[Patient Triage in Disasters and Mass Casualty Incidents]

Disasters (more than 50 people affected) and mass casualty incidents (more than 10 people affected) which are the result of natural or civilisation disasters, traffic accidents or terrorist attacks are characterised by a large number of injured persons. In these critical situations, triage - prioritisation of patients based on the severity and type of the injury must be performed. Patients are sorted into those who need immediate medical intervention and those whose care can wait. Triage is a generally accepted tool assisting the health-care professionals in treating large numbers of injured people following mass casualty incidents. It is a stressful situation requiring not only professional expertise, but also experience and the ability to stay on top of things. Fortunately, such situations do not occur very often in our country. This paper aims to present experience gained during humanitarian missions abroad (Iraq, Kurdistan, Nepal), internships in hospitals in Israel and in Chris Hani Baragwanath Hospital in Johannesburg, South Africa. Key words: mass casualty incidents, triage priority schemes, triage labels.

[Comparison of Hospital Preparedness to Deal with Crisis Situations in Mass Casualty Incidents According to the UN Human Development Index]

PURPOSE OF THE STUDY This thesis presents the very current topic of general hospital preparedness to deal with crisis situations in mass casualty incidents. MATERIAL AND METHODS The key part of the work consists in a questionnaire survey of 26 foreign and domestic respondents, which provides a very good description of this issue in various countries of the world. The group is divided into health facilities in developed and developing countries of the world according to the UN Human Development Index. Another sub-group consists of hospitals in areas with a higher frequency of terrorist attacks and a separate group is formed by 5 hospitals in the Czech Republic. Based on the results of the questionnaire survey, the preparedness of hospitals for dealing with mass casualty incidents is compared in both the groups according to the advancement of the country and also in the subgroup of hospitals in the Czech Republic and in countries with frequent terrorist attacks. The maximum achievable score evaluating the hospital readiness is 20 points. The data obtained by the questionnaire survey is evaluated using statistical methods. RESULTS Higher preparedness of hospitals was found in developed countries, with a hospital preparedness score of 12.9 points compared with 5.9 points in developing countries' hospitals. Hospitals in the Czech Republic show a similar readiness for mass casualties as the other hospitals in developed countries, with the mean score of 12.2 points. Hospitals in countries with a higher number of terrorist attacks did not show a higher readiness to deal with crisis situations associated with mass casualties - the mean score of 9.4 points. DISCUSSION The following discussions and evaluations, together with personal experience and thorough knowledge of real-life solutions, became the basis for recommendations of triage procedures, organization of surgery and traumatology departments and material equipment of medical facilities in the Czech Republic. CONCLUSIONS By applying the results of the habilitation thesis it is possible to achieve an optimal solution and increase the reliability in the preparedness of hospitals in dealing with crisis situations, especially to eliminate the discrepancy between theory and practice. Key words: mass casualty incidents, triage, hospital preparedness, disaster management response.

[Recommendations for Crisis Management in Mass Casualty Incidents, with a Focus on a Terrorist Attack]

Recently, there has been an apparent increase in terrorism-related incidents. The security experts believe that the risk of terrorist attacks cannot be fully ruled out in the Czech Republic either. For this reason, it is appropriate to obtain information from regions with more experience with terrorism and to learn from their mistakes. Based on the analysis of terrorist attacks in Madrid (2004), Israel (2001-2012) and Paris (2015) and our own experience gained during the humanitarian missions in Libya, Syria, Iraq and Ukraine, adequate recommendations for crisis management are presented. An integral part of the preparedness is also a regular training of activation of disaster management plan and simulation of reaction to a mass casualty incident. Key words: mass casualty incident, terrorist attack, disaster management plan.

