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An unexpected incident is not everyday issue for a Pre-hospital emergency care nether hospital emergency care operative. However in the case of its occurrence and need of solving a high number of patients it is necessary to be at least basically informed about this matter. It is important to realize that the pre-hospital emergency care, which is given to the patient at the place of accident is as important as the care given to the patient later in the hospital. In the present diploma thesis we tried to find out the theoretical knowledge of selected participants from the ranks of non-medical workers in health care. To this end, we created three goals: to evaluate the level of theoretical knowledge in dealing with emergencies with mass disabilities, evaluate the personal experience with active emergencies with mass disabilities and to evaluate the education and training of non-medical medical staff in the inpatient part of RES in selected hospitals in the South Bohemian region to deal with emergencies with mass disabilities. We used three research questions to determine these goals: What is the knowledge of non-medical staff of the inpatient part of in solving the problem of emergencies with a massive disability? How did the non-medical medical staff of the inpatient part have an extraordinary value event with a collective disability in which it was present? What is the attitude of non-medical medical staff of the inpatient part of RES in selected hospitals in the South Bohemian Region to the preparation and education in the field of dealing with emergencies with mass disabilities? The research was conducted using a qualitative method of semi-structured interview. In these interviews, we focused on the issue of emergencies with mass disabilities, the classification of patients and the link between pre-hospital emergency and emergency hospital care. From the analysis we found out that each respondent was able to give a solution of accepting patients at a hospital. From the interviews we also discovered that a great problem was reading sorting and identity cards of patients who come from the place of incident. A great part of participants had no knowledge about these generally. So exercising and education would be convenient for all participants.

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.

Theoretical part of the diploma thesis is focused on preparedness and crisis management of healthcare services during occurrence of emergency event with mass health disability. The first chapters provides simple and complete overview of various types of catastrophes, the explanation of emergency events, their causes and outcomes. Theoretical part deals with analysis of Integrated rescue system and puts emphasis on Medical rescue service and its role in mass health disability control in pre-hospital phases. The whole chapter is devoted to recommended procedure of resolving emergency event with mass health disability in the medical facility. Other chapters emphasize on medical facility crisis preparedness focused on traumatological plan. The aim of the diploma thesis was to find out the contemporary state of crisis preparedness of Nemocnice Písek, a.s. emphasizing on traumatological plan and to identify its potential deficiencies as well as to find the best possible solutions that would eliminate the problem to minimum or would remove the problem completely. The second mainstay of the diploma thesis was to evaluate knowledge of medical staff in Nemocnice Písek, a.s. concerning the issue of traumatological planning and evaluate their preparedness to admission of patients during mass health disability and providing quality medical and nursery health care. In my diploma thesis I also looked into the case whether the researched medical facility organises practices of crisis preparedness of traumatological plan in collaboration with the Integrated rescue system, which make the major presumption for quality and professional managing of emergency event with mass health disability. SWOT analysis was used to achieve the set goals, a managerial tool which aims at evaluation of internal and external environment of medical facility through strengths and weaknesses, opportunities and threats, was used. Quantitative research was also used in the thesis, particularly the method of questionnaire survey which gathered data about traumatological planning awareness and attitude of researched group of respondents. The results of questionnaire survey were surprising. Medical staffs are theoretically aware enough of procedures necessary for handling with emergency event with mass health disability according to the traumatological plan. On the other hand, the negative finding is the fact that 74% of medical staff do not participate in practice to handle mass admission of injured people, which in my opinion shows underestimation of the preparedness of the medical facility for emergency event or crisis. The traumatological plan of the chosen medical facility follows the regulations given by the valid legislation and is regularly updated but the interview with the head doctor of the surgical department MUDr. Marta Horáková reveals the weaknesses of traumatology planning. The traumatological plan contains practical deficiencies so that it is recommended to make it more specific, detailed and adapted to technical disposal of the hospital. In particular, the system of calling out the staff in case of traumatological plan activation during out of working hours has not been fully resolved; furthermore, direction points for the Integrated rescue system and the public have been marked insufficiently or have not been marked at all. The last major weakness is the absence of contact point for the media or the public. In the final part of my thesis I suggested measures for elimination or at least reduction of the crisis points.

