The theme of my thesis is the System of logistical support for emergencies in the Emergency Medical Service in selected regions of the Czech Republic. I chose this theme mainly because of the fact that I work as a rescuer in the Emergency Medical Service of the Central Bohemian Region. In the first part of the thesis, there is specified the essential terminology which is included in the whole project. There is described the historical summary of the beginning of the Emergency Medical Service and the logistics. Other chapters concern the description of the Integrated Rescue System and the essential cooperation of its elements during the intervention. I also analyse the issue of the logistics and public health disabilities on the place of the intervention. In addition, I describe individual Emergency Medical Services in three selected regions of the Czech Republic. It included the Emergency Medical Service of the Central Bohemian Region, the Prague Emergency Medical Service and the Emergency Medical Service of the South Bohemian Region. In chapters which deal with these Emergency Medical Services, there are expounded their forces, (medical) facilities and material support for coping with emergencies. In last chapters, I submit the summary of activities of the Ministry of Health. Furthermore, I mention activities of the allowance organization of Medical Support for the State of Emergency and also activities and roles of the Administration of State Material Reserves ? Czech Republic. Lastly, I summarize findings of the whole thesis in the chapter called ?Discussion?. I also evaluate the accomplishment of set goals and answer to scientific questions which I have already put before the formation of this thesis in the Groundwork for the thesis. In the part ?Results?, I illustrate the amount of exit positions of EMS in individual regions through the use of tables and graphs and I add an overview of the average number of exit positions and rescue teams related to the area of the territory and the number of inhabitants in the region. The aim of my thesis (was): ? to describe the state of the logistical support of the Emergency Medical Service in three selected regions of the Czech Republic (the Central Bohemian Region, Prague, the South Bohemian Region) ? to choose the most appropriate model of the logistical support for emergencies Questions of research: ? What are differences in logistical support for emergencies in the Emergency Medical Services in selected regions of the Czech Republic? ? Which aspects influence the selection of the most appropriate model? The main aim of my thesis ? to describe the state of the logistical support of the Emergency Medical Service in three selected regions of the Czech Republic ? was accomplished. I go into details in chapters 6, 7 and 8. In the chapter ?Discussion?, I described differences in logistical support and in this chapter I write that the mathematical quantification of the material support is not as important as the fact that there is a logistical planning of support for emergencies based on an analysis of risks which are the part of an emergency medical plan of concrete Emergency Medical Services in all selected regions of the Czech Republic. Each of mentioned EMS has special modules for the solution to eventual emergencies and in their usage employees are regularly schooled. In my opinion, this is the most important fact.

O pronto socorro é uma unidade do hospital destinada à assistência a pacientes externos com ou sem risco de morte, que necessitam de atendimento imediato, cujo funcionamento se dá nas 24 horas do dia sendo fundamental a determinação do número necessário de profissionais de enfermagem para prestar assistência com qualidade satisfatória, pois a falta de profissionais de enfermagem com diferentes níveis de formação e a sobrecarga de trabalho aumentam o risco de ocorrência de falhas com prejuízo da qualidade na assistência ao paciente. Os instrumentos de classificação de pacientes são utilizados pela enfermagem em qualquer unidade assistencial e estabelecem as características da população assistida de acordo com a necessidade de cuidados requerida, sendo indispensável para a determinação das necessidades de pessoal e alocação quantitativa e qualitativa dos mesmos. Com o objetivo de caracterizar o perfil assistencial dos pacientes adultos durante a internação no pronto-socorro como um dos subsídios para o dimensionamento