Datensätze der von Berliner Ärzten abgerechneten psychosomatischen und psychiatrischen Leistungen des Einheitlichen Bewertungmaßstabs (EBM) in den Jahren 1995-1997 werden im zeitlichen Verlauf untersucht und mit Veränderungen der Leistungsdefinition verglichen. Die Abrechnungsdaten werden nach Fachrichtung, Geschlecht und Stadtteil des abrechnenden Arztes gruppiert und mit Daten zur Qualifikation des Arztes - aus einem von Berliner Ärzten beantworteten Kurzfragebogen zur psychosomatischen Grundversorgung (PSGV) - korreliert. Hypothesen zu strukturellen Unterschieden beim Abrechnungsverhalten innerhalb der Ärzteschaft werden formuliert. Weiterhin wird untersucht, wie das Abrechnungsverhalten von Ärzten durch Änderungen in der Gebührenordnung beeinflußt wird. Zuletzt wird nach Kriterien gesucht, die den Bedarf an PSGV quantifizieren. Die in der Arbeit postulierten Hypothesen lassen sich wie folgt beantworten: (H 1.a.): Das Geschlecht des Arztes spielt für die Abrechnungshäufigkeit psychosomatischer Leistungsziffern keine Rolle. (H 1.b.): Ärzte im Westteil Berlins rechnen häufiger Leistungen der PSGV ab als ihre Ostberliner Kollegen. (H 1.c.): Gesprächstherapien werden von Ärzten mit hoher Balintgruppenerfahrung häufiger durchgeführt. (H 2.a.): Die therapeutische Leistungsziffer 851 wird trotz besserer Bewertung ab dem Jahr 1996 nicht häufiger abgerechnet. (H2.b.): Die Budgetierung einer Leistung verringert deren Abrechnungshäufigkeit. (H3.a.): Ärzte rechnen seltener Leistungen der PSGV ab als sie es aufgrund der geschätzten Häufigkeit psychosomatischer Erkrankungen am eigenen Patientenklientel könnten. Zufällig findet sich in der Datenanalyse ein statistischer Fehler. Die bereitgestellten Leistungsstatistiken der KV-Berlin stellen in Bezug auf den Mittelwert keine korrekten Abrechnungsgegebenheiten dar. Die asymmetrische Verteilung der Abrechnungsdaten läßt sich durch Angabe des Median und eines Perzentilenbereiches besser beschreiben als der derzeitig ausgewiesene arrhythmetische Mittelwert. Die Leistungsmengenausweitungen nach Einführungen des EBM ab dem Jahr 1996 können auch durch diesen Umstand mitverursacht worden sein. Bei der Literaturbetrachtung fällt auf, dass die Morbidität psychischer und psychosomatischer Erkrankungen zunimmt und diese einen hohen volkswirtschaftlichen Schaden in Hinblick auf Krankheitszeiten und Medikamentenkosten verursachen. Qualitätsverbessernde Maßnahmen in der PSGV können effektiv Krankheitskosten reduzieren. / Data sets about psychosomatic and psychiatric services from “Einheitlichen Bewertungmaßstabs” (EBM), which were deducted from Berliner physicians during the years 1995 -1997 will be researched in a time dependent process and will be compared to the change of definition of achievement. The billing data will be grouped according to the field, gender and district of the accounting physician, and will be correlated with data which comes from a short questionnaire, answered by Berlin physicians, about the psychosomatic primary health care, for the qualification of the physician. Hypotheses of structural distinctions from the account behaviour, within the Medical profession, will be formulated. Furthermore, it will be examined, how the account behaviour of the physicians will be affected by change in the tariff. Lastly, we will be searching for criteria, which will quantify the demand of psychosomatic primary health care. The postulated hypotheses in this work can be answered as follows: (H 1.a.): The gender of the physician is irrelevant to the settlement frequency of the psychosomatic output figures. (H 1.b.): Physicians in West Berlin account for services from psychosomatic primary health care more often then there colleagues in East Berlin. (H 1.c.): Physicians with high Balint group experience administer more client-centered therapies. (H 2.a.): Despite the better valuation starting from the year 1996, the therapeutic output figure 851 does not become more frequently accounted for. (H 2.b.): The budgeting of an achievement reduces their account frequency. (H 3.a.): Physicians account more rarely for services of psychosomatic primary health care as they could do it due to the estimated frequency psychosomatic diseases of there own patient clientele. A statistic error is coincidental in the data analysis. The provided statistical activities of the KV-Berlin don’t represent correct account conditions in reference to the median. The asymmetrical distribution of the billing data can be better described by the indication of the median and a percentile range, than by the current stated arrhythmetic median. The expansions of achievement quantities after changing of the EBM, starting from the year 1996, could be, among other things, caused by this circumstance. During the examination of the literature, it becomes noticeable, that the morbidity of psychological and psychosomatic diseases increases, and these cause high economical damage in terms of illness times and medication cost. Quality-improving measures in the psychosomatic primary health care can effectively reduce disease costs.

