Paramedics in the State Fire Service - from Theory to Practice

Cel: Celem artykułu jest analiza prawnych aspektów funkcjonowania ratownika medycznego w jednostkach Krajowego Systemu Ratowniczo-Gaśniczego (KSRG). W artykule określono także obszary, w których wskazane jest wykorzystanie wiedzy i umiejętności ratowników medycznych w ramach funkcjonowania KSRG, oraz przedstawiono ocenę stanu zatrudnienia tej grupy zawodowej w Państwowej Straży Pożarnej (PSP). Wprowadzenie: Liczba ratowników medycznych w KSRG stale rośnie, choć w poszczególnych województwach jest ona zróżnicowana. Zauważalna jest jednak także niekorzystna tendencja – tylko co trzeci ratownik medyczny chce utrzymać swoje uprawnienia uzyskane na studiach lub w studium. Wnioski: Analiza aktów prawnych pozwala zauważyć pewne sprzeczności w ich zapisach, co oznacza, że konieczne jest doprecyzowanie obecnie funkcjonującego prawa. Sytuacja ta powoduje, że osoby decydujące o kształcie KSRG ostrożnie podchodzą do zmian w zakresie ratownictwa medycznego. Równocześnie coraz częściej można spotkać jednostki Ochotniczej Straży Pożarnej (OSP) specjalizujące się w ratownictwie medycznym, w tym te wyposażone w ambulanse. Należy podkreślić, że liczba tzw. izolowanych zdarzeń ratownictwa medycznego, a więc tych, podczas których jednostki KSRG prowadzą działania z powodu czasowej niewydolności Państwowego Ratownictwa Medycznego (PRM), stale rośnie, w związku z czym wymagania wobec ratowników w zakresie ratownictwa medycznego się zwiększają. Coraz większe są też wymagania prawne dotyczące zapewnienia bezpieczeństwa ratownikom podczas skomplikowanych i niebezpiecznych działań oraz ćwiczeń. W zabezpieczeniu prowadzonych przez siebie działań i ćwiczeń jednostki KSRG często chcą posiłkować się zespołami PRM, co spotyka się z odmową dyspozytorów medycznych (brak odpowiednich regulacji prawnych). Muszą być wówczas stosowane rozwiązania doraźne, a nie systemowe, co niekiedy wiąże się z dodatkowymi kosztami. Z uwagi na obowiązkowe wyszkolenie każdego ratownika PSP w zakresie kwalifikowanej pierwszej pomocy, a także z uwagi na wynikający z prawa system przeprowadzania – co trzy lata – egzaminów potwierdzających posiadanie odpowiednich kwalifikacji w każdej jednostce ratowniczo-gaśniczej (JRG) musi być grupa instruktorów prowadzących systematycznie zajęcia doskonalące. Również do utrzymania należytego poziomu wyszkolenia ratowników medycznych konieczne jest stworzenie w PSP własnego systemu doskonalenia zawodowego tej grupy zawodowej – programów szkoleń, systemu nadzoru i certyfikacji, centrów symulacyjnych. Problematyczna może okazać się sprawa obrotu lekami, które ratownicy medyczni mogą stosować w ramach świadczeń zdrowotnych poza PRM.Aim: The purpose of this paper is to analyse the legal aspects of the functioning of a paramedic in KSRG units. The paper also defines the areas in which it is advisable to make use of the knowledge and skills of this professional group within the framework of KSRG operations, and offers an assessment of the employment status of this working group in the State Fire Service (PSP). Introduction: The number of paramedics in the KSRG has been growing steadily, although the figures differ by voivodeship. The reasons for this state of affairs cannot be determined unambiguously. Also, one unfavourable trend is noticeable – only one in three paramedics wishes to maintain his or her qualifications obtained during studies. Conclusions: An analysis of legal regulations reveals some contradictions that require further clarification in current law. This situation contributes to the cautious attitude of those who decide on the shape of the KSRG in relation to changes in the field of emergency medical services.It should be emphasised that the number of so-called isolated medical events, i.e. those in which the KSRG units operate due to the temporary unavailability of the PRM, is constantly increasing. Therefore, the requirements for paramedics providing emergency medical services are growing. We can also observe the tightening of the legal requirements to ensure the safety of paramedics during complicated and dangerous activities and exercises. KSRG units often call for PRM teams to take part in securing their activities and exercises, which is denied (on the grounds of there being no laws governing this area). This necessitates the use of ad-hoc, rather than standardised, solutions and is sometimes associated with additional costs. Due to the compulsory training of each PSP paramedic in advanced first aid as well as the legally required system of conducting examinations every three years confirming the possession of appropriate qualifications in each JRG, there must be a group of instructors conducting regular professional training. Also, to maintain a proper level of training for paramedics, it is necessary that a professional development system be created for this group within the PSP units, complete with training programmes, a supervision and certification system, and simulation centers. A particularly problematic issue relates to the purchase of medicines by paramedics for the purposes of providing health services outside of the PRM

