This diploma thesis deals with security in the hospital enviroment. The work creates a new evacuation plan for large-monoblock Hospital for adults in FN Motol. Evacuation plan covers all activities of the announcement of evacuation after the removal of the last patient from the hospital. For developed evacuation plan at workcompiled four simulation models in SIMUL8. With these models, theevacuation plan and tested models provide a quantitative value, according to which it can better prepare for possible evacuation. This thesis has fulfilled its purpose -- was created functional evacuation plan, and simulation models provide additional information as to which should be ensured smoother running of the evacuation.

L’importance de gérer la crise provoquée par une catastrophe naturelle, et plus particulièrement par les inondations, nécessite le développement de systèmes d’évacuation efficaces. Un système d’évacuation efficace doit tenir compte de certaines contraintes, notamment celles liées au trafic sur le réseau, à l’accessibilité, aux ressources humaines nécessaires et aux équipements matériels (véhicules, points de rassemblent, etc ..). L’objectif principal de ce travail est d’apporter une assistance aux services techniques et aux forces de secours en termes d’accessibilité en proposant des itinéraires relatifs aux opérations de secours et d’évacuation des biens et des personnes. Nous considérons dans cette thèse, l’évacuation d’une zone urbaine de taille moyenne, exposée à l’aléa d’inondation. En cas d’inondation, la plupart des habitants seront évacués en utilisant leurs propres véhicules. Deux sites d’étude sont sélectionnés dans le projet ACCELL 1, val de Tours (Fr, 37) et val de Gien (Fr, 45). Protégé de l’aléa d’inondation par un ensemble de digues, le site du val de Tours est doté d’un système de prévision de crues fournie par le SPC 2 (DREAL 3) et le SCHAPI 4 permettant aux décideurs d’anticiper une crise majeure par une évacuation préventive. Contrairement au site tourangeau, le val de Gien peut bénéficier d’une évacuation de la population avant et pendant la catastrophe. L’inondation sur ce second val est du type lente par débordement (site partiellement digué), les coupures de routes au cours du temps sont prises en compte lors d’une évacuation pendant la crise. Notre objectif est de construire, pour chacun de ces deux sites, un plan d’évacuation, i.e., fixer pour chaque individu la date de départ et le chemin pour atteindre le point de rassemblement associé. Le plan d’évacuation doit éviter la congestion sur le réseau routier. Nous présentons ici un modèle d’optimisation spatio-temporel (STOM5) dédié à l’évacuation de la population exposée à une catastrophe naturelle et plus particulièrement à un risque d’inondation. / The importance of managing an urban site threatened or affected by flooding requires the development of effective evacuation systems. An effective evacuation system has to take into account some constraints such as the transportation traffic which plays an important role as well as others such as the accessibility, necessary human resources and material equipment (vehicles, assembly points, etc...). The main objective of this work is to bring assistance to the technical services and brigade forces in terms of accessibility by providing itineraries with respect to rescue operations and the evacuation of people and goods.We consider the evacuation of a middle size area, exposed to a risk, and more precisely to a risk of flooding. In case of flooding event, the most of inhabitants will be evacuated by themselves, ie., using their personal vehicles. Considered case here, the flooding can be forecast in advance, and then the population has few days (2-4) to evacuate. Our aimis to build an evacuation plan, ie., fixing for each individual the date of departure and the path to reach the assembly point (also called shelter) associated. Evacuation plan must avoid congestion on the roads of evacuation network.Here, we present a spatio-temporal optimization model for the evacuation of the population exposed to natural disasters, and more particularly to a flood risk.

Act no. 328/2001 of the Collection of Laws defines that, apart from others, evacuation must be planned for handling emergency situations that require an alarm of the third or spe-cial degree to be raised. Successful evacuation requires an evacuation plan be made as part of crisis preparedness plans and this project could become a template for preparing evacuation plans for emergency situations at Fakultní nemocnice (a teaching hospital) in Motol, Prague. The teaching hospital in Motol is one of the largest hospitals in central Europe. It has 2,500 beds at its disposal, 350 of which are with intensive care. The hospital has large prem-ises the heart of which consists of two monoblocks, one for children patients and the other for adult ones. The other buildings in the hospital house its technical and administrative facilities or some special departments. The set of persons in question includes all the people in danger on the premises at the time of raised evacuation. It means hospitalized patients, outpatient ones, employees, students and teachers of the 2. Lékařská fakulta UK (the Medical Faculty of Charles University) and visitors. The objective of this work is to create model templates for evacuation plans for se-lected wards as well as larger departments, including the entire hospital complex. The other objective is to verify, or refute, the hypothesis that evacuation, partial or complete, of a large hospital can be finished within 12 hours. The methodology was based on detailed data collection about each ward and bed de-partments (location, number of beds, number of staff at various time of the day etc). Another source of information was a detailed survey of the entire premises focused at finding potential evacuation routes inside as well as outside the buildings, capacity of corridors, stairways, lifts, and other important information related to evacuation. The results of the project are presented in the form of ten model evacuation plans for various individual parts as well as whole units of the hospital: 1. Evacuation of one ward of the children{\crq}s monoblock, 2. Evacuation of one wing of the children{\crq}s monoblock, 3. Entire evacuation of the children{\crq}s monoblock, 4. Evacuation of one ward of the adult{\crq}s monoblock, 5. Evacuation of one floor in one communication node of the adult{\crq}s monoblock, 6. Evacua-tion of one entire communication node of the adult{\crq}s monoblock, 7. Entire evacuation of the adult{\crq}s monoblock, 8. Evacuation of the other hospital facilities, 9. Evacuation of another pa-vilion, 10. Entire evacuation of the whole hospital. The final results show that it is not possible to have one universal evacuation plan that would include all potential situations but several plans for particular kinds of exposure and sizes of departments in danger. The hypothesis was verified for variants 1., 2., 3., 4., 5., 6., 8. and 9. but it was not verified for variants 7. and 10. Evacuation of the entire adult{\crq}s mon-oblock and evacuation of the whole hospital cannot be finished within 12 hours after alert.

