SUMMARY. Emergency Medicine (EM) has evolved since 1950s- in the Czech Republic as well as abroad-from Anaesthesiology and Resuscitation in parallel with the Burn Medicine which has separated from Plastic Surgery. EM creates a link between the laymen first aid and the specialized hospital care, which is realized by the Emergency Medical Service (EMS). The EMS interventions for serious burn patients comprise the early professional prehospital medical care: establishing free airway and breathing, establishing intravenous/intraosseous access into the blood circulation, early shock therapy, early pharmacotherapy and analgesia. aseptic covering of damaged body surface, releasing escharotomies of circumferential burns of the chest and neck and optimal transport of patients into burn centres..
In der Tschechischen Republik hat sich die Notfall Medizin vom Fachgebiet Anästhesiologie and Resuszitation im Jahre 1998 getrennt. Die Spezialisten für die Notfall Medizin werden vorwiegend im Rettungsdienst angestellt. Die Notärzte leisten den Verletzten die erste ärztliche Hilfe auf dem Unfallort. Im Rahmen einer Betreuung von schwer verbrannten Verletzten leisten die Ärzte folgende Eingriffe. die das Risiko des Todes vermindern oder eliminieren:
Der Arzt muss auf dem Unfallort den Umfang and die Schwere der Verbrennungsverletzung beurteilen and einen entsprechenden Transport der Verletzten wáhlen. Die Verletzten sollten in eine spezialisierte Klinik innerhalb vier Stunden gebracht werden (die Kinder innerhalb einer Stunde).
Key words: burn patient, on the spot care for severe burn patients, prehospital medical care, emergency medicine, emergency medical service, directing of burn patients
Emergency medicine has evolved in the Czech Republic as well as abroad from Anesthesiology and Resuscitation (Critical Care Medicine). From 1970s anaesthesiologists have organizatory and professionally carried out the Rapid Medical Aid, the predecessor of the contemporary Emergency Medical Service (EMS). Anaesthesiologists are optimally trained to provide the qualified lifesaving care in critical states due to the insufficiency or failure of vital functions from any origin.
In first phases of the burn injury they assist the severly afflicted patients as follows:
For all 50 years of existence and development of the specialized care for severe burn patients in the Czech Republic anaesthesiology and resuscitation (critical care) in parallel has developed from the most modest beginnings to the basic medical specialization.
The severe burn injury imposes on the anaesthesiologist unique problems:
In the Czech Republic, the Emergency Medicine has achieved the position of higher medical specialization in 1998. Now, we have 256 specialists, including 12 from the Slovak Republic. Most specialists are working in the Emergency Medical Service, and in hospital emergency departments. In the last years, the number of emergency departments in hospitals has been increasing. The emergency department is the best equipped working place in the hospital to ensure fluent and faultless transfer of severe wounded and ill patients from the prehospital into the inhospital immediate and specialized care. Emergency medicine, provided by the EMS, creates a link between the layman first aid on the spot of injury and the specialized care available in burn centres.
The major contribution of emergency medicine for the prognosis of severely burned patients is the raised professional level of care on the spot early after the accident. In the EMS Rapid Rescue Teams there are physicians-specialists in emergency medicine and their closest co-workers are paramedics.
In case that the injured are given the layman first aid, the members of the EMS Rapid Rescue Team continue with the care, they are the first ones who are starting the medical care. Due to the EMS organization, modern equipment and qualification, they can reach the spot of accident in 15 minutes after the emergency call and can start to perform the interventions of the prehospital immediate care, namely:
Contemporary connection methods by wire and mobile telephones enable the citizens to inform by emergency call the operators of the EMS Medical Dispatching Centre of the need for the EMS help very quickly after the accident. The modern EMS Medical Dispatching Centre equipment enables to react immediately after the emergency call and to use up personnel and technical means for providing optimally rapid and effective prehospital immediate care in single or multiple burn victims occurrence.
The covering of the whole state territory by surface and air mobile EMS means enables us to offer a severe burn patient anywhere on the Republic's territory in the shortest time professional medical care on the spot by the EMS workers and to transport him directly to the place of definitive specialized treatment in one of the Burn Centres (Praha, Brno, Ostrava).
In the last 50 years, the Rescue Service was able to ensure, according to its equipment and possibilities, the rapid transport of severe burn patients and other seriously wounded and ill patients from the spot into the nearest hospital. The equipment of old ambulance cars have made possible but the transport. The treatment or monitoring possibilities were limited. The Rescue Service physicians were able just to watch the patient. They were not trained for the prehospital immediate care and for their job in the EMS any medical speciality was acceptable. They were expected to be able to offer the first aid only. For such system there is used the term "scoop and run".
In the year 1974, the Ministry of Health has issued 4 Methodical Measures of basic importance which have proved to be the starting point for transformation of the Health Care according to the principles of Differentiated Care and for building up Emergency Medical Service - most often at the Departments for Anaesthesiology and Resuscitation (Critical care). In the EMS Rapid Rescue Teams most often anaesthesiologists were sent out to take care of seriously ill patients on the spot. So the realisation of the principle "stay and play" has started. The physician is going out to the see the patient in order to offer him early medical care. This change has brought with significantly better results in the care for patients in critical state. The Emergency Medical Service turned to be an "extended hand of the hospital".
The material equipment of ambulance cars and helicopters has been gradually improved. This modern level enables the care of severe burn patients on the spot by means comparable with the equipment of the hospital Emergency Department.
In 1995, the profession "paramedic" for high school graduates and in 1999 higher medical specialization "Emergency Medicine" were established.
The Chair for Emergency and Disaster Medicine in the Institute for Postgraduate Medical Education in Prague has organized since 1994 educational courses "Method and Training of Cardiopulmonary Resuscitation" for all physicians and "Basic Emergency Medicine" for physicians working in the EMS whose main job is in another medical profession. They must be ready to face critical states not seen in their specialization.
Since 2001, the Chair has organized and realized for physicians of all specialities before their I. degree specialization examination obligatory course "Medical First Aid". For medical workers non-physicians obligatory courses "Urgent First Aid" are organized.
Since the establishment of the higher specialization the Chair every year has arranged specialization courses for applicants to achieve the speciality. It should be stressed that in this medical specialization there are only contained chapters from disaster medicine to prepare physicians working in the EMS for the organisation and management of rescue operations to face the mass casualties after accidents and disasters.
In the year 1992 there was issued the Order of the Ministry of Health "On the Emergency Medical Service". Since then District and Regional EMS Centres were given rise separately from hospitals as independent legal subjects. Now, they possess modern motor-car base and a logistic base, they posses conditions for rapid organization of rescue operations in individual as well as in mass casualties, they possess a modern Medical Dispatching Centre, the connection to the Air Rescue Service and they have their own personnel, including physicians.
The co-operation of Anaesthesiology and Resuscitation and Emergency Medicine with the Burn Medicine has developed beneficially and efficiently for severe burn injuries.
Address for correspondence: