Other

Organization of emergency care in an ambulance. Organization of medical care for the rural population

To provide urgent assistance, the team (doctors and support staff) must master basic resuscitation techniques - external cardiac massage, artificial ventilation, puncture of arteries, veins and cardiac cavities, defibrillation, cardiac pacing, etc.

An important condition for providing qualified specialized medical care in an emergency is a clear distribution of responsibilities between team members (responsible for cardiac massage, artificial ventilation, injections, etc.), coordinated actions of personnel during resuscitation, removing the patient from an emergency condition.

In a general therapeutic hospital, among the staff on duty, headed by the doctor on duty, it is necessary to create teams that are proficient in resuscitation techniques, and to prepare staff to provide emergency therapeutic care. In hospitals, in particular in specialized ones, where there are departments (blocks, wards) of intensive observation, treatment and resuscitation, medical and support staff of other departments must be trained in urgent therapy and begin resuscitation measures, removing the patient from an emergency condition, without waiting for the arrival of the team from the intensive care unit.

The correct organization of emergency therapeutic care and further improvement of its organizational forms based on modern scientific achievements are of great importance.

At the prehospital stage, the main element of emergency therapeutic care for the population is the teams of city ambulance stations. In addition to general therapeutic teams, specialized cardiology teams have been created and operate in large cities, providing mainly medical care to patients with myocardial infarction. They, obviously, should be called “specialized infarction teams.” A further stage in improving medical care for patients with diseases of the cardiovascular system was the creation of so-called small cardiological teams at many city ambulance stations. Their staff is smaller than specialized cardiology (heart attack) teams, but medical and support staff undergo special training in emergency cardiology. The team has an electrocardiograph at its disposal. The creation of these teams is due to the fact that specialized cardiology (heart attack) teams are not always able to provide medical care to all patients with myocardial infarction and patients with suspected myocardial infarction, not to mention assistance to patients with other urgent cardiac diseases and conditions. Unlike specialized cardiological (heart attack) teams, small cardiological teams go to the patient not on a call from a linear ambulance team, but directly on a call from the patient. This significantly reduces the time it takes to provide specialized cardiac care after a “heart attack.”

Specialization of the prehospital stage of emergency therapeutic care has so far been carried out only in cardiology, but the creation of a network of specialized hospitals with other profiles will undoubtedly lead to corresponding specialization at the prehospital stage. Thus, a number of cities already have hematology teams, and pulmonology teams will be created.

The basis for organizing specialized medical care for patients with myocardial infarction was the following main factors.

With myocardial infarction, sudden or rapid death often occurs (up to 70-80% of cases).
The highest mortality rate is observed in the first hours (up to 50-60% or more) and the first day (up to 80-90%) of the disease.
The most common causes of death: ventricular fibrillation, asystole, cardiac arrhythmias, cardiogenic shock, acute heart failure, thromboembolism and cardiac ruptures,
Early diagnosis of myocardial infarction and intensive care can prevent life-threatening complications.
Early diagnosis of complications of myocardial infarction and timely resuscitation and intensive care can prevent death.
For resuscitation of patients with myocardial infarction, diagnosis of the disease and its complications, provision of emergency care and intensive care, special instrumental and laboratory equipment and services are required, as well as highly qualified training of medical and support personnel.
Treatment of patients with myocardial infarction is divided into stages: pre-hospital (medical care at home), hospital (in the department or unit of intensive monitoring and treatment, infarction department, early rehabilitation department) and sanatorium (late rehabilitation). At each stage, organizational measures, diagnosis and treatment have their own characteristics (specialization).

In almost all more or less large cities, specialized heart attack ambulance teams have been created and are functioning (pre-hospital stage), there are specialized heart attack departments with intensive observation and treatment units, in many cities rehabilitation departments for patients with myocardial infarction have been opened, special sanatoriums or departments have been opened in them to carry out the final stage of rehabilitation for patients with myocardial infarction.

The organization of medical care for rural residents is based on the same principles as for the urban population. However, the characteristics of living in rural areas influence the formation of a system for its provision. The main difference in providing medical care to the rural population is its stages:

Fig. 1 Stages of providing medical and preventive care to the rural population

- First step- these are healthcare institutions in rural settlements that are part of a complex therapeutic area. At this stage, rural residents receive pre-hospital medical care, as well as basic types of qualified medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental). One of the most important structural units of healthcare institutions (district, district, central district hospital), to which a rural resident first turns, is paramedic-midwife station.

- second phase providing medical care to the rural population is carried out by healthcare institutions of the municipal district, among which the leading place is occupied by central district hospital (CRH). The Central District Hospital provides the main types of specialized qualified medical care and at the same time performs the functions of a health care management body on the territory of the municipality.

- third stage- these are health care institutions of a constituent entity of the Federation, among them regional (regional, district, republican) hospitals play the main role. At this stage, specialized medical care is provided in all major specialties.

Rural medical station- a complex of medical and preventive institutions providing medical care to the rural population (first link).

The rural medical district includes a rural district hospital (or outpatient clinic), paramedics, paramedic-obstetric stations, paramedics' health centers at enterprises and state farms located on the site, collective farm maternity hospitals, seasonal and permanent nurseries, and nurseries.

All medical institutions of rural medical districts are organizationally united and operate according to a single comprehensive plan under the leadership of the head of the district - the chief physician of a rural district hospital or outpatient clinic.

The average population in a medical area ranges from 5-7 thousand inhabitants with an optimal radius of the area 7-10 km (the radius varies depending on the geographical location - in the north it is 50-100). The number of settlements also varies, depending on the nature of the distance, average population and the development of the road network.

Tasks of the rural medical station:

Providing treatment and preventive care to the population;
introduction into practice of modern methods of prevention, diagnosis and treatment of patients;

Development and improvement of organizational forms and methods of medical care for the population, improving the quality and effectiveness of medical and preventive care;

Organization and implementation of a set of preventive measures among the population of the site;

Carrying out therapeutic and preventive measures to protect the health of mothers and children;

Studying the causes of general morbidity and morbidity with temporary disability and developing measures to reduce it;

Organization and implementation of clinical examination of the population, especially children and adolescents;

Implementation of anti-epidemic measures (vaccinations, identification of infectious patients, dynamic monitoring of persons who were in contact with them, etc.);

Carrying out current sanitary supervision of the condition of industrial and communal premises, water supply sources, child care facilities, public catering establishments;

Carrying out treatment and preventive measures to combat tuberculosis, skin and venereal diseases, malignant neoplasms;

Organization and implementation of events for sanitary and hygienic education of the population, promotion of a healthy lifestyle, including rational nutrition, strengthening physical activity;

Fighting alcohol consumption, smoking and other bad habits;

Wide involvement of the public in the development and implementation of measures to protect public health.