do pessoal de enfermagem desenvolveu-se uma pesquisa exploratória no método do estudo de caso, em um pronto-socorro, clínico e cirúrgico, de um hospital geral, público estadual que possui 24 leitos de observação e dez leitos na unidade de atendimento de emergências, localizado no extremo leste do município de São Paulo que trabalha com demanda espontânea do usuário. Os sujeitos da pesquisa foram os pacientes adultos internados na unidade de emergência e nas salas de observação durante o mês de janeiro de 2009, os dados foram coletados por meio da aplicação do instrumento de classificação de pacientes de Fugulin (2002) que avalia nove áreas de cuidado (Estado mental, Oxigenação, Sinais Vitais, Motilidade, Deambulação, Alimentação, Cuidado Corporal, Eliminação e Terapêutica). Foram realizadas 1.228 avaliações, sendo verificados 91 pacientes na categoria de cuidados intensivos, 75 na categoria de cuidados semi-intensivos, 245 com alta dependência para assistência de enfermagem, 272 com complexidade assistencial intermediária e 545 com a mínima. Houve a constatação de muitos pacientes da psiquiatria internados no pronto-socorro a espera de vagas para internação na unidade especializada requerendo da equipe de enfermagem uma assistência diferenciada para a manutenção da integridade física desses pacientes. Verificou-se por meio do número médio mensal de atendimentos realizados que a maioria dos usuários do pronto-socorro não necessitava de internação mas foram atraídos para esse serviço em busca de consultas de rotina acabando por sobrecarregar a equipe multiprofissional que atua nessa unidade que apresentou uma taxa de ocupação média acima da previsão dos leitos oficiais disponíveis tornando a planta física inadequada para pacientes e profissionais devido às internações em macas pelos corredores, reflexo da falta de um serviço de regulação. / The emergency medical service is the hospital ward designated to outpatient care with or without death risk for those who need immediate care, whose attendance is 24 hours a day, being essential the determination of a required number of nursing professionals for delivering satisfactory quality care, since the lack of nursing professionals with different levels of background and work overload increase the risk of errors, impairing the quality of patient care. The instruments of patient classification are used by nursing in any care ward and set up the characteristics of the population assisted, according to the need of care required, being vital for determining the personnel needs and its quantitative and qualitative allocation. Aiming to characterize the adult patient care profile throughout the admission at the emergency medical service, as a support for nursing personnel dimensioning, it was developed an exploratory research in a study of case method, at a clinic and surgical emergency room of a general, public state hospital that holds 24 observation beds and 10 beds at the emergency attendance ward, located at the extreme east of São Paulo city and which works with spontaneous demand of users. The subjects of research were adult patients admitted at the emergency ward and the observation rooms throughout the month of January, 2009. Data was collected through the application of an instrument of patient classification by Fugulin (2002), which evaluates nine care areas (Mental Status, Oxygenation, Vital Signs, Motility, walking, Feeding, Body Care, Elimination and Therapeutics). It was made 1228 evaluations, in which 91 patients in the intensive care category were verified, 75 in the semiintensive care, 245 with high dependence of nursing care, 272 with intermediate care complexity and 545 with minimal one. There was the evidence of many psychiatric patients admitted in the emergency room waiting for a vacancy in the specialized ward requiring from the nursing staff special care for keeping the physical integrity of those patients. It was verified by the monthly average number of attendance that most emergency room users didnt need admission, but they were attracted to this service in search for routine appointments, leading to overload the multi-professional team that works in this ward, which presented an average occupancy rate above the prediction of official beds available, making the physical space inadequate for patients and professionals, due to the admissions in beds spread in corridors, result of lack of service control.