Administration of armies has been sadly neglected in historical studies but the ability of the AIF to develop an efficient system of administration and to fit into the equally efficient British system, had much to do with the success of the AIF, especially late in the war. The various Empire governments had made some preparations for an alliance system of fighting in the event of a major war, but in practice these needed a great deal of adjustment. This thesis examines the manner in which the dominions and Britain planned for a possible war and the way in which changes had to be made in practice. It examines the manner in which the AIF developed a system and the many facets of this system, which had developed a remarkable degree of efficiency by the end of the war. Because the AIF and CEF were so alike in size, composition and in the problem they faced, a recurring theme of the thesis is a comparison between the two. It embraces the following: a. Prewar preparation for a combined empire army. b. The organisation of the administrative system of the AIF and the manner this improved through the war. c. The organisation and problems of the CEF administrative system d. The development of a system of capitation to pay for the services supplied to the AIF and CEF. e. Supply of equipment. f. Manner in which both forces worked to maintain their forces. g. The manner in which both forces catered for the needs of the individual soldiers. h. Supply in the field i. Medical administration in the AIF j. The administration in the AIF k. The administration of discipline in the AIF l. The demobilisation of the AIF.

This research project addresses the following: how topical talk operates in the organisation and management of MSE interactions; and how topical talk operates in the co-ordination of specific service requests and service provisions. It draws on a corpus of audio-recorded and transcribed interactions between general practitioners and persons seeking general medical services in suburban clinics in Brisbane, Australia. The corpus comprised a total of 67 medical service events (henceforth MSEs), audio-taped with the full informed consent of the participants. Many contemporary medical sociological accounts of the operation of topical talk in MSEs, typified by the work of Mishler (1981, 1984) and Waitzkin (1991), remain anchored to the 'professional dominance' thesis (Freidson 1970a; 1970b), arguing for the fundamental conflict between two perspectives - lay and professional. Topical talk has been formulated as one expression of this conflict in 'doctor-centred' communicative 'styles' (Byrne and Long 1976; Silverman 1987). Within such accounts, familiar interactional patterns in MSEs, including the content and structure of topics, have been theorised as instruments of power and control whereby the dominance of specialised medical knowledge and expertise are established and maintained. Mishler's (1984) characterisation of the conflict between a biomedically oriented 'voice of medicine' used by professional physicians (henceforth GPs) and a 'voice of the lifeworld' used by persons seeking medical services (henceforth Ps) is an expression of the 'professional dominance' thesis. The voices are characterised as attesting to a fundamental, theoretically problematic, asymmetry of power relations between GPs and Ps, thereby reinforcing the ideological status of professionals in general and the medical profession in particular. Further, recommendations regarding correctives to 'professional dominance' centre on advice GPs to attend to the primacy of Ps' talk on their experiences of illnesses rather than apparently 'ignoring' or transforming these topics into biomedical accounts of disease. This research project critiques this formulation of topical talk and the traditional theoretical and empirical bases on which it has drawn. This critique arises from the application of ethnomethodological approaches to the study of MSEs. Such approaches, as outlined in Chapters 2 and 3, are characterised by a number of conceptual and analytic premises: First, particular social structural features of social activities and the institutional contexts within which activities occur should not be assumed to be the primary criteria for judging the import and adequacy of situated action. Second, the parties to situated social events mutually constitute those events in the real world. Third, issues of agency are collaborative situated accomplishments such that the management of everyday social activities is accomplished by the people involved who show one another the rationalities of their actions as they assemble the familiar scenic features of those same institutional events (Garfinkel 1967; Sacks 1992a, 1992b). These assumptions have been applied in ethnomethodological analyses of social action, including the analysis of professional service encounters that have critiqued the 'professional dominance' thesis (Eglin and Wideman 1986; Sharrock 