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© Borgis - Postępy Nauk Medycznych 5/2018, s. 279-283 | DOI: 10.25121/PNM.2018.31.5.279
Przemyslaw Zuratynski1, Daniel Slezak1, Piotr Robakowski2, Marlena Robakowska3, Anna Tyranska-Fobke1, Kamil Krzyzanowski1, *Klaudiusz Nadolny4, 5
The management of a mass casualty incident/disaster by a medical dispatcher in a centralized medical dispatch center
Zarządzanie w trakcie zdarzenia masowego/katastrofy przez dyspozytora medycznego w skoncentrowanej dyspozytorni medycznej
1Chair and Department of Emergency Medicine, Medical Rescue Workshop, Faculty of Health Sciences with Subfaculty of Nursing and Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Poland
2Faculty of Social Sciences, University of Gdansk, Poland
3Department of Public Health and Social Medicine, Faculty of Health Sciences with Subfaculty of Nursing and Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Poland
4Department of Emergency Medicine, Faculty of Health Sciences, Medical University of Bialystok, Poland
5University of Strategic Planning in Dabrowa Gornicza, Poland
Streszczenie
Zdarzenie o charakterze masowym czy katastrofa wymagają wdrożenia wielu procedur z zakresu dysponowania, planowania, raportowania oraz administrowania. Wiele z nich spoczywa na dyspozytorze medycznym jako najważniejszym ogniwie pomiędzy poszkodowanymi a osobami udzielającymi medycznych czynnos?ci ratunkowych czy s?wiadczen? zdrowotnych. Szczegółowo dyspozytor medyczny zobligowany jest głównie do przyjmowania powiadomien? o zdarzeniach, ustalania priorytetów i niezwłocznego dysponowania zespołów ratownictwa medycznego na miejsce zdarzenia. Całos?c? powinna współgrac? z Systemem Wspomagania Dowodzenia Pan?stwowego Ratownictwa Medycznego. W przypadku zdarzenia o charakterze masowym dyspozytor medyczny pracujący w skoncentrowanej dyspozytorni otrzymuje zgłoszenie alarmowe. Każde stanowisko w dyspozytorni wyposażone jest w radiostacje do kontaktu z zespołami ratownictwa medycznego i szpitalami. Dyspozytor medyczny opiera się na procedurach postępowania na wypadek wystąpienia zdarzenia mnogiego/masowego. Procedury uzyskały status zalecen? konsultanta krajowego w dziedzinie medycyny ratunkowej, a także zostały zatwierdzone i wprowadzone do stosowania przez ministra zdrowia. Każdy dyspozytor medyczny zobligowany jest do stałego doskonalenia zawodowego określonego w odpowiednich aktach wykonawczych.
Summary
A mass casualty incident or a catastrophe require implementation of numerous dispatching, planning, reporting and management procedures. Many procedures involve a medical dispatcher who is the most significant link between the injured and rescuers providing emergency medical services and healthcare. The main responsibilities of medical dispatchers include: collecting information on incidents, setting priorities and prompt dispatching emergency medical service teams to the scene. Actions of the medical dispatcher should be coordinated with the functioning of the Command Support System of the State Emergency Medical Services. In case of a mass casualty incident, an emergency medical dispatcher who works in a centralized dispatch center receives an emergency call. Every workstation in the dispatch center is equipped with a radio station to ensure contact with emergency medical service teams and hospitals. The medical dispatcher follows the procedures related to potential cases of mass casualty incidents/plural events. The procedures have become guidelines of the national consultant in emergency medicine and were confirmed by the Ministry of Health. every medical dispatcher is obliged to regularly participate in professional development training described in the relevant implementing acts.
A mass casualty incident and a disaster require an implementation of numerous dispatch, planning, reporting (analytics), and management procedures. Many of the procedures involve a medical dispatcher who is the most significant link between the injured and the rescuers performing emergency medical procedures and providing healthcare (1). The Law of 8 September 2006 on State Emergency Medical Services (Journal of Laws of 2013, item 757, with amendments) (2) ensures a complete understanding of the role of a medical dispatcher.
