<p>För att kunna erbjuda god och lättillgänglig hälso- och sjukvård vid stora olyckor och katastrofer krävs en katastrofberedskap grundad på planläggning, utbildning och övning. Sjukvårdens särskilda beredskap måste kunna hantera såväl den "lilla vardagsolyckan" som den stora olyckan eller katastrofen. Syftet med denna studie var att undersöka hur enhetschefer och distriktssköterskor vid primärvården i två kommuner i Jämtlands län upplevde sig förberedda inför en katastrof eller en stor olycka där utryckning krävdes utanför vårdinrättningar till olycksplats. Syftet var även att undersöka hur katastrofberedskap prioriteras av enhetschefer. En intervjustudie har genomförts med tre enhetschefer och fem distriktssköterskor. Intervjuerna har analyserats med kvalitativ innehållsanalys. Utifrån analysen skapades två<strong> </strong>kategorier: ”känsla av säkerhet”<strong> </strong>och ”organisation” samt fyra underkategorier ”beredskap”, ”prioritet”, ”förmåga” och<strong> </strong>”kunskap”. Huvudfyndet var att samtliga intervjudeltagare önskade ha övningar för att känna sig mer förberedd vid en stor olycka. I dagsläget övades det inte alls på katastrofberedskap.</p> / <p>In order to provide good and accessible healthcare in case of emergencies and disasters, an emergency plan based on planning, training and practice is required. Special care must be prepared to deal with both the ”small everyday accident” but also the major accident and disaster. The purpose of this study was to examine how unit managers and districtnurses in primary care in two municipalities in Jämtland county experience themselves prepared in case of a disaster or a major accident which requires emergency care facilities outside the unit. The aim was also to examine how emergency preparedness is a priority for the unit managers. An interview study has been carried out with three unitmanagers and five districtnurses. The interviews were analyzed with qualitative content analysis. Based on the analysis two categories were created: 'feeling of security "and" organization "and four sub-categories of" security "," priority "," ability "and" knowledge ". Major findings was that all the interview participants wished to have exercises to feel more prepared for a major accident. For the time being, no practice in disaster preparedness is carried out.</p>