Bakgrund: Den prehospitala vården bedrivs utanför sjukhusets trygga väggar när en patient är i akut behov av sjukvård. Av patienten kan den prehospitala vården upplevas skrämmande och kan leda till en känsla av maktlöshet. Ambulanssjuksköterskan ska i mötet med patienten kunna genomföra ett systematiskt, stödjande och reflekterat omhändertagande. För att kunna genomföra detta omhändertagande är det av stor vikt att kunna skapa tillit i den vårdande relationen. Tidigare forskning visar att patienten såg tillit som en betydelsefull faktor i samspelet med sjuksköterskan. Syfte: Syftet är att belysa hur patienten upplever att tillit skapas i mötet med ambulanssjuksköterskan i den prehospitala vården. Metod: Tre systematiska artikelsökningar genomfördes. Tolv stycken kvalitativa artiklar granskades och inkluderades i litteraturstudien. Analysen genomfördes i nio steg enligt en stegmodell framtagen för kvalitativa litteraturstudier. Meningsbärande enheter skapades och öppen kodning av materialet gjordes. Därefter skapades teman och subteman som utgjorde resultatet. Resultat: Tillit skapades enligt patienten genom verbal och icke verbal kommunikation. Relevant information samt en ambulanssjuksköterska som var närvarande och hade ett lugnt bemötande skapade tillit. Resultatet presenteras enligt följande teman: Dialog med subteman; verbal och icke verbal kommunikation skapade tillit samt informationsöverföring skapade tillit. Professionalism med subteman; kompetens och kliniska färdigheter skapade tillit, lugn skapade tillit, en helhetssyn skapade tillit, förmåga att generera delaktighet skapade tillit samt närvaro skapade tillit. Slutsats: Tillit är en avgörande faktor för att patienten ska lita på ambulanssjuksköterskans kunskap och kompetens. Litteraturstudien bidrar med kunskap om hur tillit skapas och vilka förutsättningar som skapar en tillitsfull relation i det korta prehospitala mötet. / Background: Prehospital care is performed outside the safe environment of the hospital when a patient needs emergency care. The patient can feel powerless and experience the prehospital care as frightening. In the meeting with the patient the prehospital emergency nurse should be able to perform care that is systematic, supportive and deliberate. To be able to accomplish this care it is important to create trust. Previous research has shown that trust is an essential factor in the meeting with the nurse. Aim:The aim is to illustrate how the patient experiences trust in the prehospital setting with the prehospital emergency nurse. Method: Three systematic article researches have been conducted. Twelve qualitative articles were rated based on quality and included in the literature review. The articles were analysed based on a step-by-step guide. The guide is made for qualitative systematic reviews. Sentences that applied to the aim of the study were selected and open coding was conducted. Themes and subthemes constituted the result. Result: Trust was created by verbal and nonverbal communication. It was also important that the prehospital nurse provided relevant information, was calm and present in order for the patient to feel trust. The result was presented as follows: dialogue with subthemes: verbal and nonverbal communication created trust and information created trust. Professionalism with subthemes: competence and clinical skills created trust, calm created trust, a lifeworld perspective created trust, ability to create participation created trust and presence created trust. Conclusion: Trust was a vital factor for the patient to be able to trust the knowledge and competence the prehospital emergency nurse possesses. The literature review gave immersed knowledge regarding how to create trust and which parts that create a trustful relationship in the short prehospital care relationship.

Stroke är den näst vanligaste dödsorsaken i världen och den tredje vanligaste orsaken till funktionshinder. I Sverige drabbas cirka 25 000 personer årligen. Patienter med stroke är den enskilda sjukdomsgrupp som står för flest vårddagar på svenska sjukhus. I akut behandling av stroke används termen ”Time is Brain”, då det dör cirka två miljoner hjärnceller vid varje minuts fördröjning. Det har utförts stora ansträngningar i två decennier för att effektivisera akuta vårdkedjan vid stroke. Endast två till 13 procent av patienterna får möjlighet till behandling på sjukhus med trombolys och antalet trombektomi är mycket lägre. Av de patienter som får trombolys är det cirka en till tio procent som får trombolys inom en timme efter symtomdebut. Främsta orsaken till underbehandling är att patienter inte når sjukhuset tillräckligt snabbt för att undersökas och behandlas inom det smala terapeutiska fönstret. I Sverige år 2016 anlände 33 procent av patienterna med stroke inom tre timmar till sjukhus och antalet har inte ökat sedan 2011. Det var angeläget att beskriva befintlig kunskap om hur ambulanspersonal kan påskynda behandlingen för patienter med stroke. Syftet var att belysa ambulansteamets betydelse för att minska tiden från symtomdebut