According to the definition, a medical dispatcher must be a representative of one of the medical professions, i.e. a doctor, a nurse, and a paramedic with a minimum of five years of experience in an emergency medical team, a hospital emergency department, an intensive care and anesthetic department or the hospital admission desk. Professional qualifications of doctors and nurses should be compliant with the applicable regulations. Due to the dynamically transforming regulations, guidelines, procedures, and systems, every medical dispatcher is obliged to regularly participate in professional development training described in the relevant implementing acts. As the most important element of the total system of Emergency Medical Services, a medical dispatcher provides healthcare services (Act of 15 April 2011 on Medical Activity (3)). The exact main responsibilities of medical dispatchers include collecting information on incidents, setting priorities and prompt dispatching emergency medical teams to the place of incident. The actions of a medical dispatcher should be coordinated with the functioning of the Command Support System of the Emergency Medical Services. Within this scope, a medical dispatcher is responsible for providing required information that facilitates emergency medical procedures performed at the place of incident and supervised by the emergency team leader. A medical dispatcher is accountable for having an up-to-date knowledge about the availability of the units of the system and about the units cooperating with the system in the particular operational regions. This knowledge affects patient placement. On each occasion, a medical dispatcher should cooperate with and inform emergency departments, trauma centers or other units specialized in providing healthcare required by emergency medical services. The administrative tasks of medical dispatchers include collecting and archiving current information on incidents and ongoing emergency medical procedures. It needs to be mentioned that a medical dispatcher is the first point of contact with the emergency system for witnesses and sometimes patients themselves, and is expected to provide necessary information on first aid assistance. Consequently, the knowledge, experience, skills, and decisiveness of a dispatcher affect the chances of survival (4, 5).
The above-presented tasks that characterize the work of a medical dispatcher may be performed in any situation, e.g. in situations of crisis, i.e. in mass casualty incidents and disasters. The unified Command Support System of the Emergency Medical Services was created in agreement with the plans of the Polish Ministry of Health and in cooperation with the Polish Ministry of the Interior and Administration. The system is universal for all Polish regions and is represented by the local governors (the voivodes) in the particular Polish districts (voivodeships). This universal and unified computerized system is used to accept emergency calls and messages about incidents reported by means of the emergency numbers (112, 999), dispatch emergency medical teams, report medical incidents and localize the particular events, teams and their status on the map which is a part of the Universal Map Module (UMM) integrated with the system. The system ensures proper performance of tasks by emergency medical dispatchers, members of the emergency medical teams, emergency medical coordinating doctors, and some authorized representatives of the Ministry of Health. From the perspective of medical dispatchers, the system enables them the monitoring and management of calls, reported incidents, as well as capacities and resources of the Emergency Medical Services. The role of the system is expected to increase. What is worth mentioning is the teletransmission of the current patient’s physiological parameters (e.g. ECG) from the emergency medical team to the specific destination hospital (6, 7).
For several years, Poland has observed a process of centralization of dispatch centers. The centralized structure is expected to improve the emergency and health information management, ensure an efficient transmission of data between emergency services and public order services (accepting 112 and other emergency calls and transferring them to an adequate police unit, state fire service and emergency medical services), and secure the development of the system of Emergency Medical Services based on modern computerized technologies. According to the data provided by the Polish Ministry of Health, there are currently 42 dispatch centers with 226 workstations. The aim is to maintain 18 dispatch centers in 2028 (8).