<p>Samhället är mer eller mindre konstant utsatt för risker. De flesta av dem är så små, och har kanske till och med så pass obetydande effekter för individen om de realiseras, att vi negligerar dem i våra dagliga beslut. Vid vissa tillfällen står vid dock inför beslut som är betydligt svårare, t.ex. i vilken mån vi ska handla kostsamma försäkringar för stora olyckor som högst osannolikt inträffar men skulle få katastrofala konsekvenser. Liknande situationer uppstår för centrala beslutsfattare där man fattar beslut att genomföra riskreducerande åtgärder i samband med potentiella katastrofer. Sådana åtgärder finansieras genom skattemedel och kanske kan man då kräva att myndigheter åtminstone försöker redovisa de förväntade kostnaderna och fördelarna som följs av besluten. För detta ändamål kan man använda kostnads-nyttoanalys, vilket vanligtvis rekommenderas för riskhantering inom t.ex. vägtrafik, eller i viss mån den mindre avancerade kostnads-effektanalysen. Riskanalysens utformning är bl.a. beroende av om man hanterar risk (man kan tilldela utfallen sannolikheter) eller osäkerhet (man känner till utfallen men kan inte tilldela dem sannolikheter) och begränsas vanligtvis av en mängd ovissheter, såsom värden för olika ingående parametrar (t.ex. värdet på ett statistiskt liv).</p><p>Detta arbete tar upp teori angående värdering ex ante av kostnader i samband med potentiella katastrofer och hur dessa värden kan användas under risk eller osäkerhet i en kvantitativ riskanalys. Med hjälp av det försöker jag beskriva i stora drag hur man skulle kunna värdera den ekonomiska nyttan av riskreducerande åtgärder i samband med den s.k. fågelinfluensan. Mina slutsatser är att en probabilistisk ansats och en kvantitativ riskanalys försvåras av bl.a. ett knapphändigt material för sannolikhetstolkningar, förekomsten av kollektiv risk och svårigheter i att värdera t.ex. statistiska liv. Socialstyrelsen är nationell samordnare av arbetet med förebyggande åtgärder i samband med potentiella pandemier men varken använder eller rekommenderar andra myndigheter att använda nyttobaserade beslutskriterier som en del av beslutsunderlaget i samband med den s.k. fågelinfluensan (i detta fall). Kanske borde det tillhöra deras uppgifter att se över möjligheterna att använda samhällsekonomiska utredningar vid sådana situationer. Istället använder de vad som liknar en försiktighetsprincip, vilket också kan försvaras under förutsättningen att riskerna är påtagliga. För stora och långsiktiga beslut borde man istället införa en snävare anti-katastrof-princip innefattande en prioriteringsordning för när man, baserat på om det är möjligt och utredningsekonomiskt motiverat, ska genomföra kostnads-nyttoanalyser och när man istället ska genomföra kostnads-effektanalyser. De kan sedan vara en del av ett större beslutsunderlag.</p> / <p>Our society is constantly exposed to risks. Most of them are so small, and maybe even have so little effect if they occur, that we disregard them in our daily decisions. Quite often, however, we face decisions that are harder for us to make, as whether or not to buy expensive insurance to cover for accidents that have only a small probability to occur but also catastrophic consequences. Similar situations appear for central decision makers when they decide whether or not to reduce a certain catastrophic risk for the society as a whole. Those actions are financed through taxes and therefore it might be fair to say that the authorities should at least try to account for the possible benefits and costs associated with a risk reducing programme. For this you may use Cost-Benefit Analysis (CBA), which is usually recommended for use in, for example, risk management for traffic risks, or the less advanced Cost-Effectiveness Analysis (CEA). The shape and form of the risk analysis is to a great deal dependent of whether you are dealing with risk (it’s possible to assign the predicted states probabilities) or uncertainty (it’s not possible to assign the predicted states probabilities) and is also usually limited by a number of other uncertainties, say in value parameters (e.g. the value of a statistical life, VSL).</p><p>This paper deals with theories regarding how to value (ex ante) the costs of potential catastrophes and how these values could be used in dealing with risk or uncertainty in a quantitative risk analysis. From there I try to describe how, possibly, you could value the benefits from programmes reducing risks of an avian influenza. My conclusions are that a probabilistic approach in a quantitative analysis is complicated by, among other things, the short amount of data necessary to compute objective probabilities, the existence of collective risks and for example difficulties in measuring VSL. The Swedish National Board of Health and Welfare (Socialstyrelsen) is the national coordinator for all work regarding risk reducing actions for potential pandemics, but the board neither uses nor recommends other authorities to use utility-based criteria as a part of their decision material when dealing with, in this case, the bird flue. Quite possibly it should be a part of their work to look into the possibilities of using economic evaluations in these situations. Instead they use what resembles a Precautionary Principle, which also can be used on justified grounds as long as the risks are highly present. What should be done for large and long term decision making, though, is to define a narrower Anti-Catastrophe Principle containing orders of priorities for when, based on if its possible and financially motivated, to use CBA and when to use CEA. Those analyses could then be used along with any other decision material.</p>

För att kunna erbjuda god och lättillgänglig hälso- och sjukvård vid stora olyckor och katastrofer krävs en katastrofberedskap grundad på planläggning, utbildning och övning. Sjukvårdens särskilda beredskap måste kunna hantera såväl den "lilla vardagsolyckan" som den stora olyckan eller katastrofen. Syftet med denna studie var att undersöka hur enhetschefer och distriktssköterskor vid primärvården i två kommuner i Jämtlands län upplevde sig förberedda inför en katastrof eller en stor olycka där utryckning krävdes utanför vårdinrättningar till olycksplats. Syftet var även att undersöka hur katastrofberedskap prioriteras av enhetschefer. En intervjustudie har genomförts med tre enhetschefer och fem distriktssköterskor. Intervjuerna har analyserats med kvalitativ innehållsanalys. Utifrån analysen skapades två kategorier: ”känsla av säkerhet” och ”organisation” samt fyra underkategorier ”beredskap”, ”prioritet”, ”förmåga” och ”kunskap”. Huvudfyndet var att samtliga intervjudeltagare önskade ha övningar för att känna sig mer förberedd vid en stor olycka. I dagsläget övades det inte alls på katastrofberedskap. / In order to provide good and accessible healthcare in case of emergencies and disasters, an emergency plan based on planning, training and practice is required. Special care must be prepared to deal with both the ”small everyday accident” but also the major accident and disaster. The purpose of this study was to examine how unit managers and districtnurses in primary care in two municipalities in Jämtland county experience themselves prepared in case of a disaster or a major accident which requires emergency care facilities outside the unit. The aim was also to examine how emergency preparedness is a priority for the unit managers. An interview study has been carried out with three unitmanagers and five districtnurses. The interviews were analyzed with qualitative content analysis. Based on the analysis two categories were created: 'feeling of security "and" organization "and four sub-categories of" security "," priority "," ability "and" knowledge ". Major findings was that all the interview participants wished to have exercises to feel more prepared for a major accident. For the time being, no practice in disaster preparedness is carried out.