Responsibilities of a rural medical district doctor:

conducting outpatient visits to the population:

Inpatient treatment of patients in a rural district hospital;

Providing assistance at home;

Providing medical care in case of acute diseases and accidents;

Referring patients to other medical institutions for medical reasons;

Conducting an examination of temporary disability and issuing certificates of incapacity for work;

Organization and conduct of preventive examinations;

Timely registration of patients at the dispensary;

Carrying out a complex of medical and health measures, ensuring control over medical examination;

Active patronage of children and pregnant women;

Carrying out a set of sanitary and anti-epidemic measures;

Carrying out sanitary and educational work;

Preparation of sanitary assets;

Organizing and conducting scheduled visits of doctors to first aid stations.

FAP is organized in settlements with a population of 700 or more, with a distance to the nearest medical facility of more than 2 km, and if the distance exceeds 7 km, then in settlements with a population of up to 700 people.

The paramedic and midwife station is assigned a large range of health care tasks:

Carrying out activities aimed at preventing and reducing morbidity, injuries and poisoning among the rural population; reducing mortality, primarily child, maternal, and working age;

Improving the sanitary and hygienic culture of the population;

Providing pre-medical care to the population;

Participation in ongoing sanitary supervision of institutions for children and adolescents, communal, food, industrial and other facilities, water supply and cleaning of populated areas;

Conducting door-to-door surveys according to epidemic indications in order to identify infectious patients, persons in contact with them and those suspected of infectious diseases.

The FAP may be entrusted with the functions of a pharmacy for selling finished dosage forms and other pharmaceutical products to the population.

The work of the FAP is directly headed by the manager, whose main tasks are:

Organization of treatment, preventive and sanitary work, as well as providing the population living on the site with medicines and medical products;

Outpatient reception and treatment of patients at home;

Providing pre-hospital medical care in case of acute diseases and accidents (wounds, bleeding, poisoning, etc.) with subsequent referral of the patient to the nearest medical institution;

Preparing patients to be seen by a doctor at a medical and obstetric station and conducting medical examinations of the population, preventive vaccinations;

Carrying out anti-epidemic measures, in particular door-to-door surveys according to epidemic indications in order to identify infectious patients, persons in contact with them and those suspected of infectious diseases;

Carrying out sanitary and educational work among the population;

Organization of medical care for children in nurseries, kindergartens, kindergartens, orphanages, schools located in the territory of the FAP activities and which do not have appropriate paramedical workers on their staff.

A person who has received a secondary medical education in the specialty “General Medicine” and has a certificate in the specialty “General Medicine” is appointed to the position of head of the FAP.

In addition to the manager, a midwife and a visiting nurse work at the paramedic-midwife station.

Midwife at a paramedic-midwife station is responsible for the provision and level of provision of pre-hospital medical care to pregnant and gynecological patients, as well as for sanitary and educational work among the population on issues of maternal and child health.

The midwife is directly subordinate to the head of the medical and obstetric center, and the methodological supervision of her work is carried out by the obstetrician-gynecologist of the medical institution, who is responsible for providing obstetric and gynecological care to the population in the territory of the FAP operation.

Patronage nurse of a paramedic-midwife station carries out preventive measures to improve the health of the child population. For these purposes, it solves the following tasks:

Provides patronage to healthy children under 1 year of age, including newborns, at home, monitors the rational feeding of the child;

Carries out measures to prevent rickets and malnutrition;

Conducts preventive vaccinations and diagnostic tests;

Conducts preventive work in nurseries, kindergartens, kindergartens, orphanages, schools (located in the territory of the FAP and do not have appropriate paramedical workers on their staff);

Provides pre-hospital medical care to children in case of acute illnesses and accidents (wounds, bleeding, poisoning, etc.), followed by calling a doctor or referring the child to the appropriate medical institution;

Prepares sick children to be seen by a doctor at the paramedic-midwife station;

Conducts door-to-door surveys according to epidemic indications in order to identify infectious patients, persons in contact with them and persons suspected of infectious diseases, etc.

Due to the fact that the FAP provides medical care to the entire rural population, and not just women, the room in which it is located should consist of two halves: a paramedic and an obstetrician.

If there is no midwife or visiting nurse on staff at the medical and obstetric station, their duties are performed by the head of the FAP. If there is no position of visiting nurse on staff, the midwife, in addition to her duties, monitors the health and development of children in the first year of life.

Despite the important place of FAPs in the primary health care system, the leading medical institution at the first stage of rural healthcare is local hospital, which may include a hospital and a medical outpatient clinic. The nature and volume of medical care in a local hospital is determined by the capacity, equipment, and availability of medical specialists. However, regardless of capacity, its tasks primarily include providing outpatient care to therapeutic and infectious patients, assistance during childbirth, medical and preventive care for children, emergency surgical and trauma care.

The organization of outpatient care for the population is the most important section of the work of a local hospital. It can be provided by an outpatient clinic that is part of the hospital, or independently. The main task of this institution is to carry out preventive measures to prevent and reduce morbidity, early identification of patients, clinical examination, and provision of qualified medical care to the population.

Doctors see adults and children, make house calls and provide emergency care. Paramedics can also take part in the reception of patients, but outpatient care in a rural medical outpatient clinic should primarily be provided by doctors. In the local hospital, an examination of temporary disability is carried out and, if necessary, patients are sent to medical examination.

Doctors from the central (city, district) hospital go to outpatient clinics and primary care centers according to a certain schedule to conduct consultations. Recently, in many regions of the Russian Federation, there has been a process of reorganization of local hospitals and outpatient clinics into centers of general medical (family) practice.

The capacity of the central district hospital depends on the population, its provision with other hospital institutions, other medical and organizational factors, and is established by the administration of municipalities. As a rule, the capacity of central district hospitals ranges from 100 to 500 beds.

Fig. 2 Approximate organizational structure of the central district hospital

Profile and number of specialized departments within the Central District Hospital depend on its power, but the optimal number should be at least five: therapeutic; surgical with traumatology, pediatric, infectious diseases, maternity and gynecological (if there is no maternity hospital in the area).

Chief physician of the central district hospital is the head of healthcare of the municipal district. Organizes the work and manages the activities of middle and junior medical personnel chief nurse hospitals.

Methodological, organizational and advisory assistance to doctors of complex therapeutic areas and paramedics of FAPs is provided by specialists from central regional hospitals. Each of them, according to the approved schedule, goes to the complex therapeutic area to conduct medical examinations, analyze dispensary work, and select patients for hospitalization.

In order to bring specialized medical care closer to the rural population, interdistrict medical centers . The functions of such centers are performed by large central district hospitals that are capable of providing the population of a given municipal area with the missing types of specialized, highly qualified inpatient or outpatient medical care.

There is a polyclinic within the structure of the Central District Hospital, which provides primary health care to the rural population through the referrals of paramedics from FAPs, outpatient doctors, and general medical (family) practice centers.

The provision of out-of-hospital and inpatient treatment and preventive care to children in the municipal region is entrusted to children's clinics (polyclinics) and children's departments of central district hospitals. Preventive and therapeutic work in children's clinics and children's departments of district hospitals is carried out on the same principles as in city children's clinics.

The provision of obstetric and gynecological care to women in the municipal region is assigned to antenatal clinics, maternity and gynecological departments of central district hospitals.

The functional responsibilities of paramedical workers in the Central District Hospital are not fundamentally different from the responsibilities of paramedical staff in city hospitals and outpatient clinics.