In the case of a mass casualty incident, an emergency medical dispatcher who works in a centralized dispatch center receives an emergency call. Every workstation in a dispatch center is equipped with radio stations to ensure contact with emergency medical teams and hospitals. A medical dispatcher follows the procedures related to potential cases of mass casualty incidents/plural events (9-11). The procedures have become guidelines of the national emergency medicine consultant and were confirmed by the Ministry of Health. They were implemented in 2014 during expert consultation meetings. The subject of these procedures was the unification of emergency actions in events of potential mass casualty or plural character in all areas of emergency medical services and other areas of Polish healthcare. The procedures have been designed to ensure a proper organization of rescue actions. This objective requires an efficient communication system based on a unified and properly interpreted terminology, as well as on clearly defined information exchange channels. The scope of procedures involves the following positions and areas: emergency medical dispatchers, the national dispatcher of the independent public healthcare units of the Polish Medical Air Rescue, the leader coordinating emergency medical procedures, emergency medical team members, emergency medical coordinating doctors, hospital emergency departments, hospital admission desks, hospital units specialized in emergency medical healthcare services, voivodes (local governors). Each of the above-mentioned areas or roles involves a description of the scope of tasks and expected procedures along with an action checklist form and an action evaluation form (9).

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Piśmiennictwo
1. Briggs S, Brinsfield K: Wczesne postępowanie medyczne w katastrofach. Wydawnictwo Lekarskie PZWL, Warszawa 2007: 1-13.
2. Ustawa z dnia 8 września 2006 roku o Państwowym Ratownictwie Medycznym (Dz. U. z 2013 r., poz. 757, z późn. zm.).
3. Act of 15 April 2011 on Medical Activity (Journal of Laws No. 112, item 654, with amendments).
4. Rzońca G, Nadolny K: Centralizacja Systemu Powiadamiania Ratunkowego na podstawie Zintegrowanej Dyspozytorni Medycznej w Olsztynie. Na Ratunek 2016; 3: 49-52.
5. Popławska M, Maślarz M: Organizacja skoncentrowanych dyspozytorni medycznych w województwie małopolski. Emerg Med Serv 2015; II(2): 168-170.
6. Guła P: Postępowanie ratownicze w wypadkach masowych i katastrofach. Medycyna Praktyczna, Kraków 2009: 7-23.
7. Ustawa z dnia 26 kwietnia 2007 r. o zarządzaniu kryzysowym (Dz. U. z 2007 r., nr 89, poz. 590).
8. http://www.mz.gov.pl/system-ochrony-zdrowia/panstwowe-ratownictwo-medyczne/system-wspomagania-dowodzenia-prm/ (data dostępu: 18.02.2018).
9. Podgórski M, Nadolny K: Procedury postępowania na wypadek wystąpienia zdarzenia masowego. Ujednolicenie działań na miejscu zdarzenia, ze szczególnym uwzględnieniem ZRM. Na Ratunek 2016; 2: 25-31.
10. Zalecenia konsultanta krajowego w dziedzinie medycyny ratunkowej dotyczące procedur postępowania na wypadek wystąpienia zdarzenia mnogiego i masowego; http://www.mz.gov.pl/system-ochrony-zdrowia/panstwowe-ratownictwo-medyczne/organizacja-systemu-panstwoweratownictwo-medyczne/zdarzenia-mnogiemasowe/ (data dostępu: 17.08.2016).
11. Procedura postępowania na wypadek wystąpienia zdarzenia mnogiego/masowego. Ministerstwo Zdrowia, Warszawa 2015.
12. The Regulation of the Minister of Health of 10 January 2014 on framework procedures of accepting emergency calls by medical dispatchers and dispatching emergency medical teams (Journal of Laws of 2014, item 66).
13. Borowicz A, Kucap M: Analiza procedur wypadku mnogiego/masowego. Na Ratunek 2016; 2: 32-34.
otrzymano: 2018-09-12
zaakceptowano do druku: 2018-10-10

Adres do korespondencji:
*Klaudiusz Nadolny
Department of Emergency Medicine Medical University of Bialystok
37 Szpitalna Str., 15-295 Bialystok, Poland
Phone: +48 513082398
E-mail: knadolny@wpr.pl

Postępy Nauk Medycznych 5/2018
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