1979). The novelty of this study is the analysis of the operation of topic organisation as a phenomenon of order. This study also draws on recommendations within Ethnomethodology (Hester & Eglin 1997b; Watson 1997) that sequential and categorial organisations are mutually informative in the analysis of the rationality of situated social action. One of the particular contributions of this thesis is that it not only jointly applies both conversation analysis and membership categorisation analysis but also extends this recommendation to the inclusion of topic analysis as was originally provided for by Sacks (1992a , 1992b) and Garfinkel and Sacks (1970). Within this study a model of analysis has been constructed that has enabled the analytical consideration of four dimensions of social organisation: local sequential, extended sequential, topical and categorial organisations. The theoretical and empirical concepts of ethnomethodogical analysis have thus been developed and extended within this project. The central findings of this study are that in institutional service events, the 'service topic' is both significant and consequential, and that persons constitute themselves as bona fide incumbents of the categories GP or P by attending to their actions as topically organised. The local adequacy of any particular interactional move (such as questioning-answering, greetings, the design of a topic proposal, etc) is shown to be referenced to the service topic. This study found no evidence of potential or actual "struggles" between the 'voice of the life-world and the voice of medicine'. Rather, this study finds routine recognition on the part of both Ps and GPs of the centrality of the service topic and, thereby, the service task, and no evidence of orientation to distinctive biographical contributions staged in competition with biomedically relevant service topics. It is found that Ps' biographical references were made in the context of an assembled service topic such that particular service tasks, however conventional, were constituted as both relevant and reasonable as medical goods and service for the specific service recipient and provider. At the most general level, it is concluded that the service topic operates as a phenomenon of order in MSEs where order, as defined by Garfinkel and Weider (1992: 202), refers to all of the rationalities evident in the generic features of institutional events and settings, that is, the situated logic and intelligibility as well as the procedures whereby they are constituted as recognisable social events. The thesis concludes with a discussion of the implications of the findings for the theorisation, policy-making, medical education, and practices of GPs and Ps within MSEs. Overall, the significance of this work for researchers into medical interactions is that the relevance of the service topic and its pervasive organisational consequences need to be considered analytically. A major outcome of this thesis is the establishment of a new order of interest within the study of institutional interactions. The project demonstrates the pervasive consequences of service topics and thus provides a step forward in the study of institutional service interactions and ways of theorising their rationality, a step that extends beyond social structural pre-theorisations of power and domination and also beyond interactional accounts of the primary relevance of turn taking structures.

在現代外科實務中，我們今天認為是標準作業程序的手術，追溯到初期可能是激進創新。多年來，外科技術雖然已經有頻繁的修改，但往往是漸進式地。心臟和血管外科領域中的大多數創新並沒有導致日常實踐劇變。然而，在過去的幾年中，在我服務的醫院和全世界，我看到了治療腹主動脈瘤 (AAA) 的典範轉移，亦即主動脈腔內修復 (EVAR)。 相對於傳統開腹手術修復 （OSR），主動脈腔內修復較傳統開腹手術修復有顯著較低的手術死亡率。不過，長遠來說，總死亡率或動脈瘤相關死亡率並無差異；而主動脈腔內修復有較高的植入物相關併發症和必須再次手術的機率，且成本更高。然而，主動脈腔內修復還是成為腹主動脈瘤治療的支柱。這是為什麼？ 除了是激進的技術創新，主動脈腔內修復也是技術頓悟。傳統上，醫療服務是典型的技術輔助服務情境，其中包含兩個單獨的、然而是密切相關的溝通系統： 一個是產業與醫師之間，另一個是醫師與病人之間。醫師居於樞紐地位，不僅確保治療之執行，而且還要評估結果。由於現代資訊與通信技術的發達，病人可以方便地搜尋輔助醫療文獻資訊、線上資訊和個人社會網絡的意見。這就像是詮釋者的作用。這詮釋者的解釋對病人、外科醫生、和醫療產業界產生了實質上重大的影響，反之亦然。以前在這服務體系中互相分離的部分現在可以緊密地互相配合了，這與服務導向邏輯中價值共同創造的概念是不謀而合的。 總之，對多重利益相關者之意義提升是臨床醫療服務典範轉移的原因。在醫療行業中引入服務導向邏輯的概念的重要性，不論是在日常實務和創新策略上的意義都是不容忽視的。醫療服務中，多重利益相關者比以前更涉及共同創造價值的過程。未來的創新者除了專注在技術和科技上，更必須考慮該創新對多重利益相關者之意義提升。 / In modern surgical practice, what we consider as standard procedures today may be radical innovations dated back to the early days. Over the years, there has been frequent modification of surgical techniques, often incremental though, and most innovations in the field of cardiac and vascular surgery didn’t result in drastic changes in the daily practice. However, during the past several years, I have been witnessing a paradigm shift in the treatment of abdominal aortic aneurysm (AAA) in my hospital and worldwide towards endovascular aortic repair (EVAR). In comparison to the traditional open surgical repair (OSR), EVAR was associated with a significantly lower operative mortality than OSR. However, no differences were seen in total mortality or aneurysm-related mortality in the long term, and EVAR was