Samhället är mer eller mindre konstant utsatt för risker. De flesta av dem är så små, och har kanske till och med så pass obetydande effekter för individen om de realiseras, att vi negligerar dem i våra dagliga beslut. Vid vissa tillfällen står vid dock inför beslut som är betydligt svårare, t.ex. i vilken mån vi ska handla kostsamma försäkringar för stora olyckor som högst osannolikt inträffar men skulle få katastrofala konsekvenser. Liknande situationer uppstår för centrala beslutsfattare där man fattar beslut att genomföra riskreducerande åtgärder i samband med potentiella katastrofer. Sådana åtgärder finansieras genom skattemedel och kanske kan man då kräva att myndigheter åtminstone försöker redovisa de förväntade kostnaderna och fördelarna som följs av besluten. För detta ändamål kan man använda kostnads-nyttoanalys, vilket vanligtvis rekommenderas för riskhantering inom t.ex. vägtrafik, eller i viss mån den mindre avancerade kostnads-effektanalysen. Riskanalysens utformning är bl.a. beroende av om man hanterar risk (man kan tilldela utfallen sannolikheter) eller osäkerhet (man känner till utfallen men kan inte tilldela dem sannolikheter) och begränsas vanligtvis av en mängd ovissheter, såsom värden för olika ingående parametrar (t.ex. värdet på ett statistiskt liv). Detta arbete tar upp teori angående värdering ex ante av kostnader i samband med potentiella katastrofer och hur dessa värden kan användas under risk eller osäkerhet i en kvantitativ riskanalys. Med hjälp av det försöker jag beskriva i stora drag hur man skulle kunna värdera den ekonomiska nyttan av riskreducerande åtgärder i samband med den s.k. fågelinfluensan. Mina slutsatser är att en probabilistisk ansats och en kvantitativ riskanalys försvåras av bl.a. ett knapphändigt material för sannolikhetstolkningar, förekomsten av kollektiv risk och svårigheter i att värdera t.ex. statistiska liv. Socialstyrelsen är nationell samordnare av arbetet med förebyggande åtgärder i samband med potentiella pandemier men varken använder eller rekommenderar andra myndigheter att använda nyttobaserade beslutskriterier som en del av beslutsunderlaget i samband med den s.k. fågelinfluensan (i detta fall). Kanske borde det tillhöra deras uppgifter att se över möjligheterna att använda samhällsekonomiska utredningar vid sådana situationer. Istället använder de vad som liknar en försiktighetsprincip, vilket också kan försvaras under förutsättningen att riskerna är påtagliga. För stora och långsiktiga beslut borde man istället införa en snävare anti-katastrof-princip innefattande en prioriteringsordning för när man, baserat på om det är möjligt och utredningsekonomiskt motiverat, ska genomföra kostnads-nyttoanalyser och när man istället ska genomföra kostnads-effektanalyser. De kan sedan vara en del av ett större beslutsunderlag. / Our society is constantly exposed to risks. Most of them are so small, and maybe even have so little effect if they occur, that we disregard them in our daily decisions. Quite often, however, we face decisions that are harder for us to make, as whether or not to buy expensive insurance to cover for accidents that have only a small probability to occur but also catastrophic consequences. Similar situations appear for central decision makers when they decide whether or not to reduce a certain catastrophic risk for the society as a whole. Those actions are financed through taxes and therefore it might be fair to say that the authorities should at least try to account for the possible benefits and costs associated with a risk reducing programme. For this you may use Cost-Benefit Analysis (CBA), which is usually recommended for use in, for example, risk management for traffic risks, or the less advanced Cost-Effectiveness Analysis (CEA). The shape and form of the risk analysis is to a great deal dependent of whether you are dealing with risk (it’s possible to assign the predicted states probabilities) or uncertainty (it’s not possible to assign the predicted states probabilities) and is also usually limited by a number of other uncertainties, say in value parameters (e.g. the value of a statistical life, VSL). This paper deals with theories regarding how to value (ex ante) the costs of potential catastrophes and how these values could be used in dealing with risk or uncertainty in a quantitative risk analysis. From there I try to describe how, possibly, you could value the benefits from programmes reducing risks of an avian influenza. My conclusions are that a probabilistic approach in a quantitative analysis is complicated by, among other things, the short amount of data necessary to compute objective probabilities, the existence of collective risks and for example difficulties in measuring VSL. The Swedish National Board of Health and Welfare (Socialstyrelsen) is the national coordinator for all work regarding risk reducing actions for potential pandemics, but the board neither uses nor recommends other authorities to use utility-based criteria as a part of their decision material when dealing with, in this case, the bird flue. Quite possibly it should be a part of their work to look into the possibilities of using economic evaluations in these situations. Instead they use what resembles a Precautionary Principle, which also can be used on justified grounds as long as the risks are highly present. What should be done for large and long term decision making, though, is to define a narrower Anti-Catastrophe Principle containing orders of priorities for when, based on if its possible and financially motivated, to use CBA and when to use CEA. Those analyses could then be used along with any other decision material.