till behandling av stroke Metoden för studien var en litteraturöversikt med 16 vetenskapliga artiklar publicerade mellan åren 2012 och 2017. Artiklarna söktes i databaserna PubMed och Cinahl. Resultatet som framkom av de valda artiklarna kunde sammanställas genom två huvudkategorier och fem underkategorier. Den ena huvudkategorin handlade om ambulanspersonalens omhändertagande av patienter med stroke. Den andra huvudkategorin handlade om ambulanspersonalens kunskap. Resultatet visade att ambulanspersonal kunde genom teamarbete i ett ambulansfordon med en inbyggd röntgenapparat, kallad Mobile Stroke Unit (MSU), förkorta tiden från symtomdebut till behandling. MSU var mellan 25 till 81 minuter snabbare, jämfört med konventionell ambulans. Dörr-till-nål tiderna (tiden från det att patient ankommer till sjukhus till start av trombolys) förbättrades med fem minuter när ambulanspersonal förvarnade sjukhusen med strokelarm. Ambulanspersonal förbättrade inte akuta vårdkedjan med hjälp av telemedicin. Patienter med stroke i bakre cirkulationen hade en timmes prehospitala fördröjningar jämfört med patienter med stroke i främre cirkulationen. Akuta vårdkedjan förbättrades inte när ambulanspersonal fick en timmes föreläsning om stroke. Slutsatsen var att ambulansteamet förkortade tiden från symtomdebut till behandling genom teamarbete i Mobile Stroke Unit. Ambulansteamet förbättrade inte akuta vårdkedjan med hjälp av telemedicin. Det skedde prehospitala fördröjningar för patienter med stroke i bakre cirkulationen. Ytterligare forskning av MSU behövs. Framtida randomiserade studier bör undersöka kliniskt utfall och kostnadseffektivitet. Det bör även forskas i området om hur ambulansteamet kan minska tiden från symtomdebut till behandling av stroke i en konventionell ambulans. Nyckelord: stroke, ambulanspersonal, tid, prehospital trombolys, Mobile Stroke Unit. / Stroke is the second most common cause of death in the world and the third most common reason cause for disability. In Sweden approximately 25000 people are affected annually. Patients whit stroke are the group that accounts for most care days in Swedish hospitals. In acute stroke treatment, the term "Time is Brain" is used, as about two million brain cells die at every minute delay. Despite two decades of substantial efforts to streamline systems of care in stroke, only two to 13 percent of patients receive the treatment thtombolysis in a hospital and the rates of delivery of thrombectomy are far lower. Of the patients who are treated with thrombolysis, approximately one to ten percent receives thrombolysis within one hour after symptom on set. The main reason for such undertreatment is that patients do not reach the hospital quickly enough to be assesed and treated within the narrow therapeutic window. In Sweden 2016, only 33 percent of patients with stroke arrived to the hospital within three-hours after symptom on set and the rates has not increased since 2011. It was important to describe existing knowledge about how the ambulance staff can shorten the time from symptom on set to treatment for stroke patients. The aim was to highlight the importance of the ambulance staff to reduce the time from symptom on set to stroke treatment. The method of the study was a literature review of 16 scientific articles published between the years 2012 and 2017. The articles were searched in the PubMed and Cinahl databases. The results obtained from the selected articles were compiled by two main categories and five subcategories. One main category was about the care of ambulance staff in patients with stroke. The second main category was about the ambulance staff's knowledge. The result showed that ambulance staff can shorten the time from symptom on set to treatment though teamwork in an ambulance with an inbuilt CT-scan, called Mobile Stroke Unit (MSU). MSU was between 25 minutes and 81 minutes faster, compared to conventional ambulance. Door-to-Needle time (time from patient arriving to hospital until start of thrombolysis) improved with five minutes when ambulance staff warned the hospital with a strokealarm. Ambulance staff did not improve the system of care using telemedicine. Patients with stroke in the posterior circulation had one hour of prehospital delays compared with patients with stroke in the anterior circulation. The system of care did not improve when ambulance staff received an hour's lecture on stroke. The conclusion was that ambulance staff shortened the time from symptom on set to treatment through teamwork in the Mobile Stroke Unit. Ambulance staff did not improve the system of care using telemedicine. There where prehospital delays for patients with stroke in the posterior circulation. Further research of MSU is required. Further randomized studies should investigate clinical outcome and cost-effectiveness. It should also be researched in the area of how the ambulance staff can shorten the time from symptom on set to treatment in a conventional ambulance Keywords: stroke, emergency medical service, time, prehospital thrombolysis, Mobile Stroke Unit.