Regional (regional, district, republican) hospital is a large multidisciplinary medical and preventive institution designed to provide full, highly qualified specialized care not only to rural residents, but also to all residents of the constituent entity of the Russian Federation. It is a center for organizational and methodological management of medical institutions located in the region (region, district, republic), a base for specialization and advanced training of doctors and paramedical personnel.

Fig. 3 Approximate organizational structure of a regional (regional, district, republican) hospital

The functional responsibilities of nursing and junior medical personnel are not fundamentally different from those in a city or central district hospital. At the same time, the organization of the regional hospital has its own characteristics. One of them is the presence within the hospital regional advisory clinic (RCP) , where residents of all municipal districts of the region come for help. To accommodate them, the hospital organizes a boarding house or hotel for patients.

Patients are referred to the regional advisory clinic, as a rule, after preliminary consultation and examination by regional medical specialists.

There are 4 categories of hospitals based on capacity:

The regional hospital is due to the presence in its composition departments of emergency and planned advisory care , which, using air ambulance or ground vehicles, provides emergency and advisory assistance with travel to remote settlements. In addition, the department ensures delivery of patients to specialized regional and federal medical institutions.

The department of emergency and planned advisory care works in close connection with the regional center for disaster medicine.

In this case, practical work on performing sanitary tasks is carried out by teams of specialized medical care at constant readiness.

Unlike the city hospital, in the regional hospital functions of the organizational and methodological department much wider. In fact, it serves as a scientific and methodological basis for the healthcare management body for introducing into practice advanced organizational forms and methods of medical care for the population.

The organizational activities of the department include holding regional paramedic conferences, summarizing and disseminating the experience of leading institutions, organizing comprehensive medical examinations of the population, scheduled visits, compiling and publishing instructional, methodological and regulatory materials. Organizational forms of scientific and practical work include planning scientific research, introducing the results of scientific developments into the practical work of medical institutions, communication with departments of medical universities and departments of research institutes, organizing scientific conferences and seminars, attracting doctors to participate in the work of scientific societies, publishing materials etc. In recent years, modern telemedicine technologies have become widely used to improve the quality and efficiency of patient consultation in other healthcare institutions, holding scientific and practical conferences and other events.

Emergency(EMS) is a type of primary health care.

Emergency- 24-hour emergency medical care for sudden illnesses that threaten the patient’s life, injuries, poisonings, intentional self-harm, childbirth outside medical institutions, as well as accidents and natural disasters.

Ambulance, including specialized emergency medical care, is provided in the following conditions:

a) outside a medical organization - at the place where the ambulance team is called, including specialized emergency medical care, as well as in a vehicle during medical evacuation;

b) outpatient (in conditions that do not provide round-the-clock medical supervision and treatment);

c) inpatient (in conditions that provide round-the-clock medical supervision and treatment).

Ambulance, including specialized emergency medical care, is provided in the following forms:

a) emergency - in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life;

b) urgent - in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient’s life.

The reasons for calling an ambulance in an emergency are:

a) disturbances of consciousness that pose a threat to life;

b) breathing problems that pose a threat to life;

c) disorders of the circulatory system that pose a threat to life;

d) mental disorders accompanied by the patient’s actions that pose an immediate danger to him or other persons;

e) sudden pain syndrome that poses a threat to life;

f) sudden dysfunction of any organ or organ system that poses a threat to life;

g) injuries of any etiology that pose a threat to life;

h) thermal and chemical burns that pose a threat to life;

i) sudden bleeding that poses a threat to life;

j) childbirth, threat of termination of pregnancy;

k) duty in the event of a threat of an emergency, provision of emergency medical care and medical evacuation in the event of liquidation of the health consequences of an emergency.

In the event of an emergency medical emergency call, the nearest available general-profile mobile ambulance team or a specialized mobile emergency medical team is dispatched to the call.

Reasons for calling an ambulance in an emergency are:

· sudden acute diseases (conditions) without obvious signs of a threat to life, requiring urgent medical intervention;

· sudden exacerbations of chronic diseases without obvious signs of a threat to life, requiring urgent medical intervention;

· declaration of death (except for the opening hours of medical organizations providing medical care on an outpatient basis).

In the event of an emergency medical emergency call, the nearest available general-profile mobile ambulance team is dispatched to the call if there are no emergency emergency medical calls.

SMP is provided to citizens of the Russian Federation and other persons located on its territory free of charge in accordance with the State Guarantee Program.

To the structure of the SMP includes stations, substations, emergency medical services hospitals, as well as emergency medical services departments within hospital institutions.

NSR stations how independent medical and preventive institutions are created in cities with a population of over 50 thousand people. In cities with a population of more than 100 thousand people, taking into account the length of the settlement and the terrain, NSR substations are organized as subdivisions of stations (within a 20-minute transport accessibility zone). In settlements with a population of up to 50 thousand, emergency medical services departments are organized as part of central district, city and other hospitals.

An emergency medical service station (substation, department) is a medical and preventive institution that operates in daily operation and emergency situations (emergency situations).

Heads the work of the SMP station the chief physician, and the head of substations and departments.

Deputy Chief Physician for Medical Affairs and Operations.

Calls are received and transferred to field teams duty paramedic (nurse) for receiving and transmitting calls from the operational department of the EMS station .

It is recommended that the structure of an ambulance station, emergency department of a polyclinic (hospital, emergency hospital) include:

a) operational department;

b) communications department (radio post);

c) a unit for ensuring the transportation of infectious patients;

d) self-accounting department;

e) pharmacy (pharmacy warehouse);

f) remote advisory post (center);

g) transport division;

h) department of information and computer technology (in ambulance stations, emergency departments of polyclinics (hospitals, emergency hospitals), equipped with an automated system for recording and processing calls with software);

i) organizational and methodological department of emergency medical care;

j) line control department (line control service);

k) department (office) of statistics with an archive;

l) hospitalization department;

m) emergency medical substations;

o) branches (posts, route points) of emergency medical care;

p) room for preparing medical equipment for operation.

Mobile teams emergency medical services by its composition are divided into medical and paramedics, according to your profile are divided into general, specialized, emergency advisory, obstetric, and aeromedical. Specialized mobile teams Emergency medical services are divided into anesthesiology-resuscitation, pediatric, pediatric anesthesiology-resuscitation, psychiatric, and obstetrics-gynecology teams.

Paramedic teams include two paramedics, an orderly and a driver. The medical team consists of a doctor, two paramedics, an orderly and a driver.

The mobile emergency medical team performs the following functions:

a) carries out immediate departure (departure, departure) to the place where emergency medical assistance is called;

b) provides emergency medical care based on the standards of medical care, including establishing the leading syndrome and preliminary diagnosis of the disease (condition), implementing measures to help stabilize or improve the patient’s condition;

c) determines a medical organization to provide medical care to the patient;

d) carries out medical evacuation of the patient if there are medical indications;

e) immediately transfers the patient and the corresponding medical documentation to the doctor of the admission department of the medical organization with a note in the emergency medical care call card of the time and date of admission, the name and signature of the person receiving it;

f) immediately informs the paramedic for receiving emergency medical calls and transferring them to emergency medical teams (the nurse for receiving emergency calls and transferring them to emergency medical teams) about the end of the call and its result;

g) ensures the triage of patients (victims) and establishes the sequence of medical care in case of mass diseases, injuries or other conditions.