associated with increased rates of graft-related complications and reinterventions and was more costly. Nevertheless, EVAR is becoming the mainstay of AAA treatment. Why is this? Except for being a radical technology innovation, EVAR is also a technology epiphany. Traditionally, medical service is a typical technology-assisted service encounter, consisting of two separate, however, closely inter-related communication systems: one between the industry and the physician, and the other one between the physician and the patient. The physician is of the pivot role that not only ensures the execution of treatment but also evaluates the results.With modern information and communication technologies, patients caneasily search information from paramedical literatures, online information, and opinions from personal social network. This serves the emerging role of an interpretor. This interpretors’interpretation has substantial influence on patients, surgeons, industry, and payers and vice versa. Previously separated parts in the service system now can be closely inter-related. This is in concordance with the concept of co-creation of value in service-dominant logic. It is concluded that newly defined meanings to multiple stakeholders are the reasons for paradigm shift in clinical medical service. The importance of introduction of the concept of service-dominant logic into the medical industry, both in daily practice and in innovation strategy can never be over-emphasized. Multiple stakeholders are being involved much more than before in the process of co-creation of value in medical service.Future innovators must concentrate on meanings to multiple stakeholders as well on techniques and technologies.

<p>In the essay, the view of mistakes and disciplinary sanctions within the military aviation and health and medical service, are compared. The comparison shows that military aviation and health and medical service could have several points in common on how mistakes may occur, but that the present view of mistakes is different betwen the sectors. The view of mistakes and disciplinary sanctions is explicit within military aviation, and is based on a clear ideology on how mistakes occur, which is characterised of a systematic approach. Within health and medical service, an explicit and unequivocal ideology on how mistakes occur is missing, but, however, there are implicit ideas about infallibility and perfection. The comparison indicates that the view of mistakes is also, possibly directed by a bureaucratic model (instead of an ideology on mistakes), which aims to legitimacy, but that this may happen on the expense of not taking surrounding circumstances into consideration. In that way there may be a certain contrast in the health and medical service’s present system between rule of law and medical service safety.</p>

台灣發展醫療旅遊／國際醫療服務一直備受爭議。本研究主要以意見場域為基礎，深度訪談與次級資料的論述分析為方法，探看台灣發展醫療旅遊的過程中，相關行動者以何種論述策略正當化自身持具之立場、其中又反映了何種為行動者視為當然之預設；進而找尋各方溝通之可能性。 依照「與國際醫療服務有關的政府主要推動計畫時程」和「論辯的主要議題」兩者，本研究將所探看的發展時間分為三時期，分別為：（1）關於醫療服務國際化是否應該發展以及如何發展的討論；（2）行政院核定以公司化、專區化作為主要發展方向所引發的論辯；（3）國際醫療納入自由經濟示範區之後的實體專區發展模式所引發的論述競逐；進而歸納並分析共23種論述策略。進一步從存續的策略和消失的策略提出以下幾點命題：存續的策略彰顯出行動者在意見場域中爭奪正統地位的原則，分有「存在非營利本質的醫療」和「全民照護優先」兩者；消失的策略則意味著從意見推進至俗見的面向，分有「失敗案例不具評判國際醫療成效之效力」及「配套一次到位的不可能及其必要性」。 綜觀整體發展過程發現，國際醫療服務似仍深陷論述的泥淖中：在蘊含著各式各樣論述策略的整體發展過程中，各方雖有「存在非營利本質的醫療」和「全民照護優先」兩個共同的論辯原則，但仍存在不可達致共識的鴻溝；其中，反對發展者論述的「策略性」似不如支持發展者要多元。這樣的態勢究竟將走向收斂或發散，值得持續觀察；然而，持著「有自己的想法並尊重他人想法，同時適度修正自己的想法」此心態，當是在這「亂中有序」的態勢中達致溝通的有效前提。 / The development of medical tourism in Taiwan has been a controversial issue in recent years. Based on the concept of “field of opinion,” the thesis uses discourse analysis and interview as methods to analyze: (1) how the related actors justify themselves with diverse discourse strategies; (2) the presumptions which are underlying those justifications and taken for granted by the actors; (3) the possibility for those actors with different opinions to reach the stage of consensus.The thesis follows two principles to analyze the collected data. One is the time schedule of the related government projects; the other is the main foci in the whole development process. With the two principles, the whole development process is split into three periods: (1) the debate upon whether medical tourism should be promoted and how to promote it; (2) the debate upon the possibility of organizing hospitals in corporate form within a specific bounded area; (3) the debate upon if it is right to set up international medical centers in the “free economic pilot zones.” The thesis founds 23 discourse strategies that actors used to justify themselves in the whole development process. Furthermore, the author argues that the subsisting strategies represent the principles actors hold to compete for the orthodoxy in the field of opinion. In the thesis, the principles refer to “medical affairs as nonprofit” and “citizen first.” The disappearance of strategies then represents the doxa which used to