (2000 - 2011) and comparison of real event to training drills. This part of thesis is supplied by statistic data (transformed into graphs) of bus accidents with injuries and casualties from department of Transportation Police of the Czech republic and Fire Rescue Service Directorate. Whole practical part is made by analysis of primary (documents, EMS HQ personal visits) and secondary information (information servers, journals). Within this analysis was made evaluation of Czech emergency medical preparedness for bus accidents with large number of injuries and casualties. This analysis shows that in area of the Czech Republic is missing central directorate for Czech paramedic system. Which is shown in varying material, drill and whole preparedness for disaster situation. This problem is also made by new legislation that were not here before (law for emergency medical system and law notices). High variation of equipments and procedures in solving disasters can cause difficulties during accident intervention on the borders of paramedic regions. For comparison to other countries preparedness is in this thesis mentioned Poland - special training course for specialist in disaster management, USA - Medical Alert Center (MAC) and Israel - control system for disaster drills.