Requirements for the work of mobile teams:

- efficiency(after receiving a call, the team leaves within the first 4 minutes, arrives at the place of the call along the optimal route and reports its arrival to the operational department, spending minimal time on providing quality assistance in full)

- quality emergency medical care(correct recognition of diseases and injuries, implementation of necessary therapeutic measures, correct tactical decision)

- high-quality preparation of medical documents(full description in call card medical history and data from an objective examination of the patient, as well as additional studies (rapid tests, ECG); logical and consistent formulation of the diagnosis (ICD-10); standard time stamps from the start to the end of a call; upon delivery to the hospital, mandatory filling accompanying sheet(form 114/у) with a brief description of “when and what happened”, the patient’s condition, the assistance provided and additional information)

- interaction with employees of other emergency medical teams, as well as with employees of medical, preventive and law enforcement institutions(carried out both in the interests of the patient and the workers of the mobile team; strict compliance with job descriptions and other regulatory documents)

The main tasks of stations (substations, departments) of the NSR are:

· provision of round-the-clock emergency medical care to sick and injured people who are outside medical institutions, during catastrophes and natural disasters;

· timely transportation of sick, injured and mothers in labor to hospitals;

· provision of medical care to sick and injured people who seek help directly at the station (substation, department) of the emergency medical service;

· training and retraining of personnel on the provision of emergency medical care;

· in emergency situations - carrying out medical and evacuation measures and participating in work to eliminate the health consequences of emergencies.

SMP does not issue documents certifying temporary disability and forensic medical reports, does not conduct an examination of alcohol intoxication (but can issue free-form certificates indicating the date, time of application, diagnosis, examinations performed, medical care provided and recommendations for further treatment).

Statistical reporting of the NSR station:

Ambulance call log (f.109/u)

Emergency medical assistance call card (f.110/u)

Accompanying sheet of the ambulance station with a coupon for it (f. 114/u)

Diary of the work of the emergency medical service station (department) (f. 115/u)

Report of the station (department), emergency hospital (f.40/u)

SMP indicators:

Indicator of population provision with NSR

Indicator of timely departures of ambulance teams

Indicator of discrepancy between ambulance and hospital diagnoses

Repeat call rate

Rate of successful resuscitations

Fatality rate

The emergency medical service (EMS) is a division of the territorial emergency medical care system.

In 1933, in the 20th century, the “Regulations on Emergency Medical Care Stations” were published in Russia. In the 30-70s, emergency out-of-hospital care was provided both in outpatient clinics and emergency medical services (EMS).

In 1978 G. these services were merged. Ambulance and emergency medical care began to be provided by ambulance stations. In 1991, ambulance and emergency services were again separated: ambulance care should be provided by emergency medical services stations, emergency care - by outpatient clinics.

An EMS station can function as an independent institution with a number of calls of more than 25 thousand per year. With a smaller number of calls, EMS stations are structural divisions of other health care facilities (hospitals, clinics), especially in rural areas.

The EMS station is headed by the chief physician (and the substations are headed by the managers), each shift is headed by a senior physician. NSR station structure:

Administrative and economic part;

Operations department (manages the reception of calls and their transmission);

Hospitalization Department (keeps records of available beds in hospitals);

Transport Department (provides the station with vehicles at the rate of one car per 10,000 city and 15,000

rural residents, with the number of calls more than 75,000 per year, a car is added for control visits);

Statistics Department.

The main structural unit is the visiting team. There are: emergency medical teams (including a doctor, paramedic, orderly); transport teams (including a paramedic or obstetrician).

In addition, teams are divided into linear and specialized (appeared in the 50s of the 20th century and include doctors of the relevant specialization).

Types of specialized teams: pediatric (created when the population exceeds 100,000); anesthesiology and resuscitation (with a population of over 500,000), neurological, cardiological, psychiatric, traumatology, neuroresuscitation:*, pulmonology, hematology, etc. A doctor working in a specialized team must have at least three years of experience in his specialty.

The main tasks of the ambulance:

Providing emergency medical care (including specialized) to injured and sick people, in the shortest possible time on site and during transportation;

The fastest possible transportation of sick and injured people, women in labor, premature babies (including at the request of medical institutions);

Studying the reasons causing the need for emergency medical care and developing measures to eliminate them;

Implementation of methodological guidance of visiting teams of outpatient LTTU in relevant areas;

Providing advisory assistance;

Improving express diagnostic methods and providing emergency care at the prehospital stage.

Indications for calling the media:

Sudden life-threatening diseases that developed on the street, public places, institutions, etc., acute disorders of the cardiovascular, respiratory, central nervous and other organs and systems;

Births that occurred outside of a hospital;

Direct patient contact at the station;

Advisory and practical assistance to emergency doctors (if necessary, other health care facilities).

The call is received by the dispatcher (from the moment of the call, all conversations are recorded on magnetic tape), and transferred to the appropriate substation or directly to the brigade. In this case, the time of receiving the call, its transmission, and the arrival of the team is recorded.

A specialized team is called through the doctor on duty (in the central control room). At the same time, there is a list of indications for calling each of the teams.

For example, the neuroresuscitation team comes out in cases of coma of unknown etiology; rapidly progressing neurological pathology (with disruption of vital functions); suspicion of intracranial hemorrhage; status epilepticus; acute cerebrovascular accident (if resuscitation measures are required); acute neuroinfection.

Responsibilities of an EMS doctor:

Providing emergency assistance;

Routine disinfection of the cabin;

If the patient is unconscious - an inventory of documents and valuables indicated in the accompanying sheet;

Timely replenishment of the medical bag, spent oxygen, nitrous oxide.

The EMS doctor, at the request of the patient (or his relatives), must give his last name and call number. He must know the location of medical institutions and the service area. The doctor is responsible for the issue of accompanying the patient by relatives.

Emergency care is a system of emergency medical care provided to patients with sudden acute and exacerbation of chronic diseases in places of residence (at home, in hostels, hotels, etc.).

It is provided by special teams working in the emergency department (clinic, territorial medical association). There are separate systems

providing emergency care to adults and children. Emergency care tasks:

Providing emergency medical care (including resuscitation measures);

Calling an ambulance according to indications;

Hospitalization (carried out through the ambulance dispatch service);

Ensuring continuity with the clinic;

Ensuring communication with the territorial department of Rospotrebnadzor;

Providing emergency care to patients who directly contacted the clinic;

Ensuring the operation of a hospital at home (if available). The equipment of emergency care teams is not inferior (and

often exceeds) that for ambulance teams.