be opinions. In this regard, the thesis founds that those failing government projects become unrelated to the effectiveness of medical tourism which is being promoted. While everyone knows that to have all supporting projects settled is impossible, forming the supporting projects once and for all is still necessary. All in all, the author argues that although “medical affairs as nonprofit” and “citizen first” are the two common principles between the supporters of medical tourism and their counterpart, to reach the stage of consensus, there is still a long way to go; the supporters seem to have more diverse strategies to confront their counterpart. After all, respecting each other and modifying one’s own opinion in progress might be the effective presumption to get settled in such a full-of-chaos-but-ordered condition.

Human Systems Integration Capstone / Approved for public release;distribution is unlimited. / In the United States Air Force (USAF), a system is generally thought of in terms of technology; but there are other types of systems supporting our warfighters. A system is “a group of related parts that move or work together” (Merriam-Webster, 2014), suggesting that systems can also be a compilation of human activities and interactions. One such system is the Air Force Medical Service (AFMS). The AFMS has been charged with the delivery of healthcare for the USAF. It is an organization within which there are many workplaces, and these are prototypical of workplaces in the USAF. The USAF currently has no framework for developing organizations. This capstone project took an inside look into the organizational structure of the Keesler Air Force Base’s Base Operational Medicine Cell (BOMC). By conducting a macroergonomic analysis, I was able to make recommendations for an effective and fully harmonized organizational design. Human systems integration (HSI) played a pivotal role in the evaluation of the Keesler BOMC, as Manpower, Personnel, and Training (MPT) are key drivers in the development of organizations. The results of this analysis lead to the development of BOMC requirements and subsequently HSI requirements for organizations, or an HSI Framework for Organizations.

Made available in DSpace on 2016-12-12T20:32:04Z (GMT). No. of bitstreams: 1 77037.pdf: 700557 bytes, checksum: 4e6757d65341729b611c8a98531e3a37 (MD5) Previous issue date: 2007-06-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In the current organizational environment, successful companies are adapting their products to the needs of their customers, developing relationships with them while seeking differentials, and laboratory medicine is no exception. However, it can be observed that many private clinical analysis laboratories are located far from their medical clients, which can harm the quality and precision of laboratory and clinical diagnoses and lead to a reduction in competitiveness, productivity, innovation and the search for excellence in these laboratories. In this context, relationship marketing can be considered an adequate path for meeting the needs of doctors and providing clinical analysis laboratories with the opportunity of breaching the limits between the organization and the customers, thus creating and sharing values with its customers and partners; resulting in a long term relationship. Within this perspective, this dissertation presents a conceptual basis of relationship marketing, exposes the data obtained through a multi-case study conducted with the customer service managers and clinical analysis laboratory leaders. Interpretation of the results obtained is performed through the conversion analysis technique. The main conclusions of this work highlight the need for improving the value chain involving private clinical analysis laboratories and the medical service through the use of relationship marketing tools able to provide laboratories with a competitive advantage that will both maintain and differentiate them in the market / No ambiente organizacional de hoje as empresas bem sucedidas estão adaptando seus produtos às necessidades de seus clientes, relacionando-se com eles e buscando diferenciais, da mesma forma que ocorre na medicina laboratorial. Porém, percebe-se que muitos laboratórios de análises clínicas privados estão bastante distantes de seu cliente médico, o que pode prejudicar a qualidade e a precisão dos diagnósticos laboratoriais e clínicos e diminuir a competitividade, produtividade, inovação e a busca pela excelência nestes laboratórios. Nesse contexto, o marketing de relacionamento pode apresentar-se como um caminho adequado, para atender as necessidades dos médicos e oferecer aos laboratórios de análises clínicas a oportunidade para romper os limites entre a organização e os clientes, criando e compartilhando valores tanto com os clientes como com seus parceiros; induzindo a um relacionamento em longo prazo. Dentro dessa perspectiva, este trabalho de dissertação apresenta a base conceitual do marketing de relacionamento, expõe os dados obtidos por meio de um estudo de multicasos realizado com os gerentes de atendimento e dirigentes dos laboratórios de análises clínicas. A interpretação dos resultados obtidos é realizada por meio da técnica da análise da conversação. As principais conclusões deste trabalho destacam a necessidade da melhoria na cadeia de valor envolvendo os laboratórios de análises clínicas privados e o serviço médico por meio de ferramentas de marketing de relacionamento que poderão oportunizar aos laboratórios a vantagem competitiva para se manterem e diferenciarem-se no mercado

