Этические (моральные) аспекты подготовки персонала скорой помощи. Moral aspects of training ems personnel. УДК 61:174-057.16.


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ÝÒÈ×ÅÑÊÈÅ (ÌÎÐÀËÜÍÛÅ) ÀÑÏÅÊÒÛ ÏÎÄÃÎÒÎÂÊÈ
ÓÄÊ 61:174-057.16
Стефан
Констанчак
Çåëåíîãîðñêèé Óíèâåðñèòåò, Çåëåíà Ãîðà, Ïîëüøà,
Àííîòàöèÿ:
ïûòêó èññëåäîâàòü âàæíåéøèé ýòè÷åñêèé è
ìî
ñëóæáû ñêîðîé ïîìîùè. Êàæäîìó ÷åëîâåêó ìîæåò
ïîòðåáîâàòüñÿ ïîìîùü, ýòî óñëóãà óíèâåðñàëüíàÿ
ïîìîùü ïðåäîñòàâëÿåòñÿ íàñòîëüêî áûñòðî,
÷òîáû ïåðñîíàë ñëóæáû ñêîðîé ïîìîùè îáëàäàë
íåîáõîäèìûìè ìîðàëüíûìè è
ýòè÷åñêèìè êà÷å
ñòâàìè, êîòîðûå â
òî æå âðåìÿ ÿâëÿþòñÿ íåîá
ïåðñîíàë ñëóæáû ñêîðîé ïî
Ñòåôàí Êîíñòàí÷àê.
Ýòè÷åñêèå
(ìîðàëüíûå) àñïåêòû ïîäãîòîâêè ïåðñîíàëà ñêî
ðîé ïîìîùè // Ïðîôåññèîíàëüíîå îáðàçîâàíèå
ñîâðåìåííîì ìèðå. Ò.
Institute of Philosophy, University of Zielona Gora, Zielo
In this article the author introduces the
most important moral dilemmas which the Emergency
Medical Services (EMS) face. Since everybody may be
in need of emergency medical service, it is important
that such a service is universal and help is provided as
quickly as possible. This requires that EMS personnel
possess particular moral qualifications which at the
same time constitutes a great psychological burden
medicine, education, critical situations in medicine,
For quote:
Stefan Konstanczak
Moral aspects of
Professionalnoe obrazovanie v
sovremennom mire = Professional education in the mod
ern world
, 2016, Vol. 6, no. 4. pp. 650–657 (in
Russ).
ïîæàðà â
Âåíñêîì òåàòðå êîìè÷åñêîé îïåðû. Ñëóæáà áûëà íàçâàíà Âåíñêîå äîáðîâîëüíîå ñïà
Wiener
Freiwillige
ïåðâàÿ óñëóãà ïðîôåññèîíàëüíîé ñêîðîé ìåäèöèíñêîé ïîìîùè. Ñïóñòÿ ãîä ñóùåñòâîâàíèÿ äàííîé
ïðàêòè÷åñêèì ñòàæèðîâêàì
ýòîì îáùåñòâå. Óæå 2
îòêðûëàñü âòîðàÿ ñëóæáà ñêîðîé ìåäèöèíñêîé ïîìîùè. Ê
êîíöó 1889 ãîäû óñïåøíî ôóíêöèîíè
ðîâàëà öåíòðàëèçîâàííàÿ ñèñòåìà îïåðàòèâíîãî ëå÷åíèÿ 24 ÷àñà â
ñóòêè 7 äíåé â
íåäåëþ. Èìåííî
ýòî âðåìÿ ìîæíî ñ÷èòàòü íà÷àëîì ñòðåìèòåëüíîãî ðàçâèòèÿ ñëóæáû ñêîðîé ìåäèöèíñêîé ïîìîùè
ñòàòüå, ñîîòâåòñòâóåò ìèðîâûì òðåáîâàíèÿì (ìèðîâîé ìîäåëè), ïðåäúÿâëÿåìûì
â ñîâðåìåííîì ìèðå. 2016. Ò. 6. ¹ 4. Ñ. 650–657
© 2016 ÔÃÁÎÓ ÂÎ Íîâîñèáèðñêèé ÃÀÓ
Professional education in the modern world,
ìåäèöèíñêèì óñëóãàì, îñíîâíîé öåëüþ êîòîðûõ ÿâëÿåòñÿ îêàçàíèå
íèõ ëþäÿì, ò.
ñïåöèàëèñòó. Îäíàêî, êîëè÷åñòâî ïàöèåíòîâ, êîòîðûå íå
åñòü êðèòè÷åñêàÿ ñèòóàöèÿ, òàê êàê
ñâîåé áåçîïàñíîñòè
íîñòü ñâÿçàíà ñî çäîðîâüåì, íè îäèí ÷åëîâåê íå ìîæåò ñàìîñòîÿòåëüíî ïðîãíîçèðîâàòü âíåçàïíîå
çàáîëåâàíèå. Âðà÷ èëè ìåäñåñòðà òàêæå ìîãóò îêàçàòüñÿ â
êðèòè÷åñêîé ñèòóàöèè, â
êîòîðîé èõ
119).
Ñêîðàÿ ìåäèöèíñêàÿ ïîìîùü ÿâëÿåòñÿ óíèâåðñàëüíîé ñòðóêòóðîé, îáåñïå÷èâàåò íåïðåðûâíîå
íåçàâèñèìîñòè îò âíåøíèõ ôàêòîðîâ äîëæíà ïðåäñòàâëÿòü èíòåðåñ äëÿ âñåõ
ïðåäñòàâèòåëåé ìåäèöèíñêîé ïðîôåññèè. Óíèâåðñàëüíîñòü ñèñòåìû ïîäòâåðæäàåòñÿ òåì ôàêòîì,