Basic orders regulating work

Order of the Ministry of Health of the Russian Federation No. 100 of March 26, 1999 “On improving the organization of emergency medical care for the population of the Russian Federation.” The main document in accordance with which the work of the ambulance service is based is the order of the Ministry of Health of the Russian Federation No. 100 dated March 26, 1999 “On improving the organization of emergency medical care for the population of the Russian Federation.” Here are some excerpts from this document. “In the Russian Federation, a system of providing emergency medical care to the population with a developed infrastructure has been created and is functioning. It includes over 3,000 stations and emergency medical departments, employing 20 thousand doctors and over 70 thousand paramedical workers... Every year, the emergency medical service makes from 46 to 48 million calls, providing medical care to more than 50 million citizens ..." It is envisaged to "gradually expand the scope of emergency medical care provided by paramedic teams, with the preservation of medical teams as intensive care teams and ... other highly specialized teams."

“An emergency medical station is a medical and preventive institution designed to provide round-the-clock emergency medical care to adults and children, both at the scene of an incident and on the way to the hospital in conditions that threaten the health or life of citizens or those around them, caused by sudden diseases , exacerbation of chronic diseases, accidents, injuries and poisonings, complications of pregnancy and childbirth. Ambulance stations are created in cities with a population of over 50 thousand people as independent treatment and preventive institutions. In settlements with a population of up to 50 thousand, emergency medical departments are organized as part of city, central district and other hospitals.

In cities with a population of more than 100 thousand people, taking into account the length of the settlement and the terrain, emergency medical care substations are organized as divisions of stations (calculating 15-minute transport accessibility)... The main functional unit of the substation (station, department) of emergency medical care is a mobile team (paramedic, medical, intensive care and other highly specialized teams)... Teams are created in accordance with staffing standards with the expectation of ensuring round-the-clock shift work.”

Appendix No. 10 to the order of the Ministry of Health of the Russian Federation No. 100 dated March 26, 1999 “Regulations on the paramedic of the mobile ambulance team.” General provisions.
A specialist with a secondary medical education in the specialty “general medicine”, who has a diploma and an appropriate certificate, is appointed to the position of paramedic of an emergency medical team.
When performing emergency medical care duties as part of a paramedic team, the paramedic is the responsible performer of all work, and as part of a medical team, he acts under the direction of a doctor.
The paramedic of the mobile ambulance team is guided in his work by the legislation of the Russian Federation, regulatory and methodological documents of the Ministry of Health of the Russian Federation, the Charter of the emergency medical care station, orders and instructions of the administration of the station (substation, department), and these Regulations.
A paramedic of a mobile emergency medical team is appointed to a position and dismissed in accordance with the procedure established by law.

Responsibilities. The paramedic of the mobile ambulance team is obliged to:
Ensure the immediate departure of the brigade after receiving a call and its arrival at the scene of the incident within the established time standard for the given territory.
Provide emergency medical care to sick and injured people at the scene of an accident and during transportation to hospitals.
Administer medications to sick and injured patients for medical reasons, stop bleeding, and carry out resuscitation measures in accordance with approved industry norms, rules and standards for paramedic personnel in providing emergency medical care.
Be able to use available medical equipment, master the technique of applying transport splints, bandages and methods of performing basic cardiopulmonary resuscitation.
Master the technique of taking electrocardiograms.
Know the location of medical institutions and station service areas.
Ensure that the patient is carried on a stretcher and, if necessary, take part in it (in the working conditions of the team, carrying a patient on a stretcher is regarded as a type of medical care). When transporting a patient, be next to him, providing the necessary medical care.
If it is necessary to transport a patient in an unconscious state or in a state of alcoholic intoxication, carry out an inspection for documents, valuables, money indicated in the call card, hand them over to the hospital reception department with a note in the direction for signature of the duty personnel.
When providing medical assistance in emergency situations, in cases of violent injuries, act in the prescribed manner (report to the internal affairs authorities).
Ensure infection safety (comply with the rules of sanitary and hygienic and anti-epidemic regime). If a quarantine infection is detected in a patient, provide him with the necessary medical care, observing precautions, and inform the senior shift doctor about the clinical, epidemiological and passport data of the patient.
Ensure proper storage, accounting and write-off of medications.
At the end of duty, check the condition of medical equipment, transport tires, replenish medications, oxygen, and nitrous oxide used during work.
Inform the administration of the ambulance station about all emergencies that occurred during the call.
At the request of internal affairs officers, stop to provide emergency medical care, regardless of the location of the patient (injured).
Maintain approved accounting and reporting documentation.
In the prescribed manner, increase your professional level and improve practical skills.

Rights. A paramedic of a mobile emergency medical team has the right to:
If necessary, call an emergency medical team for help.
Make proposals to improve the organization and provision of emergency medical care, improve working conditions for medical personnel.
Improve your qualifications in your specialty at least once every 5 years. Pass certification and recertification in accordance with the established procedure.
Take part in medical conferences, meetings, seminars held by the administration of the institution.

Responsibility. The paramedic of the mobile ambulance team is responsible in the manner prescribed by law:
For professional activities carried out in accordance with approved industry norms, rules and standards for paramedic emergency medical personnel.
For illegal actions or inaction that resulted in damage to the patient’s health or death.

In accordance with the order of the Ministry of Health of the Russian Federation No. 100, visiting teams are divided into paramedic and medical teams. The paramedic team consists of two paramedics, an orderly and a driver. The medical team includes a doctor, two paramedics (or a paramedic and a nurse anesthetist), an orderly and a driver.

However, the order further states that “the composition and structure of the team is approved by the head of the station (substation, department) of emergency medical care.” In almost real working conditions (for reasons understandable in our economic living conditions), a medical team - a doctor, a paramedic (sometimes also a paramedic) and a driver, a specialized team - a doctor, two paramedics and a driver, a paramedic team - a paramedic and a driver (maybe also and a nurse). In the case of independent work, the paramedic is the driver’s direct superior during the call, and therefore must also represent his rights and obligations.

Appendix No. 12 to the order of the Ministry of Health of the Russian Federation No. 100 dated March 26, 1999 “Regulations on the driver of an emergency medical team.” General provisions.
The driver is part of the emergency medical team and is an employee who provides driving of the ambulance service "03".
A 1-2 class vehicle driver who has special training in the program of providing first aid to victims and is trained in the rules of their transportation is appointed to the position of driver of an emergency medical team.
During a call, the driver of the emergency medical team is directly subordinate to the doctor and paramedic, and is guided in his work by their instructions, orders and these Regulations...
The appointment and dismissal of the driver is made by the head of the emergency medical service station or the chief physician of the hospital, the structure of which includes the emergency medical service unit, and when using cars on a contractual basis - by the head of the vehicle fleet.

Responsibilities.
The driver of the ambulance team is subordinate to the doctor (paramedic) and carries out his orders.
Monitors the technical condition of the ambulance and promptly refills it with fuel and lubricants. Performs wet cleaning of the vehicle interior as necessary, maintaining order and cleanliness.
Ensures that the brigade immediately responds to a call and that the vehicle moves along the shortest route.
Contains in functional condition special alarm devices (siren, flashing light), search light, portable spotlight, emergency interior lighting, entrenching tool. Performs minor repairs to equipment (locks, belts, straps, stretchers).
Together with the paramedic(s), he ensures the carrying, loading and unloading of sick and injured people during their transportation, assists the doctor and paramedic in immobilizing the limbs of the victims and applying tourniquets and bandages, transfers and connects medical equipment. Provides assistance to medical personnel accompanying mentally ill patients.
Ensures the safety of property, monitors the correct placement and securing of on-board medical devices.
It is strictly prohibited to store any items other than approved service equipment inside the vehicle.
Strictly follows the internal regulations of the emergency medical service station (substation, department), knows and observes the rules of personal hygiene.
The driver must know: the topography of the city; location of substations and healthcare facilities.

