The need for increasing efficiencies for medical resource delivery during a mass casualty incident/event is a paramount logistical planning factor that could mean life or death to the citizens affected by a disaster. As such, Washington State has prioritized emergency management and preparedness. Using the just-in-time system by way of Baghbanian' s complex adaptive decision-making theory as the foundation, gave purpose to this qualitative study. This was accomplished by analysis of emergency management professional responses, and to what degree, improvements can be made to the medical resource delivery system during a mass casualty incident/event. Data were collected through semi structured interviews with a random sample of 12 experienced emergency professionals from the State of Washington. This study was guided by primary research questions that focused on emergency managers and their understanding and adaptability toward preparedness. Interview data were deductively coded and analyzed through a thematic analysis procedure. The key theme of this study is that participants perceived slight differences in logistical and operational approaches that vector into transportation and operational understanding as the main factors influencing medical resource delivery. The positive social change association of this study is that it provides emergency managers, first responders, and medical staff with recommendations for analysis and planning development for medical resource delivery, thereby mitigating the life and death implications for citizens in future disasters.

In this thesis we introduces the user interface design and forensic analysis tool for DIORAMA system. With an Android device, DIORAMA provides emergency personnel the ability to collect information in real time, track the resources and manage them. It allows the responders and commanders to mange multiple incidents simultaneously. This thesis also describes the implementations of commander app and responder app, as well as two different communication strategies used in DIORAMA. Several trials and simulated mass casualty incidents were conducted to test the functionalities and performance of DIORAMA system. All responders that participated in all trials were very satisfied with it. As a result, DIORAMA system significantly reduced the evacuation time by up to 43% when compared to paper based triage systems.

<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>

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.

In 2011 and 2012, dramatic changes were made to the health care reform in the Czech Republic. As a consequence, almost the complete legislation related to traumatological planning was changed. This reform primarily introduced two new types of operating divisions; a department of emergency preparedness, as for the emergency medical service providers, and a contact point, from the aspect of emergency inpatient care providers. Emergency preparedness primarily processes a concept of the traumatological plan for the emergency medical service and introduces potential changes. The contact point, as a department of the emergency inpatient care with continuous operation, receives calls from the emergency medical service, especially in the event of emergencies and crisis situations. The given Master's Diploma Thesis entitled "Cooperation of the Trauma Centre of the Hospital České Budějovice and Medical Operation Center of the Emergency Medical Service of the South Bohemian Region in the Event of Mass-Casualty Incident" develops a key issue of the interconnection of traumatological plans established by health service providers within the South Bohemian Region and the level of their cooperation. Then the work analyses three mass-casualty incidents which happened in the past within the area and the level of involvement and cooperation of the aforementioned departments, i.e. the Hospital's trauma centre and Medical Operation Centre upon the Medical Emergency Centre of the Region of South Bohemia. The Diploma Thesis proceeds from the qualitative research which is divided into two parts. The first one defines the V1 research question specifying the role of the Traumatological Plan of the South Bohemian health care during the cooperation with the trauma centre under the Hospital České Budějovice and medical operation centre of the Medical Emergency Service of the South Bohemian Region in the event of a mass-casualty incident. By using a comparative method, which assessed the three traumatological plans, the level of cooperation did not exceed more than 20 % owing to the fact that the Traumatological Plan of the South Bohemian health care is out-dated. As a consequence, the answer to the V1 research question was following: The role of the Traumatological Plan of the South Bohemian health care with the cooperation of the trauma centre under the Hospital České Budějovice and Medical operation centre of the Medical Emergency Service of the South Bohemian Region in the event of a mass-casualty incident is insignificant. The second part develops the V2 research question: whether the failure in communication between the aforementioned trauma centre and medical operation centre could have any impact on the injured in the event of a mass-casualty incident. The qualitative research with the use of a method of analysis implemented during the previous mass-casualty incidents and interviews with four operators working for the medical operation centre and four doctors working at the accident, emergency and plastic surgery department provided the second answer to the V2 research question: Failure in communication between the two aforementioned departments could have a significant impact on the injured in the event of a mass-casualty incident. In the end, the thesis refers to the dramatic difference between the ideal traumatological planning and the current situation pointing out the Traumatological Plan of the South Bohemian healthcare which has not been updated for three and a half years since the reform. The given work also describes the issue of the ideal solution to the establishment of contact points in hospitals and compares it with the current situation at the Hospital České Budějovice where the contact point was established only in order to comply with the legislation, i.e. the contact point is based in the operating centre of medical transport.