èìåííî

êðèòè÷åñêîé ñèòóàöèè. Íåñïîñîáíîñòü «çåâàê», æèçíè
êîòîðûõ íè÷åãî íå óãðîæàåò, ïðèéòè íà ïîìîùü ÷åëîâåêó, íàõîäÿùåìóñÿ â

ñåðüåçíîå ïðåñòóïëåíèå, êîòîðîå ïðåñëåäóåòñÿ ïî çàêîíó. Îáÿçàííîñòü êàæäîãî ÷ëåíà îáùåñòâà
êîòîðàÿ ÿâëÿåòñÿ ñåðüåçíîé íåîáõîäèìîñòüþ, äåìîíñòðèðóåò ÷åëîâåêà ñ
íèçêèìè ìîðàëüíûìè
êà÷åñòâàìè. Òàêèì îáðàçîì, ñêîðàÿ ìåäèöèíñêàÿ ïîìîùü ÿâëÿåòñÿ óíèâåðñàëüíîé è
ôóíêöèîíèðóåò, êàê â
àâòîìîáèëüíûõ àâàðèÿõ. Îäíàêî
ñëó÷àåòñÿ òàê, ÷òî íåïðîôåññèîíàëüíàÿ ïîìîùü ïîñòðàäàâøèì ìîæåò òîëüêî óñóãóáèòü ñèòóàöèþ
ìåäèöèíñêàÿ
ïîìîùü ïîñòðàäàâøèì â
àâàðèÿõ íà äîðîãå íå íóæíà ïðè óñëîâèè, åñëè îò íåå áîëüøå âðåäà, ÷åì
ïîëüçû. Îäíàêî ýòî íèêîèì îáðàçîì íå îòíîñèòñÿ ê
ìåäèêàì è
äðóãèì êâàëèôèöèðîâàííûì ìå
Ýòè îñîáûå òðåáîâàíèÿ ñëåäóþò èç íåîáõîäèìîñòè ïåðñîíàëà ìåäèöèíñêîé ñêîðîé ïîìîùè
áûòü êâàëèöèðîâàííûì íà ìàêñèìàëüíî âûñîêîì óðîâíå. Ðàáîòà ñëóæáû ñêîðîé ìåäèöèíñêîé
ïîìîùè ÷àñòî ïîäðàçóìåâàåò ñîñðåäîòî÷åíèå íà ïîâñåäíåâíûõ ñèòóàöèÿõ, òàêèõ êàê àâàðèè íà
êðèòè÷åñêèõ ñèòóàöèÿõ. ×òîáû ïîä÷åðêíóòü ýòî, èñïîëüçóþò òåðìèí «àâàðèè
÷ðåçâû÷àéíûå ñèòóàöèè» (ïðèåìíîå îòäåëåíèå ñêîðîé ïîìîùè). Ýòà ñëóæáà íå ñòàâèò ñâîåé
öåëüþ ðàáîòó ñ
òèïè÷íûìè è
ïðîãíîçèðóåìûìè ñèòóàöèÿìè è
èñïîëüçóåòñÿ òîëüêî â
ñëó÷àå, êîã
äà òàêèå ñèòóàöèè âîçíèêàþò. Êðèòè÷åñêàÿ ñèòóàöèÿ, òðåáóþùàÿ âìåøàòåëüñòâà ñëóæáû ñêîðîé
ìåäèöèíñêîé ïîìîùè, âîçíèêàåò, êîãäà íàáëþäàåòñÿ óõóäøåíèå çäîðîâüÿ ÷åëîâåêà èëè ãðóïïû
ëþäåé, è
êîãäà îáû÷íûå ìåäèöèíñêèå ó÷ðåæäåíèÿ íå ìîãóò ïîìî÷ü. Îáû÷íàÿ ìåäèöèíñêàÿ ïî
î÷åíü âàæíî îòîéòè îò íåå, ÷òîáû ïîìîùü ñòàëà ýôôåêòèâíîé. Òàêàÿ ïîìîùü
êàê ïðàâèëî, çà ïðåäåëàìè ìåäèöèíñêèõ ó÷ðåæäåíèé. Ñëóæáà
ñêîðîé ìåäèöèíñêîé ïîìîùè ïðåäíàçíà÷åíà äëÿ ñèòóàöèé, êîãäà íàáëþäàåòñÿ îñòðàÿ íåõâàòêà

