Usporedba učinkovitosti hrvatskog integralnog zdravstva i drugačijih organizacijskih modela u zbrinjavanju ranjenika [Comparison of the effectiveness of Croatian for integral health and other organizational models in the management of the injured]

Zlatar, Marijan (2012) Usporedba učinkovitosti hrvatskog integralnog zdravstva i drugačijih organizacijskih modela u zbrinjavanju ranjenika [Comparison of the effectiveness of Croatian for integral health and other organizational models in the management of the injured]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The aim of research was to investigate the success of the civil - military integrated health care in the casualties of civilians and armed forces during Patriotic war in Croatia in time from 1991 to 1995. For purposes of this research a questionnaire was made containing approximately 150 parameters and is shown in the appendix. The study was conducted on a randomly chosen sample of 5000 subjects of whom 74.1 percent were members of the armed forces, and 25.9 percent of civilians. Most were men, 93.3 percent. Most casualties were in the open space 86,0 percent, 81.1 percent of armed forces on the battlefield and civilians 72.8 percent in the place of residence. Descriptive statistic was applied to describe the data, and hypotheses are tested parametric (ANOVA) and nonparametric (x - test, Mann - Whitney test) methods. Assessment of the subjects, groups of armed forces and civilians, depending on a number of predictors was performed by logistic regression model. The most common causes of death and civilians and forces were the effects of artillery weapons. From the organ systems, most have suffered skeletal (33.2 percent) and muscular (29.8 percent), and the anatomical region of the lower extremities (36.6 percent), upper extremities (29.2 percent) and head and neck (23.8 percent). First aid as at civilians (96,0 percent) and as at forces (88.3 percent) was most frequently offered by medical teams. For civilians in the first hour help was given (71.2 percent) while in the forces (63.1 percent). The length of hospital stay was similar for civilians and members of the armed forces. In about 50,0 percent of cases it was up to 7 days, about 70,0 percent of cases it amounted to 14 days. The result of treatment was slightly better in the category of civilians where the outcome of treatments entered - "cured" (16.3 percent), and forces, 12.5 percent. Equal percentage (60,0 percent) and civilians and forces was released or transferred to other institutions with "improved" health condition. Hospital mortality as an outcome of treatment varies considerably between civilians and forces. For the category of civilians amounted to 4,0 percent, and for members of the armed forces (1, 9 percent) or an average of 2.4 percent in both groups. Comparison of the results of this work with data from the U.S., Great Britain, Israel, SSSR (Russia), Serbia and Bosnia and Herzegovina, and refer to the Vietnam War, Falklands War, the Israeli - Arab wars, the Soviet - Afghan war, modern wars leading by the U.S., NATO and its allies in Iraq and Afghanistan, and the wars in former Yugoslavia, came to the conclusion that the integrated military-civilian approach in the treatment of casualties was equally successful as the approach of large countries, but by the use of manpower and material resources was more economical.

Abstract in Croatian

Cilj istraživanja je bio istražiti uspješnost civilno - vojnog integralnog zdravstva u zbrinjavanju stradalih civila i pripadnika oružanih snaga u Domovinskom ratu od 1991. do 1995. godine. Za potrebe istraživanja sačinjen je upitnik koji sadrži oko 150 parametara i prikazan je u prilogu. Istraživanje je rađeno na slučajno odabranom uzorku od 5000 ispitanika od kojih je 74,1 % bilo pripadnika oružanih snaga, a 25,9% civila. Većina su bili muškarci, 93,3%. Najviše je stradavanja bilo na otvorenom prostoru (86,0%), i to kod pripadnika oružanih snaga u 81,1 % na bojišnici a kod civila u 72,8 % u mjestu stanovanja. Primjenjena je deskriptivna statistika za opis podataka, a hipoteze su testirane parametrijskim (ANOVA) i neparametrijskim (χ2 – test, Mann-Whitney test) metodama. Procjena pripadnosti ispitanika skupinama oružanih snaga i civila u zavisnosti od većeg broja prediktora izvedena je logističkim regresijskim modelom. Najčešći uzroci stradavanja i kod civila i kod pripadnika oružanih snaga su bila djelovanja topničkoga oružja. Od organskih sustava najviše su stradali koštani (33,2%) i mišični (29,8%), a od anatomskih regija donji ekstremiteti (36,6%), gornji ekstremiteti (29,2%) i glava i vrat (23,8%). Prvu pomoć i kod civila (96,0%) i pripadnika oružanih snaga (88,3%) najčešće su pružale liječničke ekipe, a kod civila je u prvih sat vremena pomoć pružena kod 71,2% dok je kod pripadnika oružanih snaga u 63,1%. Duljina boravka u bolnici bila je podjednaka i za civile i pripadnike oružanih snaga te je u oko 50,0% slučajeva iznosila do sedam dana, a do četrnaest dana u oko 70,0% slučajeva. Ishod liječenja je bio nešto bolji u kategoriji civila gdje je kao ishod liječenja „izliječen“ upisan kod njih 16,3% a kod pripadnika oružanih snaga kod 12,5%. Podjednaki postotak (oko 60,0%) i civila i pripadnika oružanih snaga otpušten je ili premješten u drugu ustanovu s „poboljšanim“ zdravstvenim stanjem. Bolnički mortalitet kao ishod liječenja se značajno razlikuje između civila i pripadnika oružanih snaga. Za kategoriju civila je iznosio 4,0 % a za pripadnike oružanih snaga 1,9%, ili prosječno za obje skupine 2,4%. Usporedba dobivenih rezultata ovog rada s podacima autora iz SAD, Velike Britanije, Izraela, Sovjetskog Saveza (Rusije), Srbije i Bosne i Hercegovine, a odnose se na vijetnamski rat, falklandski rat, izraelsko-arapske ratove, sovjetsko-afganistanski rat, suvremene ratove koje vode SAD, NATO i saveznici u Iraku i Afganistanu te na ratove koji su vođeni na prostorima bivše SFRJ, došlo se do zaključka da je integralni vojno-civilni pristup u zbrinjavanju stradalih bio podjednako uspješan kao i ešelonirani pristupi velikih zemalja, ali je po uporabi ljudstva i materijalnih resursa bio štedljiviji.

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