Rights. The driver of an ambulance team has the right to advanced training in the prescribed manner.

Responsibility. The ambulance driver is responsible for:
Timely and high-quality performance of functional duties in accordance with the job description.
Safety of medical equipment, instruments and sanitary property located in the ambulance vehicle.

Orders regulating work with OOI

During his work, an emergency medical technician may encounter patients with particularly dangerous infections (EDI). His actions in this case are defined by the following document:
Ministry of Health of the USSR, Main Directorate of Quarantine Infections, Main Directorate of Treatment and Preventive Care. “Instructions for carrying out initial measures when identifying a patient (corpse) suspected of having plague, cholera, or contagious viral hemorrhagic fevers.” Moscow - 1985. (excerpts).
“... When establishing a preliminary diagnosis and carrying out primary measures for these diseases, be guided by the following incubation period periods: plague - 6 days; cholera - 5 days; Lassa fever, Ebola, Marburg disease - 21 days; monkeypox - 14 days.
In all cases of identification of a patient (corpse), immediate information to the authorities and healthcare institutions according to their subordination must contain the following information:
date of illness;
preliminary diagnosis, who made it (name of doctor or paramedic, position, name of institution), based on what data (clinical, epidemiological, pathological-anatomical);
date, place and time of identification of the patient (corpse);
where he is currently located (hospital, plane, train, ship);
last name, first name, patronymic, age (year of birth) of the patient (corpse);
name of the country, city, region (territory) from where the patient (corpse) arrived, what type of transport (number of train, car, plane flight, ship), time and date of arrival;
address of permanent residence, nationality of the patient (corpse);
brief epidemiological history, clinical picture and severity of the disease;
whether you took chemotherapy drugs or antibiotics in connection with this disease;
whether you received preventive vaccinations;
measures taken to localize and eliminate the outbreak of the disease (the number of identified persons who were in contact with the patient (corpse), carrying out specific prevention, disinfection and other anti-epidemic measures;
what kind of help is needed: consultants, medicines, disinfectants, transport, protective suits;
signature under this message (full name, position held);
the name of the person who transmitted and received this message, the date and hour of the message.”

The paramedic of the emergency medical team must transfer this information to the senior doctor of the shift, and if it is impossible to do this, to the dispatcher for further transmission to the authorities.

“A medical professional should suspect a disease of plague, cholera, GVL or monkeypox based on the clinical picture of the diseases and epidemiological history... Often the decisive factor in establishing a diagnosis is the following data from the epidemiological history:
arrival of a patient from an area unfavorable for these infections for a time equal to the incubation period;
communication of the identified patient with similar patients along the route, at the place of residence or work, as well as the presence there of any group diseases or deaths of unknown etiology;
staying in areas bordering countries unfavorable for these infections, or in exotic territory for the plague.

It should be borne in mind that these infections, especially during the initial manifestations of the disease, can give pictures similar to a number of other infectious and non-infectious diseases. So, similar symptoms can be observed:
for cholera - with acute intestinal diseases (dysentery, other acute diseases), toxic infections of various natures; poisoning with pesticides;
with plague - with various pneumonia, lymphadenitis with elevated temperature, sepsis of various etiologies, tularemia, anthrax;
for monkeypox - with chickenpox, generalized vaccine and other diseases accompanied by rashes on the skin and mucous membranes;
with Lassa fever, Ebola, Marburg disease - with typhoid fever, malaria. In the presence of hemorrhages, it is necessary to differentiate from yellow fever, Dengue, Crimean-Congo fevers.”

If a sick person or a corpse suspicious for OI is detected at the scene of the call, the following measures must be taken:
The patient (corpse) is temporarily isolated in the room (apartment) where he lived or was discovered. Isolate contacts in adjacent rooms.
If you suspect a disease with plague, GVL, or monkeypox, your mouth and nose should be temporarily covered with a towel or mask before receiving protective clothing; if not, make one out of a bandage or scarf.
Transfer the information collected according to the above scheme (Scheme No. 1) to the senior shift doctor or dispatcher by phone. In his absence, without leaving the premises through a closed door or window, ask neighbors or other persons to invite your driver (do not let him into the premises), tell him the collected information and ask him to send a team of epidemiologists and protective clothing to help you. At the same time, you should prevent the spread of panic among others.
In the room where the patient and the ambulance team are located, all windows and doors are tightly closed, the air conditioning is turned off, and the ventilation holes are sealed (except in cases of cholera). The patient is not allowed to use the sewer system and the necessary containers are found on site to collect secretions, which are disinfected. The EMS brigade is equipped with special means for this purpose (scheme No. 2).
Any contact of outsiders with the patient is prohibited. When compiling lists of contacts, contacts in premises connected through ventilation ducts are taken into account (except for cases of cholera).
At the same time, the patient begins to receive the necessary medical care.
After the arrival of the epidemiological team, the paramedic and other team members put on protective suits and are at the disposal of the arriving medical specialist.
The patient and the ambulance team are hospitalized in a hospital specially designated for the isolation of patients with acute respiratory infections in accordance with the orders of local health authorities.

The procedure for putting on an anti-plague suit.
Overalls (pajamas).
Socks (stockings).
Boots (galoshes).
Hood (large headscarf).
Anti-plague robe.
Respirator (mask).
Glasses.
Gloves.
Towel (placed behind the waistband of the robe on the right side).
If it is necessary to use a phonendoscope, it is worn in front of a hood or a large scarf.
If the paramedic's own clothes are heavily contaminated with the patient's secretions, they are removed. In other cases, an anti-plague suit is worn over clothing.

The procedure for removing the anti-plague suit. They take off the suit very slowly. Wearing gloves, wash your hands in a disinfectant solution (5% carbolic acid solution, 3% chloramine solution, 5% Lysol solution) for 1–2 minutes, then:
They take out a towel from their belt.
Boots or galoshes are wiped from top to bottom with a cotton swab moistened with a disinfectant solution. A separate tampon is used for each boot.
Remove the phonendoscope (without touching the exposed parts of the skin).
They take off their glasses.
They take off the mask.
Undo the ties of the collar of the robe, belt, and sleeve ties.
Remove the robe by folding it with the outer (dirty) side inward.
Remove the scarf by rolling it from the corners to the center with the dirty side inward.
Take off gloves.
Boots (galoshes) are washed again in a disinfectant solution and removed without touching them with your hands.

All parts of the suit are immersed in a disinfectant solution. After removing the suit, wash your hands with warm water and soap.