A set of documents, called the Index of Model Activities of the Integrated Rescue System Forces was compiled to improve coordination of these forces. The Index describes organizational procedures of the IRS forces during ten cases of emergency. However, are members of basic IRS forces familiar with these documents? Are the IRS workers aware of procedures and needs of the Emergency Medical Service (EMS) staff? The objective of this thesis is to survey views and findings of the IRS workers regarding the above mentioned issues, evaluate possibilities to improve knowledge of these issues.

Impacts of global climate changes in the form of repeated natural disasters are becoming a part of the day-to-day life of the present-day society. The issue of preparedness for extraordinary and crisis situations is becoming more and more topical. The Czech Republic is no exception; it regularly faces heavy rains, floods or snow. The key prerequisite for successful management of these emergencies is an effective prevention and preparedness in the form of crisis plans or crisis preparedness plans. The objective of my thesis is to find out whether Emergency Medical Service of Zlín Region is sufficiently prepared for the occurrence of emergencies and to propose solutions if shortcomings are identified. The Emergency Medical Service of Zlín Region constitutes a basic component part of the Integrated Rescue System of Zlín Region. As a provider of emergency medical services, it is included in the Crisis Plan of Zlín Region. Capacity for action and the activities of the Emergency Medical Service of Zlín Region have to be ensured not only in day-to-day operation, but also if an emergency occurs and continues. The theoretical part of my thesis provides a general overview of emergency and crisis planning, competencies of administrative authorities with respect to emergency medical services in case of an emergency situation announcement, traumatology plan and pandemic plan. This chapter includes also characterization of the legal entity of Emergency Medical Service of Zlín Region and description of special antropogenic and natural threats. The theoretical part is followed by qualitative research, which involves in particular a detailed study of available professional resources in printed and electronic form, especially crisis and emergency planning documents of Zlín Region and internal documents of Emergency Medical Service of Zlín Region. The practical part of the thesis contains an analysis of external and internal threats at respective ambulance stations of Emergency Medical Service of Zlín Region. The external risks analysis is based on the Crisis Plan of Zlín Region and Emergency Plan of Zlín Region, while the internal risks analysis is based on an expert estimate of potential risks at respective ambulance stations of EMS ZR. I assigned the potential impact on the activity of EMS ZK to each identified risk in the risk analysis. The outputs from the analysis became the main source for the preparation of the crisis preparedness plan. The analysis of external risks confirmed that agility and EMS ZK activities may disrupt in particular the following threats: natural flood (ambulance station in Zlín Peroutkovo nábřeží, Uherské Hradiště, Vsetín), special flood (ambulance station in Zlín - Peroutkovo nábřeží, Karolinka, Vsetín), risks arising from climatic conditions (especially heavy snow in Wallachia), disruption of pharmaceuticals and medical supplies (secondary consequence of the crisis) and electricity cuts (especially ambulance stations that do not dispose of emergency power unit). The thesis result is a proposal of Crisis Preparedness Plan of Medical Emergency Service of Zlín Region. A legal entity or an individual who secures the performance of measures resulting from the regional crisis plan is responsible for the preparation of the crisis preparedness plan. The particulars and manner of preparation of the crisis preparedness plan are described in detail in the Government Decree No. 462/2000 Coll., which implements the provisions of Sec. 27(8) and Sec. 28(5) of Act No. 240/2000 Coll., on Emergency Management and Amendment to Some Acts. When drafting the plan I proceeded according to valid legislation. This plan is an internal document of the legal entity to solve the challenges of security in crisis situations.