Population evacuation plan is one of the plans of specific operations, which are covered within the region's emergency plan according to Decree No. 328/2001 Coll.Evacuation belongs among the basic methods of population protection, being a summary of principles and organisation measures to ensure moving the persons, animals and material assets from the area endangered by an extraordinary event to other area. In the case of an extraordinary event endangering larger territorial unit, not only the populated agglomerations and industrial facilities may be included in the area evacuation, but also the inpatient healthcare facilities, where the situation difficulty is amplified by the patients depending on care by medical personnel and provision of healthcare services. Presently, there is no clear legal standard imposing an obligation on organisations to elaborate a complete evacuation plan. This issue is covered only partially in the sphere of legislation concerning fire protection. Nevertheless within the region's emergency plan elaborated for solution of extraordinary events requiring declaration of the third level (in the case of endangering more than 100 and less than 1,000 persons) and special level of alarm (when more than 1,000, a part of a municipality or enterprise grounds are endangered), all organisations with more than 100 persons should have the evacuation plans prepared. In the case of inpatient healthcare facilities, elaboration of evacuation plans is absolutely inevitable. The theoretical part of the dissertation describes the general principles and methods of performing the population evacuation. Attention was paid also to professional coverage, evacuation authorities and organisations and their structure according to the scope of the taken measures. In the chapter called "Application of the evacuation plan to inpatient healthcare facilities", the general principles and procedures concerning evacuation were applied to the inpatient healthcare facilities. In the practical part of the dissertation, an analysis of preparedness of the inpatient healthcare facilities for possible area evacuation to all-nation extent was made and the hitherto experience of the personnel of the inpatient healthcare facilities with any type of evacuation and their preparedness for possible complete evacuation were examined. Such examinations were made by questionnaire surveys. The collected data have been processed by statistical methods. The evaluation of results is presented in the "Results" chapter. On the basis of the acquired knowledge, a proposal of evacuation plan was drafted for the inpatient healthcare facilities. At the end of the dissertation, the procedures are suggested that may help manage perfectly the potential complete evacuation. Expected utilisation of the dissertation results was directed to definition of the optimum procedures and measures leading to successful management of evacuation of an inpatient health care facility. The dissertation conclusions may be used not only as the document for creating evacuation plans for other health care facilities, but they may contribute to considerable extent to elaboration of uniform evacuation preparation methodology within the emergency preparedness of the healthcare services.

This graduation thesis has primary target in faithful imagine of basic evacuation steps within all-around idemnity of her ensuring. Today{\crq}s, this topic rise to important theme and we can tell that if is evacuation correct provided than it means the most effective instrument of people safety and create the files of differents measurement as well. Together build one entity of very complicated planning and providing procedures in their individual steps. The document is dividing to fourth sections. First include actual stage and law procedures of evacuation process within Czech Republic area. Second section is devote to 3 evacuation types, namely floods, chemical disaster following by outflow of chemical materials and fires. These are completed by example of flood due to weit disruption. On the base of victims testimony and research by auxiliary investigation with people are discuss closely some answers to basic questions concerning to evacuation. Finaly is described severally steps and subprocesses of evacuation secure. Additional value of this document is in basic information disclosure for readers questions with effort to inform society. Effective and flexible comunication is main and key point of success.