Bakgrund: Patienter tillbringar längre tid på akutmottagningen under 2018 jämfört med året innan. De lämnas ofta ensamma under många timmar i väntan på handläggning eller vårdplats. Kommunikationen och informationen mellan vårdpersonal och patienter är stundtals bristfällig vilket kan påverka patientens upplevelse av vistelsen på akutmottagningen. Syftet med studien var att beskriva patienters upplevelse av kommunikation och information vid ett besök på akutmottagningen. Metoden som användes var en allmän litteraturöversikt av både kvantitativa och kvalitativa artiklar. Sexton artiklar inkluderades. En innehållsanalys gjordes på artiklarnas resultat inklusive identifiering av meningsbärande enheter, kodning och syntetisering av innehållet till kategorier. Resultatet bildade tre huvudkategorier: Upplevelse av organisationen, upplevelse av vårdmiljön och upplevelse av vårdrelationen. Patienterna var i behov av en tydligare information gällande verksamhet och handläggning. Även brister i kommunikationen gällande exempelvis uppdatering av väntetider, undersökningar och provresultat framkom. Patienterna önskade en mer frekvent interaktion med sjukvårdspersonalen och kunde stå ut med väntetiderna bara de fick kontinuerlig information om förseningarna. Slutsats: Patienter kan känna sig övergivna och bortglömda på akutmottagningen. Att arbeta med personcentrerad vård på en akutmottagning är en utmaning även om behovet finns. En förbättrad kommunikation mellan vårdpersonal och patient kan påverka patientens upplevelse av akutsjukvård i en redan sårbar situation. / Background: Patients are spending more time at the emergency department in 2018 compared to the previous year. They are often left alone for many hours while waiting for treatment or care. A lack of communication and information between healthcare professionals and patients might affect the patient's experience of the stay at the emergency department. The aim of the study was to describe patients’ experience of communication and information during a visit at the emergency department. The method used was a general literature review of both quantitative and qualitative articles. Sixteen articles were included. A content analysis was performed, including identifying meaning units, coding and synthesizing the content into categories. Results: Three main categories emerged: Experience of the organization, experience of the care environment and experience of the care relationship. Patients were in need of clearer information about the expected course of events and management. Also lack of communication such as updating of waiting times, examinations and test results were identified. The patients wanted more frequently interactions with the healthcare staff and could endure the waiting times if only they were given information about the delays. Conclusion: Patients might feel abandoned and forgotten at the emergency department. To use a person-centered care at an emergency department is a challenge, even if the need exists. An improved communication between nursing staff and patients might affect the patient's experience of emergency care in an already vulnerable situation.

Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Of these, 30 underwent helicopter EMS ETI, 29 ground EMS ETI, and 6 ED ETI. Seventeen cases (26%) of tracheal tube misplacement were recognized. After multivariable analysis, tracheal tube misplacement was independently negatively associated with body weight (OR 0.86; 95% CI, 0.76–0.99; p = 0.032) and helicopter EMS ETI (OR 0.20; 95% CI, 0.04–0.97; p = 0.036). Two of nineteen patients received tube thoracostomy due to endobronchial intubation. Mortality and length of stay were comparable in patients with misplaced tubes and correctly placed tubes. The results suggest that particularly small children require attention to avoid tracheal tube misplacement, which emphasizes the need for special training. Helicopter EMS physicians’ expertise might be beneficial in prehospital pediatric trauma patients requiring advanced airway management.