[Surgical Treatment of Calcaneus Fractures with C-Nail]

PURPOSE OF THE STUDY The calcaneus bone is the largest tarsal bone of a complex shape, the restoration of which after fracturing, often caused by a high-energy injury, is critical. The top priority in treating these fractures is to correctly asses the condition of the surrounding soft tissues that may be further excessively traumatized by inappropriate timing, surgical approach or technique. Even when adhering to all the rules and guidelines, complications in surgical wound healing have been described in up to 16-33% cases when the extended lateral approach was used. Therefore, the development of minimally invasive techniques, approaches and implants are a promise for improvement. One of them is the C-Nail developed by Medin. MATERIAL AND METHODS In the period from 1 January 2014 to 30 March 2017, a total of 25 patients with calcaneus bone fracture treated with C-Nail using the sinus tarsi approach were followed up at our department. Radiological assessment was made in the patients, the fractures were classified by Sanders and Essex-Lopresti classification systems, the Böhler and Gissane angles before and after reduction were measured. The occurrence of postoperative complications in soft tissue healing and complications caused by the C-Nail and the functional outcome according to the Ankle-Hindfoot Score (AOFAS) were tracked. RESULTS Only one complication in wound healing, namely in case of sinus tarsi approach, was reported in this group of patients. In 9 patients, prominence of osteosynthesis material was observed. Of whom in 4 patients a clinically significant prominence into posterior talocalcaneal articulation was present. Severely limited subtalar range of motion was seen in 5 patients, in other three patients ankylosis was observed, or arthrodesis performed. 8 patients experienced mild reduction of subtalar joint range of motion. 6 patients suffered from mild reduction of range of motion in talocrural joint. The functional outcome according to the Ankle-Hindfoot Score (AOFAS) was 89.4 on average. CONCLUSIONS Our so far limited experience with the osteosynthesis of calcaneal fractures using the C-Nail entitles us to claim that this type of osteosynthesis material allows for adequate stability and subsequent healing of a correctly reduced calcaneal fracture. It is an implant inserted by a minimally invasive surgery and the fracture reduction, when mastering the learning curve, can be efficiently performed from sinus tarsi approach. In our group of patients, the number of complications in soft tissue healing was low, which is why we believe that this type of osteosynthesis is another suitable option to treat the comminuted calcaneal fractures. The handling of the implant as such and other osteosynthesis material is safe provided all the rules covered in detail in the discussion are observed. Key words: calcaneal fracture, C-Nail, sinus tarsi approach.

[Influence of the Weather on the Incidence of Fractures in the Elderly]

PURPOSE OF THE STUDY The incidence of geriatric fractures (proximal femur, distal radius, proximal humerus and thoracolumbar spine injuries) in the population increases with ageing. However, the role of weather conditions, such as icy and slippery winter, should not be overlooked. A deeper insight into this relationship may bring about a better understanding of the fracture aetiology and thus allow for improvement in the prevention of fractures in elderly people. MATERIAL AND METHODS This prospective study included 676 patients (469 women and 207 men) aged 65 and over. Relationships between the incidence of geriatric fractures in these patients and the season, weather phenomena (i.e., air temperature, atmospheric pressure, air humidity, wind speed, visibility, rain, snow, mist and storm) and global biometeorological data in the period from 1 January 2012 to 31 December 2013 were investigated. Patients with high velocity trauma or those with pathological fractures were excluded. Time (day/night), the place of injury (outdoor/indoor/home environment), comorbidities and chronicuse medication were also recorded. Weather forecast records with weather health loads (biotropic indices) were obtained from the commercial service Weather Underground and the Czech Hydrometeoro-logical Institute. The results were statistically analysed using the Statistika 12 programme. RESULTS The incidence of fractures was higher in winter months but there was no statistically significant correlation between the number of fractures and various weather characteristics (temperature, atmospheric pressure, air humidity, wind speed, visibility, rainfall, snow, mist or storm). On the other hand, a relationship between the incidence of geriatric fractures and the biometeorological data (biotropic index) for that day was significant (r = 0.65, p= 0.0401). The majority of fractures occurred during the daytime (83.7%) and in the indoor environment (83.1%); of the latter fractures, 85.2% were home injuries. The most frequent comorbidities included cardiovascular disease (36.2%), obesity (31.1%) and diabetes mellitus (25.4%). DISCUSSION Studies investigating seasonal patterns in relation to the incidence of geriatric fractures are contradictory. Sixteen previous studies have examined seasonal variations and the incidence of some types of geriatric fractures in different parts of the world. The majority of them have dealt with hip fractures, three with forearm injuries and one compared the incidence of hip, distal forearm, proximal humerus and ankle fractures in the four seasons of the year. Of 13 studies in geographic areas located north of 40°latitude, eight showed no seasonal variation in the incidence of fractures, four recorded an increase in the number of fractures in winter and two showed an increased number of fractures in summer. Three of them also studied the effect of daily temperature. Only one study paid attention to biometeorological data and related the biotropic index to the number of injuries treated at the emergency department. Three studies showed that fractures occurred most frequently in the home environment and during the daytime. CONCLUSIONS This study did not prove any statistically significant relationship between the incidence of geriatric fractures and different weather phenomena. Nevertheless, it showed a higher incidence of fractures in winter, from December to February. Most fractures occurred in indoor environments and during the day. A high value of the biotropic index was significantly related to the incidence of geriatric fractures. The most frequent comorbidities included cardiovascular disease, obesity and diabetes mellitus. Key words: geriatric fracture, season, weather, biometeorological forecast.