The aim of this masters thesis, based on discourse analysis and organization theory, is to study how individuals in different Swedish cultural organizations- and agencys are working with disaster preparedness. The purpose of this is to examine whether organizational structures affect different persons work, cooperation and practical application concerning disaster preparedness in collaboration with both external and internal organizations. The research shows that disaster preparedness are affected by priority issues as well as financial resources causing consequences for future work concerning this kind of issues. Another problem which is also examined and discussed in this thesis are the problematic approach to personal initiative which today is the leading operation for the organizations to deal with disaster preparedness instead of creating professional titles for the persons handles these complex issues.

Readiness of the urgent reception to mass disasters This thesis is dedicated to the readiness of the urgent reception to mass disasters. It deals with the history, evolution and the current state of the urgent reception, both in the Czech Republic in the first place and in the world. Within the scope of this thesis I focus mainly on the work scope of the urgent receptions in dependence to their structure, equipment and their actual preparedness to deal with mass accidents. I focus besides other things on technical equipment of the urgent receptions, which is in frames of the Czech Republic very heterogeneous, but totally crucial to handle possible mass accident. A very import aspect is the matter of education and further training of the medical employees on all levels. It concerns not only medical positions, but also nurses and auxiliary staff. The question of the conditions severity of the admitted patients, their classification according to these conditions and transparent processing of the information about them cannot be passed over. Furthermore the thesis discusses emergency medicine as a discipline and the direction it should, in my opinion, further be heading in order to improve the functioning of the present system of pre-hospital and hospital emergency care. Urgent receptions in the Czech Republic represent a relatively new thing, which results into certain ambivalence of their concept and structure. Each urgent reception is somehow original and adapted to the requirements of the founder and the local situation. There is one thing the urgent receptions have in common, overload with patients who fall into the competence of practitioners. This is associated with the financial loss-making of these departments within the medical facilities. This, especially in the case of the private hospitals, leads to a reluctance of the founder to invest to the urgent reception. In this thesis I mention legal framework, contingency planning in the Czech Republic, contingency plans, their content purpose and type plan with its importance for solving crisis events. Another plan that is resolved in my thesis and that has crucial importance especially, for urgent receptions is the trauma plan of medical facility whose application into practice in the Czech Republic in many health care facilities is very problematic. And the practice of the trauma plan activation itself is, according to my research, the prerogative of only a very small amount of medical facilities.