Trauma preparedness of medical care of a particular region represents the professional core of public health emergency preparedness. The key subjects are medical rescue service and hospital service provider. Current legislation imposes the providers of medical service with duty to work out the trauma plan which covers the system of activities used if some mass disaster happens. Topic of this diploma thesis focuses on trauma planning, specifically on mass health damage and on knowledge mapping and medical staff orientation in trauma plans and preparation on not common accidents with great number of wounded. I focused on non-medical staff of the regional emergency rescue service and the regional hospital. I focused on their knowledge and orientation in terms of trauma preparedness of the given subject. The theoretical part serves as a base for the research. It is split into chapters which deal with pre-hospital necessary care, co-operation of the integrated rescue system members and procedures of participating rescuers- mostly medical staff. I paid more attention to the terminology of mass health damage and separation of wounded at the place of an accident. I also described the subsequence of medical care at medical facilities. While searching for the level of preparedness of subjects for an uncommon accident I used the method of data comparison. There I focused on comparison of trauma plans of two subjects: the regional hospital and the regional emergency rescue service and I was researching the level of co-operation of both subjects based on the similarity of the trauma plans. In the second part I was mapping the medical staff knowledge of the trauma plan directive via quantitative research, for that purpose I used the survey. The respondents had to circle the correct answer. The questions were modified and applied to directives of both trauma plans. The respondents were non-medical workers of emergency rescue service in CB and non-medical workers of the hospital of CB. I tightened the workers of the hospital to trauma emergency staff and the resuscitation department staff. The survey consists of 28 questions. Five of it had rather an information character, they were searching for: the sex, age, years of praxis, education and a grade. The rest 23 were used for the statistic research. Those questions dealt with the theory presented in directives of both subjects. The received information I worked out in the chapter results. The comparisons of trauma plans were presented at charts. The survey was evaluated by nonparametric testing and a chi-square test of a good match.

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

Reception of a large number of the injured to a medical facility as a result of a mass disaster or a catastrophe puts high demands on health care. Such situations can not be dealt with the mere improvisation; it is necessary to create unified organizational procedures defining the composition of medical teams and their activities during the multiple reception of the injured to a medical facility. The theoretical part of this thesis provides a comprehensive overview of the current state of emergency preparedness in healthcare facilities. In the empirical part, I analyzed the readiness of health facilities for a mass disaster in the capital city of Prague. A structured interview with open questions was chosen as a method of data collection. Based on the survey, I concluded that the readiness of health facilities in the capital city of Prague differs. I recommend setting up a phone line while receiving patients as a result of a mass disaster in order to improve the situation in Prague. The sole purpose of such a line would be reporting emergencies. I also recommend health care facilities participate actively in exercises within the integrated rescue system and clearly identify and determine facilities where the reception of the injured takes place if a mass disaster occurs. Keywords: mass disaster,...

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.

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.

This work focuses on finding state of preparedness of hospitals with acute inpatient care in the Pardubice region in the case of a direct threat to the Pardubice Regional Hospital, Inc. (hereinafter "PRH") by chemical, biological, radiological or nuclear agents (hereinafter referred to as "CBRN"). The thesis is based on a comparison between the trauma plans that have been established as an indicator of a preparedness of hospitals in case of mass disaster and the legal standard, i.e. Decree No. 101 of 2012 Sb. dealing with the details of the content of trauma plan of the one-day or inpatient medical care and process for its preparation and negotiation, as amended (hereinafter the "Decree 101 of 2012"). The theoretical work describes the applicable laws governing the conditions for the provision of health care, trauma plan content and procedures of the Emergency Service (ES) components in preparation for dealing with emergencies. The next part discusses the characteristics of CBRN agents. Furthermore, the work focuses on defining terrorism and CBRN terrorism. The chapter also includes a brief historical summary of the use of CBRN agents and their threats. The following section describes the Security System of the Czech Republic and its elements. It is crucial to mention its existence in relation to the prevention of emergencies and crisis situations and elimination of their consequences. This part also introduces a selection of documents, which have a direct relationship to the security policy of the country and to this thesis. It may be noted that most of these documents have been prepared, inter alia, on the basis of current CBRN threats. The penultimate section characterizes individual hospitals with acute inpatient care in the Pardubice region and includes also a risk analysis of this region. The analysis is based on the Emergency Plan of Pardubice region. I believe that the knowledge of the possible threats pointed out in the risk analysis is important in a preparation for an emergency response in the relation to an emergency medical care. Analysis of risks and threats, based on the Decree 101 of 2012, is also a part of the trauma hospital plans. The last part of the thesis describes the different types of trauma plans and certain procedures in the process of an activation of these plans. Even though, the theme of the work is focused more on trauma plans of hospitals, in cooperation with ambulance services and regional authorities in addressing the consequences of emergencies, I find it important to pay attention to a trauma plan for emergency medical services, and also the one, which is part of the emergency plan of the region. Based on the practical experience it was decided the readiness of hospitals with acute inpatient care in the Pardubice region in case of a threat PRH is sufficient. Subsequently, a relative comparison of interdependence trauma plans was performed in selected hospitals to evaluate their index of readiness by means of comparative analysis. The overall index IPi scales the state of preparedness of the hospitals. The input parameter?s values for the index evaluation were determined based on the contents of the trauma plans. The concluding chapter presents the results evaluated by the described method. This uncovered that the degree of readiness of the examined hospitals, based on the mentioned parameters, was insufficient in three cases. Only Chrudimska Hospital, Inc. achieved satisfactory results. Based on these results, the specific measures were recommended to be taken the level of preparedness of the hospitals. The findings and the results of this thesis are mainly practical. The most important benefit of this work is the suggested measures for the activation of trauma plans for hospitals with acute inpatient care in the Pardubice region.