ãóáèòåëüíî
ôèíàíñîâóþ îòâåòñòâåííîñòü. Òàêèì îáðàçîì, îáùåñòâî çàèíòåðåñîâàíî
òîì, ÷òîáû ãðàæäàíå èìåëè ìèíèìàëüíûå çíàíèÿ äëÿ òîãî, ÷òîáû îöåíèòü, íóæíà ëè èì èëè
îêàçàíèÿ ìåäèöèíñêîé ïîìîùè, êîòîðûå îíè ìîãóò óñïåøíî ïðèìåíÿòü äëÿ ñåáÿ èëè äðóãèõ ëþäåé
ìåäèöèíñêèé ïåðñîíàë äîëæåí ïðèíèìàòü ÷ðåçâû÷àéíûå ìåðû áåçîïàñíîñòè äëÿ îáåñïå÷åíèÿ
êîòîðîìó íåîáõîäèìî ñëåäîâàòü,

ýòî ÷óâñòâî ìîðàëüíîãî ÷åëîâå÷åñêîãî äîëãà
: “
Âî âðåìÿ ýêñòðåí
íîãî âûçîâà áåçîïàñíîñòü êàæäîãî ÷ëåíà ñëóæáû ñêîðîé ïîìîùè (ñïàñàòåëüíàÿ áðèãàäà) äîëæíû
Ýêñòðåííûå ñèòóàöèè, òðåáó
êàêîé ñòåïåíè ïàöèåíò ìîæåò ñîäåéñòâîâàòü
áûñòðîãî âûçäîðîâëåíèÿ. Ñëîæíî îæèäàòü êàêîãî-ëèáî ðàçóìíîãî
îïàñíîñòè, â
ðåçóëüòàòå ÷åãî ìîãóò âîçíèêíóòü ñåðüåçíûå îñëîæíåíèÿ ñî çäîðîâüåì. Êðîìå òîãî,
ïåðñîíàë ñëóæáû ñêîðîé ìåäèöèíñêîé ïîìîùè íå äîëæåí äîâåðÿòü ïðàâèëüíîñòè ïîñòàíîâêè
Îäèí èç íàâûêîâ, íåîáõîäèìûõ ïåðñîíàëó ñëóæáû ñêîðîé ìåäèöèíñêîé ïîìîùè,

ýòî óìåíèå
îöåíèòü ñîñòîÿíèå çäîðîâüÿ ïîñòðàäàâøåãî ïðè íàëè÷èè îãðàíè÷åííîé èíôîðìàöèè íàñòîëüêî
çîâîâ ñêîðîé ïîìîùè, êîãäà ïîìîùü íå ìîæåò áûòü îêàçàíà âñåì, íàïðèìåð, â