Bakgrund: Forskning inom omvårdnad har betonat vikten av ett personcentrerat förhållningssätt i vårdmötet, varje patient ska betraktas som en unik individ med olika behov att tillgodose. För patienter med ett akut vårdbehov kan ambulanssjukvården vara det allra första mötet som de gör med hälso- och sjukvården. Tidigare forskning har beskrivit att omhändertagandet i prehospital akutsjukvård fokuserat på det medicinska tillståndet framför de emotionella behoven, vilket har betytt att behov ur ett holistiskt perspektiv inte alltid har tillgodosetts. Forskning från patienters perspektiv är bristfälligt, vilket innebär att patienters upplevelser och känslor inte prioriterats. Syfte: Att beskriva patienters upplevelser av att få sina grundläggande vårdbehov tillgodosedda i prehospital akutsjukvård. Metod:Litteraturöversikt med systematisk sökstrategi. Datainsamling gjordes via två databaser, PubMed och CINAHL. Totalt inkluderades 15 kvalitativa artiklar, publicerade mellan 2011–2023, analyserades med en integrerad analysmetod. Resultat: Beskrev patienternas positiva och negativa upplevelser i ett prehospitalt omhändertagande. Resultatet presenteras i tvåkategorier och fem underkategorier. Kategorierna som arbetades fram beskrev övergripande känslan av att vara patient i prehospital akutsjukvård, vilket belyser känslan av att överlämna sig själv och hur det är att vara patient i en ambulans. Ambulansteamets förhållningssätt belyser viktiga hörnstenar som delaktighet, värdet av dialog, att känna sig bekräftad eller stigmatiserad vid psykisk ohälsa. Resultatet utifrån artiklarna belyser fördelar medpersoncentrerad vård. Slutsats: Patienter som fick sina grundläggande vårdbehov tillgodosedda hade en positiv effekt på dem och även en positiv upplevelse utav ambulanssjukvården oavsett utfall. Genom att fokusera på patientperspektivet är det möjligt för framtida hälso- och sjukvårdspersonal att öka förståelsen och därmed förbättra kvalitén på vården, med betoning på personcentrerad vård. Det är viktigt att varje individ får vård och omsorg utifrån ett helhetsperspektiv där både de fysiska och emotionella behoven tillgodoses, oavsett om det gäller medicinsk vård eller omvårdnad. / Background: Research in nursing has emphasized the importance of a person-centered approach in the care encounter, where each patient should be seen as a unique individual with different needs to be met. For patients with an acute care need, ambulance care may be their very first encounter with health care. Previous research has described that care in prehospital emergency medicine has focused on the medical condition rather than the emotional needs, meaning that holistic needs have not always been met. Research from the perspective of patients is lacking, hindering a comprehensive description of their experiences and emotions. Aim: describe patients' experiences of having their basic care needs met in prehospital emergency care. Method: A literature review with a systematic search strategy. Data was collected from two databases, PubMed and CINAHL. A total of 15 qualitative articles published between 2011–2023 were included and analyzed using an integrated analysis method. Results: Described patients' positive and negative experiences in prehospital care. The results were presented in two main categories and five subcategories. The categories described the overall feeling of being a patient in prehospital emergency care, highlighting the feeling of surrendering oneself and what it is like to be a patient in an ambulance. The approach of ambulance staff highlighted important aspects such as participation, the value of dialogue, feeling validated or stigmatized in cases of mental illness. The results from the articles emphasized the benefits of person-centered care. Conclusion: Patients whose basic care needs were met had a positive impact on them and a positive experience with ambulance care regardless of the outcome. By focusing on the patient perspective, future healthcare professionals can increase understanding and improve the quality of care, with an emphasis on person-centered care. It is important that each individual receives care and support from a holistic perspective where both physical and emotional needs are met, whether it is medical care or nursing care.

The current system and working status of medical rescue service related to mass accidents has undergone changes in recent years, including gradual development, progress, modification and improvement. Together with that development, the conditions and opportunities needed for provision of timely and high-quality urgent pre-hospital care have transformed and improved automatically. The provision of professional pre-hospital urgent care for conditions endangering human life has been becoming the basic contents of activity of the rescue service. The care can be provided through operation centres that should receive and evaluate distress calls on line 155 and through field rescue vehicles pulling out of a network of trip points all over the country. The unification of the procedures and organization when settling mass accidents constitutes an indispensable measure leading to improvement of such interventions. The adequate procedure may lead to life rescue and to mitigation of the consequences of injuries for a number of persons equal to the number of the whole year of standard activity of the medical rescue service. Of course, the opposite may apply too. Therefore each physician or rescue worker should know the basic rules of behaviour at the point of the accident. The goal of the submitted dissertation is to map the general suggestions for the work of the medical rescue service of the Czech Republic, to analyze three medical rescue services related to mass accidents - that of the South Bohemian Region, the South Moravian Region and the