Installation for collecting native material from a patient with suspected cholera (for non-infectious hospital institutions, emergency medical care stations, outpatient clinics, SKP, SKO) - scheme No. 2.
Sterile jars of at least 100 ml - wide-necked with lids or ground-in stoppers - 2 pcs.
Sterile spoons (sterilization period 3 months) - 2 pcs.
Plastic bags - 5 pcs.
Gauze napkins - 5 pcs.
Referral for analysis (forms) - 3 pcs.
Adhesive plaster - 1 pack.
Simple pencil - 1 pc.
Bix (metal container) - 1 pc.
Instructions for collecting material - 1 pc.
Chloramine in a bag of 300 g per 10 liters of 3% solution and dry bleach in a bag at the rate of 200 g per 1 kg of discharge.

If cholera is suspected, stool and vomit should be taken for laboratory testing immediately when the patient is identified and always before treatment with antibiotics. The secretions in a volume of 10–20 ml are transferred with spoons into sterile jars, which are closed with lids and placed in plastic bags. Samples are delivered to the laboratory in a container or in metal containers (boxes). Each test tube, jar or other container in which material from the patient is placed is tightly closed with lids, and the outside is treated with a disinfectant solution. After this, they are placed in bags and sealed with adhesive tape or tied tightly.

Job orders

In addition to the orders, excerpts from which were given above, the emergency medical technician must be guided in his work by the following documents:
Order of the USSR Ministry of Health No. 408 dated July 12, 1989 “On measures to prevent viral hepatitis.”
OST 42–21–2–85 (from 1985) “Disinfection, pre-sterilization cleaning and sterilization of medical products.”
Order of the Ministry of Health of the Russian Federation No. 295 of 1995 - “On the implementation of the rules for conducting mandatory medical examination for HIV and the list of workers in certain professions, industries, enterprises, institutions and organizations who undergo mandatory medical examination for HIV.” This document lists the groups of people who are subject to mandatory HIV testing, the rules for conducting this testing, as well as a list of clinical manifestations on the basis of which AIDS can be suspected in a patient.
Order of the Ministry of Health of the Russian Federation No. 375 of December 23, 1998 “On measures to strengthen epidemiological surveillance and prevention of meningococcal infection and purulent bacterial meningitis.” The clinical picture of meningitis and treatment tactics for the patient are outlined.
Order No. 171 of the USSR Ministry of Health dated April 27, 1990 “On epidemiological surveillance of malaria.”
Order of the Ministry of Health of the Russian Federation No. 330 of November 12, 1997 “On measures to improve the accounting, storage, prescribing and use of narcotic drugs.”
Order of the Ministry of Health of the Russian Federation No. 348 of November 26, 1998 “On strengthening measures to prevent epidemic typhus and combat lice.” The clinical picture of epidemic typhus and Brill's disease, the mechanism of infection, complications and treatment are described.
Certain other orders and instructions and orders and instructions from local health authorities. The significance of these documents is periodically checked at the workplace by representatives of the relevant commissions, as well as by the heads of medical institutions.

The ambulance service is one of the most important links in the healthcare system in our country. The volume of medical care provided to the population by medical and paramedic teams is constantly growing. In rural areas, emergency medical departments have been established at the Central District Hospital. Calls to the population there are almost universally served by paramedic teams.

Stations have been created in cities, and emergency medical substations have also been created in large cities. They include line medical teams serving the majority of a wide variety of calls, specialized teams (intensive care, trauma resuscitation, pediatric intensive care, toxicology, psychiatric), as well as paramedic teams. The functions of paramedic teams in cities mainly include transporting patients from one medical institution to another, transporting patients from home to a hospital in the direction of local doctors, delivering women in labor to maternity hospitals, as well as providing assistance to patients with various injuries when there is no need for intensive care help, as well as some others. For example, if the reason for the call is “stumbled, fell, broke an arm (leg)” - this is a call for a paramedic team, and if it is known in advance that the victim fell out of a seventh floor window or was hit by a tram, it is more advisable to immediately send a specialized team to such a call brigade.

But this is in cities. In rural areas, as already noted, almost all calls are carried out by a paramedic. In addition, in real work conditions, it is sometimes impossible to determine in advance what actually happened, and a paramedic working independently must be prepared for any most unexpected situations.

When working as part of a medical team, the paramedic is completely subordinate to the doctor during the call. His task is to carry out all assignments clearly and quickly. Responsibility for decisions made lies with the doctor. The paramedic must master the technique of subcutaneous, intramuscular and intravenous injections, ECG recording, be able to quickly install a system for drip administration of fluid, measure blood pressure, count the pulse and number of respiratory movements, insert an airway, and perform cardiopulmonary resuscitation. He must also be able to apply a splint and bandage, stop bleeding, and know the rules for transporting patients.

In the case of independent work, the ambulance paramedic is fully responsible for everything, so he must be fully proficient in diagnostic methods at the prehospital stage. He needs knowledge of emergency therapy, surgery, traumatology, gynecology, and pediatrics. He must know the basics of toxicology, be able to independently deliver a child, assess the neurological and mental state of the patient, and not only register, but also roughly evaluate an ECG. Emergency care is the pinnacle of medical art, which is based on fundamental knowledge from various fields of medicine, combined with practical experience.

Basic orders regulating work

Rights. The driver of an ambulance team has the right to advanced training in the prescribed manner.

Orders regulating work with OOI

All parts of the suit are immersed in a disinfectant solution. After removing the suit, wash your hands with warm water and soap.

Job orders

Chapter 7. Program of state guarantees for the provision of free medical care to citizens of the Russian Federation

Chapter 8. Medical personnel with secondary vocational education

Chapter 9. Organization of work of nursing staff in outpatient clinics

Chapter 10. Organization of work of nursing staff in hospitals

Chapter 12. Features of organizing the work of paramedical personnel of healthcare institutions in rural areas

Chapter 14. The role of paramedical workers in the organization of medical prevention

Chapter 15. Ethics in the professional activities of nursing staff

Chapter 16. Ensuring the sanitary and epidemiological welfare of the population and protecting consumer rights in the consumer market

Chapter 17. Organization of healthcare in foreign countries

Chapter 11. Organization of work of emergency medical personnel

11.1. GENERAL PROVISIONS

Emergency (EMS) is provided to citizens in circumstances requiring urgent medical intervention (in case of accidents, injuries, poisoning and other conditions and diseases), it is carried out immediately by medical institutions, regardless of territorial, departmental subordination and form of ownership. Emergency medical care is provided to citizens of the Russian Federation and citizens located on its territory free of charge.

The structure of the EMS service includes ambulance stations and substations, emergency departments within hospitals, and emergency hospitals. Ambulance stations as independent treatment and preventive institutions are created in cities with a population of over 50 thousand people. In cities with a population of more than 100 thousand people, taking into account the length of the settlement and the terrain, emergency medical substations are organized as divisions of stations (within a twenty-minute accessibility zone). In settlements with a population of up to 50 thousand, emergency medical departments are organized as part of city, central, district and other hospitals.

11.2. TASKS OF EMERGENCY MEDICAL CARE

Emergency medical care facilities are designed to solve the following complex of medical problems:

Providing round-the-clock timely and high-quality medical care to sick and injured people who are outside medical institutions, as well as during disasters and natural disasters;

Implementation of timely transportation of sick, injured and mothers in labor in need of emergency hospital care;

Providing medical care to sick and injured people who sought help directly from the station and emergency medical services departments.