çàíÿòîé èëè íàïðÿæåííûé ïåðèîä). Äèñïåò÷åðû ñëóæáû ñêîðîé
ïîìîùè âñåì ïàöèåíòàì îäíîâðåìåííî, íà ïåðâûé ïëàí âûõîäèò êîìïåòåíöèÿ äèñïåò÷åðà ñêîðîé
ïîìîùè, îò êîòîðîé çàâèñèò, âûæèâåò ëè ïàöèåíò èëè íåò. Â
ýòîì ñëó÷àå ïðîáëåìîé ñòàíîâèòñÿ òî,
òåëåôîíó) çíà÷èòåëüíî áîëüøèé ðèñê äëÿ ïàöèåíòà,
òîì èëè èíîì ñëó÷àå. Äèñïåò÷åð ñëóæáû ñêîðîé
ïîìîùè äîëæåí ïîìî÷ü çâîíÿùåìó, íå íàâðåäèòü åãî ñîñòîÿíèþ, à
ïàöèåíòîì: ïîëîæåíèå ïàöèåíòà, ïîääåðæàíèå òåïëà (òåìïåðàòóðû òåëà
ïàöèåíòà), ñîõðàíåíèå õëàäíîêðîâèÿ è
ñàìîîáëàäàíèÿ, îñòàíîâêà êðîâîòå÷åíèÿ, îáåñïå÷åíèå
ò.
ä.» (
Styka, Piechocki, 2003,
Íå ïðåäïðèíÿòü òàêèå äåéñòâèÿ ÿâëÿåòñÿ àìîðàëüíûì, ïîýòî
ìó äèñïåò÷åðû ñëóæáû ñêîðîé ïîìîùè èíñòðóêòèðóþò îáðàòèâøèõñÿ è
îáúÿñíÿþò íåîáõîäèìîñòü
âûïîëíåíèå
òå÷åíèå äíÿ. Îäíàêî, ðå÷ü íå âñåãäà èäåò î
ëå÷åíèÿ. Òîëüêî â
ýòîò ïåðèîä ïîìîùü ïàöèåíòó áóäåò íàèáîëåå ýôôåêòèâíîé, òîãäà êàê ïîñëå
ýòîãî ïðîìåæóòêà âðåìåíè áóäåò óæå ïîçäíî. Òàêèì îáðàçîì, âðåìÿ äëÿ ëå÷åíèÿ ïàöèåíòà äîëæíî
îïðåäåëÿòüñÿ ýòèì òåðìèíîì. Ýòî òàêæå äîñòàòî÷íûé ïåðèîä âðåìåíè äëÿ îêàçàíèÿ ïîìîùè, âðåìÿ,
äàííîå ïåðñîíàëó ñêîðîé ïîìîùè íà âûïîëíåíèå íåîáõîäèìûõ ìåð ïî ñïàñåíèþ ÷åëîâå÷åñêîé
æèçíè è
òî÷êè çðåíèÿ ïàöèåíòà, î÷åíü âàæíî, ÷òîáû âðåìÿ, ïîòðà÷åííîå
Ïðîôåññèîíàëüíîå
. 2016. Ò. 6. ¹
Professional education in the modern world, 2016, Vol. 6, no. 4

êî âíóòðåííèìè ÷àñàìè êàæäîãî îòäåëüíî âçÿòîãî ÷åëîâåêà, âðåìÿ, êîòîðîå èçâåñòíî òîëüêî òåëó
îðãàíèçìó, âðåìÿ, èç êîòîðîãî ìû ìîæåì èçâëå÷ü ïîëüçó è

ñàìîãî íà÷àëà ïðîèçîøåäøåé àâàðèè (íåñ÷àñòíîãî
ëþáîé ìîìåíò, êîòîðîãî çà÷àñòóþ ñëèøêîì ìàëî
ìû äîëæíû äåéñòâîâàòü áûñòðåå, ÷òîáû äàòü ïàöèåíòó åùå îäèí øàíñ è
îêàçàòüñÿ ñïîñîáíûìè
ïîìî÷ü ïîñòðàäàâøåìó. Òîãäà ýòî âðåìÿ ñòàíîâèòñÿ çîëîòûì. Ýòî âðåìÿ èçìåðÿåòñÿ óðîâíåì
(Brongel, 2007).
Ëå÷åíèå, íà÷àòîå êàê ìîæíî ðàíüøå, áåðåò âåðõ íàä ñòðàõîì ñîâåðøèòü îøèáêó.
ñóùåñòâóþùèõ îïàñíîñòÿõ ïðè ðàáîòå
äîðîæíî-òðàíñïîðòíûõ ïðîèñøåñòâèÿõ èëè êàòàñòðîôàõ. Çàùèòíàÿ îäåæäà
ñòåðèëüíûå óñëîâèÿ íåîáõîäèìû, òàê êàê íå òîëüêî ïàöèåíòû èìåþò ðàçëè÷íûå îòêðûòûå ðàíû
ïîòîìó, ÷òî ïåðñîíàë ñëóæáû ñêîðîé ìåäèöèíñêîé
êðàò÷àéøèå ñðîêè. Äàæå ìîæíî ñêàçàòü, ÷òî íåâîçìîæíîñòü ñîáëþäàòü òùàòåëüíóþ