Effects of exercise of different intensity on gut peptides, energy intake and appetite in young males

Introduction and research aims: The aim of the work was an evaluation of the impact of physical exertion on the regulating of food intake and digestive system hormone release as well as the partly connected phenomenon of evaluating the subjective sensation of hunger and the amount of food consumed at various time following physical exercise. Materials and methods: The tests covered 12 young, healthy men, for whom the effects of physical exertion of a moderate and high intensity on the subjective sensation of hunger/satiety, evaluated by means of visual analogue scales, on food intake as well as on the metabolic and hormonal parameters were tested. Results: Physical exertion resulted in a fall in the subjective sensation of hunger, but only following intensive exertion was this statistically significant. The intake of food was greater after exertion when compared to the control group. Moderate exertion resulted in a statistically significant but short-lived increase in the ghrelin level. This effect was not observed after intensive exertion, while in those tests during the post-meal period there occurred a fall in the concentration of ghrelin in the plasma. After exertion a physical fall was observed in the concentration of insulin in the plasma, for the intake of food resulted in a notable increase in its level. Conclusions: Physical highly intensive exertion, results in a temporary reduction in the subjective sensation of hunger but leads to an increased food intake. The current research suggests that moderate but not intensive physical exertion stimulates the secretion of ghrelin

Effect of acute sprint exercise on myokines and food intake hormones in young healthy men

Physical exercise is known to influence hormonal mediators of appetite, but the effect of short-term maximal intensity exercise on plasma levels of appetite hormones and cytokines has been little studied. We investigated the effect of a 30 s Wingate Test, followed by a postprandial period, on appetite sensations, food intake, and appetite hormones. Twenty-six physically active young males rated their subjective feelings of hunger, prospective food consumption, and fatigue on visual analogue scales at baseline, after exercise was completed, and during the postprandial period. Blood samples were obtained for the measurement of nesfatin-1, ghrelin, leptin, insulin, pancreatic polypeptide (PP), human growth factor (hGH) and cytokine interleukin-6 (IL-6), irisin and plasma lactate concentrations, at 30 min before exercise, immediately (210 s) after exercise, and 30 min following a meal and at corresponding times in control sedentary males without ad libitum meal intake, respectively. Appetite perceptions and food intake were decreased in response to exercise. Plasma levels of irisin, IL-6, lactate, nesfatin-1 and ghrelin was increased after exercise and then it was returned to postprandial/control period in both groups. A significant rise in plasma insulin, hGH and PP levels after exercise was observed while meal intake potentiated this response. In conclusion, an acute short-term fatiguing exercise can transiently suppress hunger sensations and food intake in humans. We postulate that this physiological response involves exercise-induced alterations in plasma hormones and the release of myokines such as irisin and IL-6, and supports the notion of existence of the skeletal muscle-brain-gut axis. Nevertheless, the detailed relationship between acute exercise releasing myokines, appetite sensations and impairment of this axis leading to several diseases should be further examined