- / This article makes critical observations about the popular examination of dying and its care, identifies the key challenges to modern dying, and argues for a public health approach to end-of life care. Only by adopting a global and non-clinical perspective on the human experience of dying can we address people’s concerns where these arise—in their own homes and workplaces—and to offer alternatives to the more radical choices offered by modern medicine.

The topic of this master’s thesis is design of rescue vehicle, more specifically medical rescue vehicle in the category C intended for immediate medical assistance and subsequent transport. The main aim of this design is to create object fulfilling the ergonomic, technical and esthetic requirements.

The pre-hospital industry is faced with many challenges, one of which is the skills shortage of advanced life support paramedics in the country. The industry has naturally dictated competition both nationally and internationally for the recruitment of these advanced life support paramedics. Staff turnover has increased as a result of this issue which also has financial implications on the individual business of constant recruitment and turnover. The purpose of this study is to investigate problems that currently exist in the industry with regards to the advanced life support paramedic employment which will provide valuable information on retention strategies and reduce staff turnover.

The pre-hospital industry is faced with many challenges, one of which is the skills shortage of advanced life support paramedics in the country. The industry has naturally dictated competition both nationally and internationally for the recruitment of these advanced life support paramedics. Staff turnover has increased as a result of this issue which also has financial implications on the individual business of constant recruitment and turnover. The purpose of this study is to investigate problems that currently exist in the industry with regards to the advanced life support paramedic employment which will provide valuable information on retention strategies and reduce staff turnover.

The diploma thesis analyzes the topic of preparedness of individual regional and training centers of medical rescue service providers and employees of such organizations for cases of emergencies with mass casualties. In order to collect the data required for the empirical part of the diploma thesis, I prepared two questionnaires: one was a qualitative research aimed only at managers of educational and training centres of individual regional medical rescue services. The other questionnaire was used for a quantitative research, in the form of an anonymous non-standardized questionnaire, which was prepared for employees of medical rescue service. The evaluation of the results of the questionnaire surveys has shown that in spite of the usually appropriate conditions secured by the medical rescue service providers and in spite of the relatively frequent trainings, the knowledge of individual employees in this field is not sufficient. Based on the results acquired it is obvious that individual educational and training centres of medical rescue service providers should pay more attention to the professional training of their employees on this issue. These results will be, upon request, presented to the representatives of individual educational and training centres, and should be used to make the preparation of their employees for cases of emergencies with mass casualties more effective.

A research report submitted in partial fulfilment of the requirements for the degree Master of Science in Medicine in the Field of Emergency Medicine in the Division of Emergency Medicine, University of the Witwatersrand / Introduction: Control over the patient bears time-critical importance in emergency medicine. In the entrapment situation after a Motor Vehicle Collision (MVC), emergency care including airway management may need to be initiated before extrication and thus with restricted access. Objective: This manikin study aimed at answering the question of which advanced airway device can be inserted the fastest and most reliably by paramedics in the simulated entrapped patient. Methods: Paramedics were asked to insert four airway devices (endotracheal tube with the Macintosh laryngoscope, endotracheal tube with the Airtraq® optical laryngoscope, Laryngeal Mask Airway - SupremeTM, and Laryngeal Tube Suction - DisposableTM) in randomised order into a manikin seated in the driver seat of a light motor vehicle. Time to first successful ventilation and number of attempts required for successful insertion were measured. Following each insertion, participants were asked by means of a questionnaire to rate the degree of insertion difficulty (scale 1 – 10) and provide reasons for this rating. Finally, participants were asked which device they preferred and why. Results: Prospectively collected data from 26 paramedics were analysed. The LMA-SupremeTM had the shortest mean time to first successful ventilation (16.7 seconds (CI [0.95]; 14.9 - 18.6)), followed by the LTS-DTM (19.4 seconds (CI [0.95]; 18.0 - 20.8)), ETI using the Macintosh laryngoscope (37.7 seconds (CI [0.95]; 31.8 - 43.5)) and ETI using the Airtraq® (41.2 seconds (CI [0.95]; 36.7 - 45.6)). Both face-to-face ETI with the Macintosh laryngoscope and the insertion of the LMA-SupremeTM had 100% first-attempt success. Five participants required a second attempt to successfully intubate the manikin using the Airtraq® and one participant had to re-insert the LTS-DTM for correct placement. In terms of insertion difficulty, the LMA-SupremeTM received the lowest mean score (1.7/10 (CI [0.95]; 1.2 - 2.1)) followed by the LTS-DTM (2.5/10 (CI [0.95]; 1.8 – 3.2)), face-to-face ETI using the Macintosh laryngoscope (3.7/10 (CI [0.95]; 2.9 - 4.5)), and ETI with the Airtraq® (4.5/10 (CI [0.95]; 3.7 - 5.3)). Most participants chose the Macintosh laryngoscope for ETI as their preferred device (10/26; 38%) followed closely by the LMA-SupremeTM (9/26; 35%). These participants stated clinical experience and ease of insertion respectively as the primary reasons for their preference. Conclusion: Besides ETI, Supraglottic Airway Devices are beneficial alternative airway devices to be considered by paramedics in the entrapped patient after a MVC. The LMA-SupremeTM was the fastest and least difficult airway device to insert. Face-to-face endotracheal intubation with the Macintosh laryngoscope remains an important definitive airway that was shown to be performed competently by participating paramedics. The Airtraq® can be used for face-to-face ETI and enables improved laryngoscopy.

Providing aid to the inhabitants struck by the stress incentives is on a good level. The findings show that the system of aid providing is set and guarantees its functionality as well as efficiency. Its part is also the preparation of the members of components of the Integrated Rescue System to provide the aid during the stress load of the inhabitants. It is provided on the sufficient level with a significant effort of services bodies and services bodies for its development and structuring. The problem consists in the level of preparedness of the inhabitants. Their behaviour does not correspond to the needs, the people behave in a chaotic way, do not respect the instructions, underestimated the danger. The reason is not that no suitable conditions were created for their preparation or that such a preparation was not performed at all. It was found out that the offer for the substantial education of inhabitants is on the sufficient level and has an adequate scope. Also its forms cover real expectations. The problem is its limited usage by inhabitants for the reason of underestimation of risks and danger. The people are indifferent and persuaded they personally cannot be endangered or struck. The consequence is the state in which neither the individuals nor their communities are prepared on the extraordinary events and they do not know how to behave during them rationally and safely. This leads to the further deepening of the stress load and to the gradation of the initiated psychological problems. As a solution, the creation of a general public meaning is recommended alerting to danger of extraordinary events and to the necessity of a responsible personal preparation on them, including the awareness of the associated psychological endangerment.

To deal with and prepare for extraordinary events, the Czech Republic has the Integrated Rescue System, which is not an individual organization as such, but rather a system of co-ordinated activities of basic bodies, namely the Fire-Brigade of the Czech Republic and fire prevention units included in the area coverage, the Police of the Czech Republic and the Medical Rescue Service of the Czech Republic. It is the coordination of the Integrated Rescue System{\crq}s basic bodies what is absolutely essential for the effectiveness of the intervention in the place of an extraordinary event. To make the process of rescue and liquidation work really effective, type activities for the basic bodies during a collective intervention have been put together for selected extraordinary events. These activities focus mainly on the co-ordination of the bodies in the place of the extraordinary event as well as the co-ordination of the related bodies by their operations centres. This thesis aimed to analyze the work of the Czech Police as a body of the Integrated Rescue System in the area of extraordinary events as well as to point out possible insufficiencies and propose some ways of improvement. The findings gained can be used in the professional training of individuals, particularly from the ranks of the Czech Police, which handle the question of dealing with extraordinary events. The thesis includes a list of these type activities approved by the Integrated Rescue System{\crq}s bodies with reference to the effective legal documents and the analysis of responsibilities performed by the Police of the Czech Republic within the individual type activities. The conclusion indicates disparities between the theory and the practice, which arose during the elaboration of the thesis, particularly insufficient knowledge of the type activities on behalf of the policemen and deficient material facilities of the Czech Police as an Integrated Rescue System{\crq}s body, mainly protective aids for performing tasks related to potential contamination of the policemen by various chemical, biological and radioactive substances etc.