Mass accidents and catastrophes do not occur on a daily scale, they occur irregularly and unpredictably and always have devastating consequences that negatively affect the society or nature. They are usually accompanied by a large number of casualties or damage whose removal cannot be managed using usual local means. To cope with such events, it is necessary to have a professionally trained staff in the Integrated Rescue System and an appropriate coordination of rescue and liquidation. In recent years, there has been an increase of such incidents which have resulted in a mass disability of people. The events of recent days have brought a series of terrorist acts, for example in Paris or Brusselles, of suicide bombings that claimed 130 dead and numerous wounded. These acts, which are associated with the current migration crisis on the European continent, cause considerable tension in the society and evoke questions like whether the readiness of IRS to eliminate the consequences of such events is sufficient. Due to these facts, the thesis tries to find out what knowledge the members of the emergency medical service in South Bohemia have on the issue of disaster medicine and mass accidents. The theoretical part of the thesis titled Knowledge of the Members of the Emergency Medical Service in SB on Disaster Medicine and Mass Accidents defines disaster medicine and all tasks and subjects it deals with. It also mentions the Integrated Rescue System including its basic and other components, its powers and organizational structure resulting from the legislation. Furthermore, it describes the security system and planning, specifically crisis and emergency planning, up to the individual partial plans related to this issue. Finally, the thesis deals with the organization of emergencies with a mass disability of people and a detailed procedure of medical emergency regarding the sorting and evacuation of the wounded. The aim of this thesis is to map the knowledge of the members of the emergency medical service in SB, which concern the issue of disaster medicine and mass accidents, where the level of knowledge is later analyzed to confirm or disprove the hypothesis that the knowledge of the SB IRS members corresponds with a normal distribution frequency. The practical part uses a quantitative method based on questionnaires completed anonymously, where 50 questionnaires were selected randomly as a statistical set. The survey focuses on a group of emergency workers in South Bohemia. The meetings with them were organized during previous practical studies. The results of the survey were analyzed using statistical investigation. The statistical investigation used the methods of scaling, measurement of the absolute, relative and cumulative frequency. Later on, the empirical parametres used for non-parametric testing were counted. The results of this pilot study indicate the current state of the knowledge of the SB IRS members on disaster medicine and mass accidents. The thesis will be a beneficial study material for current and future paramedics and students of the field of population protection.

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.

This thesis introduces various approaches to natural catastrophe risk assessment in (re)insurance environment. Most emphasis and further elaboration is put on probabilistic models in comparison to the standard model as proposed by Solvency II. The outcomes of natural catastrophe modeling play an important role in the design of proper actuarial models related to catastrophe risk. More specifically it is shown that they can be entirely understood in a wider actuarial context, namely risk theory. Within the Solvency II framework, probabilistic model outcomes are translated by means of the proposed decomposition methodology putting them into a similar language of the standard formula in order to create the ability to compare different results implied by either probabilistic model or standard formula. This enables both comparison of the implied dependence structure of probabilistic model to standardized correlations assumed in Solvency II, and scenario year loss factors of Solvency II to implied damage factors of probabilistic models in defined cresta zones. The introduced decomposition methodology is illustrated by flood and windstorm model outcomes calculated on exposure data of Czech insurance companies and compared to the respective standard formula parameters and outcomes. Finally, other applications of the proposed decomposition methodology are introduced, such as measurement of diversification effect or blending of different results calculated by different models or even approaches to natural catastrophe risk assessment.

The title of the Diploma thesis is "The role of public finances in restoring municipal facilities and territory". The thesis assesses a participation of the public finances sector in a process of restoring the essential municipal facilities and territory damaged by disaster. It analyses the public investments released on prevention of natural disasters and intended to subsequent restoration as illustrated by example of flood. To assess an effectiveness of spending the public funds to disaster prevention, the example of flood has been chosen, because the Czech Republic is suffered especially from flooding. The outcome of this thesis is to evaluate the effectiveness of public expenditures in comparison with the experience of neighboring European countries and to formulate recommendations for improving the system of financing the destructive after-effects of natural disasters.