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.

The goal of this thesis was to analyze processes of the Emergency Medical Dispatch Center of the Emergency Medical Service of the Pilsen Region (ZOS ZZS Pk) when dealing with a mass casualty incident. The theoretical part of the thesis provides basic information relevant to the Pilsen Region, the Emergency Medical Service of the Pilsen Region, basic information on operations and general work processes of an emergency medical dispatch center during a normal work regime, and specific activities performed when dealing with a mass casualty incident. The research part of this thesis analyses activities and processes of an emergency medical dispatch center as described in the Mutual Mission Types Manual for Integrated Rescue System forces while at a mutual incident - Activities of Integrated Rescue System Forces at a Mass Casualty Incident (STČ 09/IZS). Further on the thesis evaluates activities of the ZOS ZZS Pk taken while dealing with two mass casualty incidents. These were a bus accident nearby Rokycany town in 2013 and a two trains collision nearby Horažďovice town in 2015. In order to make the analysis of readiness of the ZOS ZZS Pk to deal with mass casualty incidents more complex, SWOT analysis was added to the results. Based on the results of the STČ 09/IZS-manual analysis and of the SWOT analysis, suggestions for new manuals were made, that should make all the actions taken by employees of the ZOS ZZS Pk while dealing with a mass casualty incident more efficient and more effective. The goal of this thesis: to analyze activities of the ZOS ZZS Pk while dealing with a mass casualty incident, and to create suggestions of which inadequacies to remove and how to make operations of the ZOS ZZS Pk more efficient and more effective when dealing with mass casualty incidents; has therefore been fulfilled. The main outcome of the thesis are the final recommendations for making operations of the ZOS ZZS Pk more efficient and more effective when dealing with a mass casualty incident.

Syfte: Att kartlägga triagekunskap hos kliniskt verksam ambulanspersonal i en masskadesituation med patientfall från MACSIM. Metod: Studien är en kvantitativtvärsnittsstudie som baseras på en webenkät med 84 respondenter som arbetar inom ambulansverksamheten. Enkäten innehöll slutna bakgrundsfrågor och ett kunskapstest med 30 patientfall som bygger på simuleringsverktyget MACSIM. All data bearbetades med analytiskoch deskriptiv statistik. Resultat: Studien resulterade i totalt 2520 triageringar, inklusive 924 triageringar av barn. Resultatet visar total korrekt triage (66,8 %), undertriage (17,9 %) och övertriage (15,2 %) samt triage av barn som visar korrekt triage (72,7 %), undertriage (8,4 %) och övertriage (18,8 %). Studien visar signifikanta och icke signifikanta skillnader i ovanstående triageresultat beroende på bakgrundsfaktorer. Konklusion: Det framkommertydligt i denna studie att ambulanspersonal är i behov av mer utbildning i hur man triagerar enligt sållningstriage vid en masskadesituation. Sållningstriage är tänkt att vara ett enkelt tillvägagångssätt under det första triaget vid en masskadesituation. Trots detta var det bara ett fåtal av deltagarna som hade en acceptabel nivå av såväl korrekt triage som undertriage.Däremot visar det totala resultatet en acceptabel nivå av övertriage. / Aim: The aim of this study is to identify triage knowledge of clinically active ambulance personnel in a mass casualty incident (MCI) with patient cases from MACSIM. Method: The study is a quantitative, cross-sectional study based on a digital survey with 84 respondents working in the prehospital organization. The survey included closed background questions and a knowledge test with 30 patient cases based on the simulation tool, MACSIM. All data were processed with analytical and descriptive statistics. Results: The study resulted in total of 2520 triages, including 924 triages of children. Results showed a total correct triage (66,8 %), undertriage (17,9 %) and overtriage (15,2 %) and triage of children showing correct triage (72.7%), undertriage (8.4%) and overtriage (18.8%). The study shows significant and nonsignificant differences in the above triage results depending on the background factors.Conclusion: It stands clear in this study that ambulance personnel need more education in how to triage according to MCI triage. MCI triage is supposed to be an easy approach during the first triage in an MCI. Even so, only a small number of the participants had an acceptable level of correct triage as well as undertriage. However, the overall result showed an acceptable level of overtriage.