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.  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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