Vysočina Region - and to compare weak and strong points of the medical rescue service of the Czech Republic based on the analysis of the three organizations in connection to mass accidents - of the Medical rescue service of the South Bohemian Region, the South Moravian Region and the Vysočina Region. Based on the SWOT analysis of selected medical rescue services, it was possible to identify their strengths and weaknesses, opportunities and threats. Each of the analyzed medical rescue services can see the opportunities of their respective organizations in other points. The medical rescue service of the South Bohemian Region sees its opportunities in the improvement of the education and training centre; the medical rescue service of the South Moravian Region sees its opportunities in the development of solution of mass accidents and the medical rescue service of the Vysočina Region sees its opportunities in finishing the urgent admission and first aid for schools; but all the analyzed medical rescue services see their threats in the expected lack of funds, caused by funding of new ambulances or new trip points or by increasing wages in the public sector. The lack of physicians in permanent employment is not only a matter of the above stated rescue services. The problem has countrywide character at present. The importance of the lack of physicians is not proportionally dependent only on cases of mass accidents. At present, it can be stated in general that there are multiple causes of lack of interest for internal work in rescue service. Low attractiveness of work in ambulance crews of rescue services becomes one of the main causes. Also the working conditions are usually incomparable. The crew of the rescue service must perform actions of pre-hospital urgent care in field under all and any circumstances. Another difference, as compared to the work of a physician in the hospital, consists in the need of right and quick decision-making without the opportunity to consult a specialist and without support of laboratory examinations. So the rescue service physician must constantly master different situations, from childbirth to post-mortem examination.

This thesis is divided into two basic parts a theoretical and a practical one. Its aims are to evaluate the emergency preparedness of the chosen regional emergency squad to emergencies and the efficiency of the feedback on an emergency as well as to compare the amount of human forces and the means used in chosen emergencies. Hypotheses are added to individual aims. The theoretical part constitutes an introduction to the topic. The Integrated Rescue System and the classification of incidents are mentioned in the first chapter. The second chapter is focused on an emergency, its definition and a possible procedure of rescue squads dealing with an emergency as well as on the way the injured are sorted. Following chapters deal with crisis management in health care with an emphasis on crisis management planning and preparation of individual. Last two chapters of the theoretical part are devoted to the Emergency Medical Service of the Central Bohemian Region and material and technical equipment important for a successful dealing with emergencies is mentioned there. In order to achieve the first goal, i.e. to evaluate the emergency preparedness of the chosen regional emergency squad to emergencies, I made a survey via questionnaires which was divided into two parts: The purpose of the first part was to evaluate the preparedness of the Emergency Medical Service of the Central Bohemian Region as a whole, which was achieved via a questionnaire survey conducted among medical employees working in leading positions. In order to compare the survey results with those of the South Moravian and South Bohemian Regions, the questionnaire was borrowed from Mgr. Zuzana Němečková after her personal consent. The second part is based on a survey via questionnaires the target group of which was the medical personnel of the Emergency Medical Service of the Central Bohemian Region. The questionnaire was designed according to a questionnaire by Mgr. Zuzana Táchová after her personal consent in order to compare her results received in Nemocnice České Budějovice, a.s. České Budějovice Hospital. The results of both surveys are thoroughly analysed in the discussion part. However, as regards the preparedness of the Emergency Medical Service of the Central Bohemian Region, there was no difference found compared to the preparedness of medical facilities of the South Moravian and South Bohemian Regions. On the other hand, there was quite a surprising outcome of the survey conducted among the medical personnel of the Emergency Medical Service of the Central Bohemian Region. From the statistical measurement, it was revealed that the results achieved by the medical personnel working for the Emergency Medical Service of the Central Bohemian Region for a longer time were worse than those achieved by the medical personnel with a shorter work experience. For the purposes of the second and the third aim of this thesis, namely the evaluation of the efficiency of the feedback on an emergency and the comparison of the amount of human forces and the means used in chosen emergencies, I have chosen two emergencies which took place in the Central Bohemian Region. Consequently, I compared both of them with the Recommended Procedure No. 18 issued by the Czech Society for Emergency and Disaster Medicine within the Czech Medical Association of J. E. Purkyně Health Affected in Disasters coping with the situation on scene by the emergency medical service. The outcome of the comparison is thoroughly analysed in the discussion part. In conclusion, it is possible to state the importance of the final report on the intervention.

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.