 íåîòëîæíîé ìåäèöèíå îñîáî îñòðî ñòîèò ïðîáëåìà îêàçàíèÿ äîïóñòèìûõ âûíóæäåííûõ ìåð
ñîñòîÿíèè øîêà, íàðóøåííûì âîñïðèÿòèåì, ïñèõè÷åñêè áîëüíûìè, íàõîäÿùèìèñÿ â ñîñòîÿíèè
÷àåâ ñ ñàìîïîâðåæäåíèÿìè èëè æåðòâû òåððîðèñòè÷åñêèõ àêòîâ. Íå èãðàåò ðîëè, â êàêîé ñòåïåíè
îíè èçíà÷àëüíî ýòîìó ïîäâåðæåíû. Ïîýòîìó ñïàñàòåëè ñêîðîé ïîìîùè íå äîëæíû ñîìíåâàòüñÿ â
íîñòè ïåðñîíàëà ñêîðîé ïîìîùè íå âõîäèò áîðüáà ñ ñàìèì ïàöèåíòîì, íî â òî æå âðåìÿ îíè íå
ìîãóò ïîçâîëèòü àãðåññèâíî íàñòðîåííîìó ïàöèåíòó ïðèíåñòè óùåðá ìàøèíå ñêîðîé ïîìîùè è åå
ìûå ìåðû îãðàíè÷èòü èëè èñêëþ÷èòü àãðåññèþ ïàöèåíòà äî òîãî, êàê åãî ïîìåñòÿò â ìàøèíó ñêîðîé
ïîìîùüþ ïîëèöèè èëè ðîäñòâåííèêîâ ïîñòðàäàâøåãî. Ëè÷íàÿ ñâîáîäà âñåãäà ìîæåò îòñòóïèòü
íà âòîðîé ïëàí ðàäè áëàãà è îáùåé áåçîïàñíîñòè. ×åëîâå÷åñêîå äîñòîèíñòâî äîëæíî óâàæàòüñÿ â
äà÷åé äëÿ ñîòðóäíèêîâ ñëóæáû ñêîðîé ïîìîùè. Åñòåñòâåííûå ýìîöèîíàëüíûå ðåàêöèè, òàêèå
ïñèõîëîãè÷åñêèõ ôóíêöèé» (Kokoszka, 2003, ñ.7). Äëÿ ïåðñîíàëà ñëóæáû ñêîðîé ìåäèöèíñêîé
òÿæåëûìè ñëó÷àÿìè è ïðîáëåìàìè çäîðîâüÿ. Ñìåðòü ïàöèåíòà çäåñü ñëó÷àåòñÿ ãîðàçäî ÷àùå, ÷åì â
êàì ÿâëÿåòñÿ ïðåïÿòñòâèåì ê âûïîëíåíèþ ñâîèõ îáÿçàííîñòåé. Ñëåäîâàòåëüíî, ýòà ðàáîòà òðåáóåò
Îäíàêî, ñïîñîáíîñòü îñòàâàòüñÿ õëàäíîêðîâíûì â êðèòè÷åñêèõ ñèòóàöèÿõ íå äîëæíî îçíà÷àòü
äåïðåññèè ïðåäîñòàâëåííûì ñàìèì ñåáå. ×åëîâåê â ñîñòîÿíèè òðàóðà òàêæå ñòàíîâèòñÿ ïàöèåíòîì
è, åñëè îäèí ïðîôåññèîíàë íå ìîæåò åìó ïîìî÷ü, â òàêîì ñëó÷àå íåîáõîäèìî âûçâàòü äðóãîãî
Ïðîôåññèîíàëüíîå
. 2016. Ò. 6. ¹
Professional education in the modern world, 2016, Vol. 6, no. 4
Ñèòóàöèè, òðåáóþùèå ïðîâåäåíèÿ âûøåïåðå÷èñëåííûõ ïðîöåäóð, ñëó÷àþòñÿ
äèöèíñêîé ïîìîùè. Ïðèîðèòåò ÷åëîâå÷åñêîé æèçíè, óáåæäåíèå, ÷òî êàæäàÿ ÷åëîâå÷åñêàÿ æèçíü,
íàõîäÿùàÿñÿ â îïàñíîñòè, äîëæíà áûòü ñïàñåíà, îêàçûâàåò íåâåðîÿòíîå ìîðàëüíîå äàâëåíèå, òàê
íèÿ ê ïàöèåíòó.
Ïîñòîÿííî èìåÿ äåëî ñî ñìåðòüþ è ïðèíèìàÿ ðåøåíèÿ ïî ñïàñåíèþ ëþäåé, ïåðñîíàë ñëóæáû
ñêîðîé ïîìîùè íåñîìíåííî íåñåò òÿæåëóþ ïñèõîëîãè÷åñêóþ íàãðóçêó. Âñå ìåäèöèíñêèå ïðî
ôåññèè ñâÿçàíû ñ òàêèìè ñòðåññîâûìè ñèòóàöèÿìè, íî ñëóæáà ñïàñåíèÿ ñêîðîé ïîìîùè îñîáåííî,
Îíè òàêæå äîëæíû èçó÷àòü ðàññëàáëÿþùèå òåõíèêè. Åùå îäíîé çàäà÷åé ïåðñîíàëà ñêîðîé ïîìîùè
ÿâëÿåòñÿ çàáîòà î ñîáñòâåííîì ïñèõîëîãè÷åñêîì ñîñòîÿíèè, òàê êàê îíî îïðåäåëÿåò ýôôåêòèâíîñòü
ïðèíèìàåìûõ ìåð â ñëîæíûõ ñèòóàöèÿõ. Ýòî èõ ìîðàëüíûé äîëã. Ñàìè ðàáîòíèêè ñëóæáû ñêîðîé
ïîìîùè óêàçûâàþò, ÷òî îíè ìîãóò êîíòðîëèðîâàòü ñâîå ïñèõîëîãè÷åñêîå ñîñòîÿíèå ñ ïîìîùüþ
îñîáûõ ìåð (Woloszyn, 2007, ñ. 93). Ñóùåñòâóþò òî÷íûå àëãîðèòìû äëÿ ñëîæíûõ ñèòóàöèé, êîòî
âðåìåíè, âîçìîæíîñòåé è ðåñóðñîâ. Îøèáêà – íå õóäøåå ìîðàëüíîå ïðåñòóïëåíèå, íåñïîñîáíîñòü
ïðèíÿòü êàêèå-ëèáî ìåðû è áåçäåéñòâèå ÿâëÿþòñÿ íàèáîëüøåé îøèáêîé. Ê ñ÷àñòüþ òàêèå ñèòóàöèè
Emergency Medicine has a long history, although as an organised medical help
system for emergencies it is just over 120 years old. The professional emergency medical service
was reportedly started in
Vienna
in 1881 after a disastrous fire at the Vienna Ringtheatre. Called the
first professional emergency medical service (EMS) in the world. Already, after one year in existence,
Viennese medical students began their apprenticeship there. On 2
May 1883 the service’s first callout
took place. After two years a second location was opened and by 1889 there was a centralised system
operating 24 hours a day, 7 days a week. Rapid development of emergency medical service systems can
be dated back to this time, which included the majority of European and American cities even before
the Second World War.
The current Emergency Medical System in Poland, on which this analysis is based, follows the EMS
