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

What are the limits of advanced first aid?

Aim: The applicable rules related to providing assistance to the injured person led the authors to a conclusion that indicated a need to extend the range of rescue operations performed by rescuers who have completed a course in advanced first aid (Polish: kwalifikowana pierwsza pomoc, KPP). This is crucial because there is a growing number of situations in which help is provided by people who do not have proper medical education. In authors’ opinion there is a need to set situation in order. Introduction: Having analysed the current literature, legal acts, and procedures, the authors have noticed inconsistencies in these documents. In some cases, a wider range of aid provided by laymen – the so-called ‘first aid’ – is allowed, rather than the help provided by trained rescuers.Results: The 2015 CPR Guidelines was the first document to feature a section on first aid. The issues presented in that section had been based on scientific research, so the proposed procedure is very reliable. Research in this area is not easy and may be subject to some errors; however, the information resulting from this research cannot remain outside the area of KPP. In the area of first aid, recommendations were offered on the use of haemostatic dressings, and the administration of aspirin, adrenaline and other medicines. In the area of advanced first aid, there are no procedures for such actions. Such first aid recommendations were proposed over a decade ago, but it was only recently that they have appeared in official guidelines devoted primarily to resuscitation at various levels of qualification. Resuscitation guidelines are increasingly seen to discuss the treatment of victims at risk of cardiac arrest in so-called ‘special situations’ (injuries, poisoning, drowning and many others). How to prevent such situations and how to perform a proper first aid procedure? For example, in the case of anaphylactic shock, a first aid rescuer may make a broader use of the currently available resources than in the procedure applicable to KPP rescuers. Nowadays, the need to inject a medicine (possessed by the patient) is not so obvious for the majority of rescuers.Practical meaning: Changes in the programmes of KPP courses are necessary. Nowadays, rescuers at this level of training work in many institutions associated with rescue services such as fire brigades, Volunteer Ambulance Service, Polish Army, Police and other institutions based on medical vol-unteering. This situation requires a change in the relevant legal acts and rescue procedures regarding the KPP and the scope of the equipment owned, which will be the next step in improving the skills and effectiveness of KPP rescuers

Rescue Operations of the Medical Component of the Polish Heavy Urban Search and Rescue Unit (HUSAR Poland) During the Mission After the 2015 Earthquake in Nepal

Purpose: Based on a case study, the authors, members of a heavy urban search and rescue unit (HUSAR Poland) of the State Fire Service (SFS), who participated in relief operations in the aftermath of the 2015 Nepal earthquake, try to describe the roles of medical teams within this specialist organisation. Introduction: The article starts by enumerating the key organisational bodies of the State Fire Service where the Unit’s members normally work, and proceeds to outline the history of its formal establishment, including the appointment of the first SFS Chief Commander Team for Search & Rescue. Then it describes the role of the uniform search and rescue procedures within the State Rescue and Fire-Fighting System, and presents previous international operations following earthquakes, in which Polish firefighters participated. Finally, the paper explains the legal basis for the International Search and Rescue Advisory Group (INSARAG) and the importance of its guidelines for specifying minimum international standards, and lists all the components of HUSAR Poland. The purpose of this paper was to address the question concerning the best way to utilise the potential of HUSAR Poland’s medical component during foreign search & rescue operations.Methods: Research material comprised international and domestic standards which govern the functioning of HUSAR Poland and which define the minimum standards for search and rescue groups and foreign medical teams. The paper analyses HUSAR Poland’s involvement in the 2015 Nepal operation, and conclusions drawn from the 2010 Haiti operation. Its primary research method was the analysis of documents and statistical data. The article provides an overview of USAR Poland’s medical team at different phases of the Response Cycle, and documents used in practice. As shown in the title, special attention was given to describing medical roles and responsibilities fulfilled during the Nepal operation. The authors not only present some statistical examples for the Unit’s medical team involvement in Nepal, but also refer to some similar activities carried out during the 2010 Haiti operation. Summary: In the Summary and conclusions section, the authors tried to identify the most effective ways of utilising HUSAR Poland’s medical component in international operations, immediately after the search & rescue phase involving the recovery of victims from the rubble (known as beyond the rubble) is completed, so that its potential can be used in full to meet the expectations of the affected communities and the local emergency services. These conclusions suggest that a possible role could be to serve the functions similar to those defined by the World Health Organisation for Foreign Medical Teams Type 1