In 2008, there were about 3,300 emergency medical care stations and departments operating in the Russian Federation. An approximate organizational structure of an ambulance station (substation) is shown in Fig. 11.1.

Rice. 11.1. Approximate organizational structure of an ambulance station (substation)

The work of emergency medical aid stations is headed by the chief physician, and the work of substations and departments is headed by the head. They are assisted in their work, respectively, by the chief paramedic of the station (substation, department).

The main functional unit of emergency medical care stations (substations, departments) is visiting team, which can be paramedic or medical. Paramedic team includes 2 paramedics, an orderly and a driver. In medical team includes 1 doctor, 2 paramedics (or a paramedic and a nurse anesthetist), an orderly and a driver.

In addition, medical teams are divided into general and specialized. The following types of specialized teams are distinguished: pediatric, anesthesiology and resuscitation, neurological, cardiological, psychiatric, traumatology

gical, neuroreanimation, pulmonological, hematological, etc.

Currently, there is a gradual transition from the provision of medical care by general practitioners to paramedic teams, whose main task is to carry out urgent, including anti-shock, measures and transport victims to specialized medical institutions, where they should receive the necessary assistance in full.

The mobile emergency medical team performs the following tasks:

Immediate departure and arrival to the patient (at the scene of the incident) within the time standard established for the given administrative territory;

Establishing a diagnosis, implementing measures to help stabilize or improve the patient’s health status and, if there are medical indications, transporting him to a hospital;

Transfer of the patient and relevant medical documentation to the hospital doctor on duty;

Ensuring the triage of sick or injured people and establishing the sequence of medical care in case of mass illnesses, poisonings, injuries and other emergency situations;

Carrying out the necessary sanitary, hygienic and anti-epidemic measures at the call site.

When performing duties to provide emergency medical care as part of a paramedic team, the paramedic is the responsible executor, and as part of a medical team he acts under the direction of a doctor.

The paramedic of the mobile ambulance team is obliged to:

Ensure the immediate departure of the team after receiving a call and its arrival at the patient at the scene of the incident within the time standard established in the given administrative territory;

Provide emergency medical care to sick and injured people at the scene of an incident and during transportation to hospitals in accordance with approved rules and standards;

Ensure epidemiological safety: if a quarantine infection is detected in a patient, provide him with the necessary medical care

Qing care, observing precautionary measures, and informing the senior doctor of the shift about the clinical, epidemiological and passport data of the patient;

At the request of law enforcement officers, stop to provide medical assistance, regardless of the location of the patient (injured), etc.

If the body of a deceased person is discovered, the team is obliged to urgently notify the internal affairs authorities and record all the necessary information in the “Emergency Medical Call Card” (f. 110/u). Evacuation of a corpse from the scene of an incident is not permitted. In the event of the death of a patient in the cabin of an ambulance, the team is obliged to inform the paramedic of the operational department about the fact of death and obtain permission to deliver the corpse to the forensic morgue.

Operations department (control room) provides round-the-clock centralized reception of requests (calls) from the population, timely dispatch of field teams to the scene of the incident, and operational management of their work. Its structure includes a control room for receiving and transmitting calls and a help desk. The duty personnel of the operational department has the necessary means of communication with all structural units of the EMS station, substations, mobile teams, medical institutions, as well as direct communication with operational services. The department must have automated workstations and a computer control system.

The Operations Department performs the following main functions:

Receiving calls with the obligatory recording of the dialogue on an electronic medium to be stored for 6 months;

Sorting calls by urgency and timely transferring them to field teams;

Monitoring the timely delivery of patients, women in labor and injuries to the emergency departments of the relevant hospitals;

Collection of operational statistical information, its analysis, preparation of daily reports for the management of the NSR station;

Ensuring interaction with the Internal Affairs Directorate, State Traffic Safety Inspectorate, Emergency Management (ES) and other operational services.

Calls are received and transferred to field teams duty paramedic (nurse) for reception and transfer

calls operational department (control room) of the emergency medical service station.

The on-duty paramedic (nurse) for receiving and transmitting calls, who is directly subordinate to the senior shift doctor, is required to know the topography of the city (district), the location of substations and healthcare institutions, the location of potentially dangerous objects, and the algorithm for receiving calls.

Sanitary vehicles of ambulance teams must be systematically subjected to disinfection treatment in accordance with the requirements of the sanitary and epidemiological service. In cases where an infectious patient is transported by ambulance stations, the vehicle is subject to mandatory disinfection, which is carried out by the staff of the hospital that admitted the patient.

The emergency medical service station (substation, department) does not issue documents certifying temporary incapacity for work, or forensic medical reports, and does not conduct an examination of alcohol intoxication. However, if necessary, it can issue certificates of any form indicating the date, time of application, diagnosis, examinations performed, medical care provided and recommendations for further treatment. The station (substation, department) of the emergency medical service is obliged to issue verbal certificates about the location of sick and injured people when contacting the population in person or by telephone.

The provision of specialized emergency and planned advisory assistance to patients undergoing treatment in municipal healthcare institutions (central, city, district, district hospitals) is entrusted to departments of emergency and planned advisory care, which are created in the structure of regional (regional, district, republican) hospitals (for more details, see section 12.3).

The main forms of primary medical records of emergency medical care stations (substations, departments) and emergency and planned advisory care departments:

Ambulance call log, f. 109/у;

Emergency medical assistance call card, f. 110/у;

Accompanying sheet of the ambulance station with a coupon for it, f. 114/у;

Diary of the work of the emergency medical service station, f. 115/у;

Journal of registration of calls received and carried out by the department of emergency and planned advisory assistance, f. 117/у;

Assignment for a medical flight, f. 118/у;

Assignment to the consultant doctor, f. 119/у;

Registration log of planned departures (departures), f. 120/у. Emergency medical workers should

be able to calculate and analyze basic statistical indicators:

Provision of the population of the NSR;

Timely departures of emergency medical services teams;

Discrepancies between ambulance and hospital diagnoses;

Proportion of hospitalized patients;

Share of repeat calls;

Share of successful resuscitations;

Proportion of deaths;

Share of “false” calls.

The population's use of emergency medical care is characterized by: indicator of the population's provision of the NSR, the normative value of which, in accordance with the Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation in 2010, was set at the level of 318 calls per 1000 population.

An assessment of the efficiency of EMS work is indicator of timely departures of emergency medical services teams, which is calculated as the percentage of the number of EMS calls within 4 minutes from the moment of the call to the total number of EMS calls. The value of this indicator should not fall below 98%.

Indicators characterizing continuity in the work of emergency medical services and hospital inpatient facilities are: discrepancy between ambulance and hospital diagnoses and the proportion of hospitalized patients.

The quality of work of emergency medical services teams can be assessed using indicators of the proportion of repeat calls, the proportion of successful resuscitations and the proportion of deaths. Recommended values of these indicators are 1%, 10%, 0.06%, respectively.