model as applied worldwide, but which contains its own specifics which become apparent particularly
A crisis can occur in any aspect of social life. This also applies
to the functioning of a health service, whose main objective is to provide a service for people in need,
e. specifically for those people who themselves ask for specialist help related to their health problems.
However, there is a growing group of patients who are unable to summon help in an emergency as
is often unable to summon the necessary help. As people realise the danger they can face, they try to
own sudden breakdown in health. A nurse or a doctor can also face a critical situation in which their
life is dependent on the reasonable behaviour of other people. However, critical moments in life have
certain common characteristics which enabled an emergency medical service system to be organised.
“Each crisis is characterized by three elements: suddenness and unpredictability, temporality, and the
impact on the functioning of the system” (Bankowicz, 1999, s. 119). The EMS is universal and providing
for its smooth functioning and continuity, independent of external factors, should be in the interest of
all representatives of the medical profession. Universality of the system is ensured in principle by the
fact that that each citizen can fulfil at least some of the tasks required by the system.
The aim of the EMS is to protect the values most important to each person, i.
e. life and health. The
sense of one’s dignity should itself alert one to help other people in critical situations. The failure to
come to the aid of a person in need by onlookers whose health and life is not threatened is a serious
crime prosecuted by law. Each member of society has thereby a duty to come to the aid of those in
need. Failure to provide such aid, which is a serious prerequisite, shows a person’s low moral standing.
Therefore, the EMS is universal and functions efficiently as in the case of providing help for the injured
in road accidents. However, situations occur, where providing unprofessional help to the injured person
may endanger that person’s health and life. Legislation takes this into account and medical help to road
accident victims and others need not be provided if such help would bring more harm than benefit. This
waiver by no means refers to paramedics and other medically qualified people.
These specific requirements result from the need for EMS personnel to be qualified to the highest
possible level. EMS work is commonly considered to concentrate on routine situations such as road
accidents where speed of action or life supporting skills are primary and therapeutic skills not essential.
However, the situations that EMS personnel can face are so many and varied that the survival of the
victim depends on the correct assessment of the victim’s health condition and the treatment undertaken.
The objective of the EMS is to provide critical care in critical situations. To emphasise this,
accident and emergency
(A&E) is used. The system is not meant to deal with typical and
predictable events and is called upon only when such a situation arises. A critical situation requiring
healthcare cannot be provided by medical centres. Conventional help is then unreliable and it is essential
to step outside of it for the help to be effective. Such help needs to be provided immediately and generally
outside the healthcare centres. The EMS is designed for situations where there is a shortage of time,
information and available resources. Due to its high maintenance and operating costs, the use of the