Aujourd'hui, l'accumulation des risques associés à des facteurs comme l'urbanisation croissante, le changement et la variabilité du climat, le terrorisme, les épidémies ou pandémies animales et humaines ainsi que la mobilité accrue des personnes et des biens de par le monde, ont accru le potentiel perturbateur voire destructeur de divers types de catastrophes. Des plans de gestion de crises sont élaborés pour gérer au mieux la catastrophe engendrée voire l’éviter. L’objectif de ce travail de recherche est de développer des outils d’aide à la décision pour supporter les différentes phases du plan de gestion de crises dédiés aux établissements de soins à domiciles, notamment les phases de préparation et de réponse. Un ensemble de scénarios à étudier prioritairement en considérant les différentes sources de crises et les processus métier impactés, quant à leur fréquence et leurs impacts humain et matériel, a été défini. Une approche originale d’analyse de vulnérabilité basée sur la théorie des graphes et des matrices a été développée. Le but est de pouvoir mesurer l’impact des différentes crises sur la structure d’hospitalisation à domiciles en termes d’acteurs et de flux échangés. En se basant sur cette phase d’évaluation, nous avons proposé : une classification des acteurs de l’HAD, des méthodes pour la conception des stratégies et des contremesures de mitigation pour chaque classe d’acteurs. La problématique d’accès aux soins dans le cadre d’un scénario d’intoxication massive a été abordée. Un modèle de programmation linéaire a été proposé pour simuler le scénario étudié et évaluer ses conséquences. Il modélise l'infection d'origine alimentaire et la réponse médicale dans le cadre d’une collaboration HAD-Hôpital, c.-à-d., un plan blanc élargi. La problématique d’accès aux domiciles des patients a été investiguée dans le cadre d’un scénario de type crue, épisode neigeux etc. L'outil proposé fournit un plan d'évacuation pour les patients critiques à évacuer et un plan de soutien à domicile pour les patients à risque faible qui seront maintenus à domicile, ceci en utilisant des regroupements basés sur l'évaluation du risque de chaque patient. / Today, the accumulation of risks associated with factors such as increasing urbanization, climate change and variability, terrorism, animal and human epidemics or pandemics and enlarged mobility of people and goods have increased the disruptive and even destructive impact of various types of disasters. Crisis management plans are developed to better manage the crisis or even to avoid it. The purpose of this research is to develop decision aid tools to support the different phases of the crisis management plan for home health care (HHC) structures, mainly for preparation and response phases. A set of scenarios, considering the different sources of crises and the impacted business processes, with regard to their frequency and their human and material impacts, have been defined. An original approach of vulnerability analysis based on graph theory and matrix methods has been developed. The objective is to measure the impact of different crises on the HHC structure in terms of actors and exchanged flows. Based on this assessment phase we have proposed a classification of HHC actors. Different methods have been proposed for the design of mitigation strategies and countermeasures for each class of actors. The problem of access to care in the context of a scenario of massive intoxication is considered. A linear programming model has been proposed to simulate the studied scenario and evaluate its consequences. It models a foodborne infection and its medical response as part of a HHC-Hospital collaboration, in the framework of an extended white plan. The issue of access to patients' homes has been investigated in the context of a flood-like scenario. The proposed tool provides an evacuation plan for critical patients to evacuate and a home support plan for low-risk patients who will be kept at home, using clustering based on each patient's risk assessment.

Abstract Purpose of this thesis was composet at two goals. Purpose of the first goal was evaluate present condition of Hospital Pardubice region, jsc. Hospital of Pardubice, personal's knowledges about behavior in cause of extraordinary event with emphasis on evacuation. Next goal was evaluate the overal status of preparedness of the Hospital Pardubice region, jsc. Hospital of Pardubice for evacuation. The basis of the theoretical part is in applicable legal standards of Czech republic, next this part describe planning of evacuation, including software planning, using modeling programs. In this part are describe events, when the evacuation has been done in real. The purpose of the practical part was to evaluate goals, which has been subsequently established by research questions and hypotheses. The purpose of answering the first research question, was evaluated the survey. The questionnaire has had 37 question and had been divided into 5 parts. The survey was realized during February and March 2018 at 6 departments of the Hospital Pardubice region, jsc. Hospital of Pardubice. The return of questionnaires was 58 %. More detailed specifications are given in chapter 4. To confirm whether the refutation of hypothesis nr. 1 was key respondents' answers to the questions asked, whose accuracy was compared based on the set 80% success rate of the right answers. In order to confirm whether or not the hypothesis nr. 2 was refuted, the results were subsequently processed by the 2 test statistic method - test of good agreement, which should confirm, or refute dependence of individual departments on their responses. For confirmation or refutation hypothese nr. 3, was compared results of this theses survey and results of bachelour thesis results. After the examination of the second research question, a comparison of the hospital's internal documentation with valid legal norms was carried out. An interview with the crisis manager was carried out, which examined the issue of population protection in the hospital. Last part of this research the analysis of questions (5, 7, 8, 13, 21, 24 and 25) of the questionnaire (Appendix 1). The overall success rate of staff awareness is 61 %, according to results. The overall preparedness of the hospital to evacuation is very good. The results of diploma thesis will be used especially for the analysis of own prepeardeness of the Hospital Pardubice region, jsc. Hospital of Pardubice for object evacuation.