[Incidence of proximal femur fractures in relation to seasons of the year and weather]

PURPOSE OF THE STUDY

The opinion that proximal femur fractures occur mainly in the winter season and are related to slippery surfaces prevails in both the lay and medical communities. The elucidation of this relationship would lead to a better understanding of the aetiology of these fractures and may help to prevent them in the elderly population.

MATERIAL AND METHODS

In a retrospective study conducted at two departments, the occurrence of proximal femur fractures in patients 60+ years old in relation to weather conditions (air temperature and its humidity, atmospheric pressure, rain and mist) between January 1, 2001 and December 31, 2005 was investigated. Patients with high-energy or pathological fractures were excluded. The results were evaluated by Statistika software.

RESULTS

A total of 1720 patients were studied, of whom 1313 were women and 407 were men. The numbers of fractures did not differ significantly among either the seasons or months of the year. No correlation was found between the number of fractures and each of the weather characteristics (air temperature and its humidity, atmospheric pressure, wind speed and visibility).

DISCUSSION

It is widely believed that hip fractures are connected with winter months and temperatures below zero. This is supported by several facts related to winter characteristics, such as slippery icy pavements, clumsiness due to warm bulky clothes, bodies affected by cold and thus predisposed to a fall and poorer visibility on shorter winter days. The effect of seasonal variation on hip fracture incidence has been investigated in 10 studies of which only one has taken the influence of daily temperature into consideration. All studies were conduced in the countries north of 40° latitude, i.e., in climatic conditions similar to our country, with temperatures falling below zero and ice-glazed pavements in winter months. Of them, six have found no relation between proximal femur fractures and weather conditions, two have reported an increased incidence of these fractures in winter months and two in summer months.

CONCLUSIONS

Our study did not show any significant relationship between the incidence of proximal femur fractures and weather characteristics. Seasons of the year had no effect on the number of hip fractures or the length of hospital stay due to their treatment.

[PCCP versus standard proximal femoral nail in the treatment of pertrochanteric femoral fractures]

The aim of our study was to compare two groups of patients with pertrochanteric femoral fracture types 31 A1 A2 A3 according to the AO who were treated with two different types of implants. The first group of 54 consecutive patients with above mentioned types of femoral fractures were treated using Proximal reconstruction nail manufacturer Beznoska comp., which is a standard implant we have been using for two years. The second group of 33 patients were treated with a new implant PCCP (Percutaneous Compression Plate) manufacturer Orthofix. We evaluated the time of operation, total blood loss (hgb, htc, number of blood transfusions), peri- and postoperative complications and subjective feeling of pain using the VAS (Visual Analogous Scale). The patients were at the time of procedure and after one year follow-up. The operation time of the standard and new techniques were comparable. The miniinvasive technique of PCCP was accompanied with significantly lower blood loss and significantly lower intensity of pain after the procedure. There was no difference in number of complications. One-year follow-up assessment showed greater mortality in the patients treated by the standard Proximal reconstruction nail (Beznoska CR).

[Hydatic cysts--echinococcosis]

The case diagnosis and treatment of hydatic cyst in the right and left lobe of the liver in a 28 year old pregnant woman is described in the article.