EMS help. Moreover, citizens should also be expected to possess basic life supporting skills which they
can use on themselves or on others if required.
Since each incident calling upon the EMS is critical, i.
e. extraordinary, its medical personnel
their surroundings. There is one mandatory cardinal principle, a kind of a moral and human duty to
be followed: “During callout, the safety of every team member must be ensured at all times” (Styka,
Making moral decisions in critical situations.
Emergencies requiring help from EMS personnel
are usually associated with road accidents and accidents at work. In most cases they are caused by
human mistakes. The patient is therefore the victim either of his own, or other people’s mistakes when
assessing the situation. Obviously, this does not in any way change the need to help the person, but it is
the first indication for the EMS team as to what extent the patient can co-operate with efforts to maintain
health at a level which is sufficient for a subsequent quick recovery. It is hard to expect rational co-
operation from someone who made an elementary mistake, endangered his own life and is consequently
facing a serious health problem. Besides, EMS personnel should distrust as to the correctness of the
condition as cohesively and comprehensively as possible on the basis of limited information. This also
involves prioritising emergency calls when help cannot be provided to all, like during a busy period. EMS
call handlers must also be qualified. When resources are insufficient to help everybody simultaneously,
problem is that by not providing help, even remotely (e.
g. by telephone} is a significantly greater risk
for the patient than even wrong advice as to how to proceed with the needy. The EMS call handler has to
guide the caller in such a way so as not to worsen the victim’s condition and furthermore must provide
guidance for the caller to be able to take the first rescue activities. Therefore, he is required to provide
“the caller with instructions on how to proceed with the patient: positioning, keeping warm, keeping
cool, stopping any bleeding, providing liquids and sugar, unblocking air passages, non-mechanical
. It would be immoral if such attempts were
not undertaken, so EMS c
all handlers should instruct the caller and explain the necessity of some of the
actions to be undertaken. The time taken to start the necessary actions is extremely important and the
victim’s survival often depends on it.
To emphasize the importance of the need to begin treatment, the term
is used in
emergency medicine. This term is also used in other scientific contexts e.
g. to describe the highest
potential of a human body during the day. However, it is never exactly 60 minutes. In emergency
and the start of treatment. Only during this period is help for the patient most effective; after this period
help is always late. Thus, the time remaining for the patient should be known by this name. It is also
the period with enough time to come with aid, the time given to EMS personnel to start performing the
necessary life-saving actions and medical procedures. From the patient’s point of view, it is important
that the time spent waiting for help to arrive is not spent passively as the majority of pre-hospital-
arrival deaths are caused by nobody starting the life-saving procedures on time. “The golden hour is
immeasurable time, irreversible time, time measured by the patient’s internal body clock, time which is
‘known’ only by the body, time we can make use of from time to time and stop the countdown