Exercising their profession, nursing staff in health facilities may commit a fatal mistake in tense moments in terms of time. An illustrious example may be the admission of a higher number of casualties after an emergency event. So that to prevent these negative consequences, emphasis is put on the readiness of the entire health system from the headquarters to individual care providers. Special attention is also paid to trauma planning, because especially in complex cases greater demands are developed on the functioning and rapid succession of individual operations of medical care, along with observing all approved medical principles, of course. To verify the readiness and to reveal any shortcomings and reserves tactical exercises are held. The Krnov hospital also participated in that kind of training with activating the trauma plan. Another workplace involved was also the radio-diagnostic department. A simulated bus accident was to reveal whether the individual workplaces could provide adequate examinations and treatment. The thesis is divided into several parts. In the introductory section it is explained in brief how the health system is organized. To understand the text, it was necessary to define the necessary terminology and to mention the binding, legal legislation for emergency management authorities at all levels that affect the operations and carry out supervision on medical institutions. Gradually, the theoretical part presents trauma plans, sorting out casualties in the place of an emergency event, and specific exercises in the Krnov hospital that were announced and carried out in the early afternoon, when the hospital was fully filled with staff members. In the research part the analysis of a real accident that occurred in a late evening about a year later is made. Time demandingness of individual examinations is evaluated. Factual results are compared with the data obtained from simulated exercises. In the final part I tried to assess the quality and topicality of the trauma plan elaborated by our facility as well as the internal trauma plan of the RDG department and to propose possible changes and improvements.

The theme of my diploma is the Logistic indemnity of medical interference within the area of multiple victim accidents. The world was struck by natural disasters during its long history. As well as the strengthening of natural disasters, the appearance of the disasters caused by human activity has been increasing in recent times, and at present and their after-affects are more destructive. This diploma is taken as a overall cross {--} sectional study of the topic of logistic indemnity of medical interference within the area of multiple victim accidents. After a brief approach of the history of prehospital care the diploma is focused on legislative regulation of this theme including processing of emergency plans and traumatological plans, financing of crisis set-ups, special training, procedure of salvage and liquidation operations of the units of integrated rescue systems and logistic indemnity of medical interference in the form of material and technical special equipment including human sources and psychological support. This diploma also includes some special problems of this topic (e.g. processing of traumatological plans, financing of crisis set-ups, labels of multiple victim accidents).

This bachelor{\crq}s work is concerned with the principles of crisis management and planning in the area of health service. A special attention is paid to the Rescue Service as the crucial link of the Integrated Rescue System. The theoretical part of the work provides a kind of simplified summary of information from the area of the theory of crisis management and planning. Subsequently, the basic principles of crisis management in health service are defined. The core part of this work deals with specific conditions of the Plzeň Region, unveils the basic features of the crisis plan of this region, as well as analyses the traumatological plan of the Plzeň Region and verifies its effectiveness. The work ends with the assessment of the standard of crisis management in the territory of the Plzeň Region.

The main objective of my work was to summarize entire information available about performance efficiency of rescue teams (hospitals) at massive reception of patients to hospitals. As a sample, the hospitals in South Bohemia were chosen, and that local, district and teaching hospitals as well. Even that each of the hospitals has their own traumatology emergency plan, you can hardly think of readiness without knowledge of the contents of the plan on the side of the individual administrators involved. In addition, the hospitals do not know accurate or theoretical numbers that would evaluate the performance efficiency of their rescue teams. I have collected the data from current operation of the hospital; from scheduled operation of the hospital under the conditions of massive reception of the likely affected; and from professional literature. Firstly, I focused on various causes of emergency or crisis situations, on classification of those, considering the place of origin, and on their sorting that is used as a base in order to activate the traumatology plan and the rescue team in the hospital. Secondly, I described the pre-hospital medical care at emergency and crisis situations that is covered by the medical rescue service within the Integrated Rescue System-i.e. the time before the traumatology is activated, and the people affected are received into the hospital. Thirdly, I worked with traumatology plans in the hospitals, explaining why they should exist in every hospital. After that, I described the traumatology plans of the individual hospitals that had been chosen as samples. (The Hospital České Budějovice a.s. is a teaching (big) hospital; the Hospital Tábor a.s. is a district hospital (medium type); the Nemocnice Prachatice a. s. is a local (i.e. small) hospital). Then, I processed the responses by head physicians in the trauma centres in the sample hospitals: I had asked questions related to their orientation and knowledge of the performance efficiency of their rescue teams and to activation of the traumatology plan of the hospital at massive reception of the affected. Finally, I confronted my results with the information in professional publications, especially in the article written by MUDr. Pavel Urbánek ``The Link-Up between the Pre-Hospital and Hospital Care in Case of Massive Disaster{\crqq}; then, I compared my results with the hospital medical care and capacity of hospitals in the Netherlands. In conclusion, I present my evaluation of the existing situation, following from the data and knowledge collected; there are proposals of my solutions as well.