prevent
death, but it can also be the time which turns out to be too short. This is the time given to the patient and
EMS personnel, passing unceasingly since the accident, time which we know may stop at any moment,
EMS personnel turn out to be helpful. Then that time will turn out to be golden. That time is measured
by the rate of processes occurring in the patient’s body. The greater the injury the faster the spiral
towards death” (Brongel, 2007). Starting treatment as soon as possible thus takes precedence over the
EMS personnel should also know about existing dangers when working with patients brought
from disaster and accident sites. Protective clothing and sterile conditions are needed due to the fact
that not only do some patients have various kinds of open wounds with infection being relatively easy,
but mainly due to the fact that EMS personnel must protect themselves against possible biological and
chemical hazards. There is no place under these conditions to show particular trust towards patients, or
to engage in specific communication with them, since only a range of effective treatments in the shortest
possible time counts. It can even be said that failure to maintain strict hygiene is not only a misconduct
of professional principles but also a moral offence against other EMS personnel.
In emergency medicine the issue of permissible coercive measures towards patients poses a special
problem. EMS personnel often have to deal with patients who are in shock, have a disturbed perception,
are mentally ill, are intoxicated, or pose a threat to their surroundings (e.
g. failure to maintain basic
hygiene). There may also be casualties with self-inflicted injuries or victims of terror attacks. No matter
how far EMS personnel are reluctant to use coercion, they are primarily exposed to it. Therefore, they
should not have any qualms about using coercion if the situation justifies it. EMS personnel’s duties do
not include having fights with patients, but at the same time they cannot allow an aggressive patient
to devastate an emergency vehicle. or the equipment in the emergency department of a hospital. The
rule should be to always take the necessary measures to limit or eliminate a casualty’s aggression
before they enter an emergency vehicle or the hospital’s emergency department. In such situations it
is reasonable to call on the assistance of the police or seek help from the aggressive patient’s relatives.
dignity should be respected in full, provided it does not pose a risk to others or oneself.
Contact with relatives of somebody who has died suddenly is undoubtedly a difficult situation for
EMS personnel. Natural emotional reactions such as despair and a longing for the victim may result in a
“disorganisation of psychological functions” (Kokoszka, 2003, p. 7). For EMS personnel, it is important
to maintain a psychological balance necessary for carrying out their professional duties. Working in
the EMS is connected with constantly dealing with the most severe injuries and health problems. Here,
patient deaths occur more frequently than in any other hospital department. For this reason, excessive
empathy with patients and their relatives is an obstacle to carrying out duties. Therefore, to carry this
type of responsibility requires different psychophysical predispositions than that required of other
health service employees.
. 2016. Ò. 6. ¹
Professional education in the modern world, 2016, Vol. 6, no. 4
However, the ability to remain psychologically balanced in critical conditions should not mean an
indifference to human tragedies. EMS personnel are not expected to provide a bereavement service
when a person is depressed after losing a relative but under no circumstances should such a person be
left to his own devices. A person in mourning also becomes a patient and if one professional is unable
happens very rarely, but is always a test of the moral condition of EMS personnel. Prioritising human
life when one is convinced that each endangered life should be saved, places an unusually heavy moral
burden as it requires putting into practice procedures of lesser evil. In such a situation the positive
outcome is firstly and foremost do what is possible and only then, what is fair in the sense of equal
distribution of available resources and attention devoted to patients.
Constantly dealing with death and making life-saving decisions is undoubtedly a great psychological
burden for EMS personnel. In all medical professions these kind of stressful situations arise, but EMS
personnel are particularly exposed to them as they have to work under the pressure of time. For this
reason, it is essential that EMS personnel be trained to work in difficult situations. They should also
learn relaxation techniques. Looking after their own psychological condition is thus another task for
their moral duty. EMS personnel themselves point out that they can maintain their psychological balance
by following procedures (c.
f. Woloszyn, 2007, p. 93). There are in fact precise algorithms for critical
conditions that must be followed so that overall, the necessary tasks can be performed where there is a
lack of time, capability and resources. Making a mistake is not the worst moral offence, but failure to take
any action (an
error of omission) is. Fortunately, such situations hardly ever happen in emergency care.
ÑÏÈÑÎÊ ËÈÒÅÐÀÒÓÐÛ
(1999), Kryzys (Crisis), entry in: S
ownik polityki [Dictionary of politics], edited by:
Bankowicz, Warszawa: WP.
p (Introduction). in: Z
mierci [The Golden Hour.Time
to Live Time to Die], edited by: L.
Brongel, Krak
w: Wydawnictwo Medyczne.
(2003), Psychologia w pracy ratownika medycznego [Psychology in paramedic’s work]. in:
    Jakubaszko, Wroc
rnicki Wydawnictwo Medyczne.
    Jakubaszko, Wroc
rnicki Wydawnictwo Medyczne.
Wo
oszyn P.

nowa grupa interesu?
    – ​ ​ ​
a new group of interest?],
Toru
(Çåëåíà Ãîðà, Ïîëüøà), äîê
íèòàðíûõ íàóê. ×ëåí Êîìèòåòà Ôèëîñîôñêèõ Íàóê
Ïîëüñêîé Àêàäåìèè íàóê. Çåëåíîãîðñêèé Óíèâåð
ñèòåò (al. Wojska Polskiego 71A, 65–762 Zielona G
Stefan Konstanczak

Professor, Chairman at the
Wojska Polskiego 71A, 65–762 Zielona G
ra, e-mail:

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