No 3 (2023)

Relevance. Remote incident witness counseling by emergency operator regarding on-site first aid response ensures prompt first aid actions and contributes to decreased mortality among casualties. In Russia, incident witnesses would rarely initiate first aid response. Mainstreaming basic first aid response activities provided by incident witnesses under emergency operator guidance is critically demanded in healthcare today, including the development of common guidelines for emergency

operators regarding incident witness remote counseling. Dedicated emergency operator training is mandatory and shall provide for both theoretical knowledge and practical skills.

The objective is to analyze comprehensive research evidence with regard to relevant emergency operator training in the field of the assisted first aid response counseling, as well as to identify priority areas in emergency medical operator training to be incorporated in the common national operator-assisted first aid action program.

Methods. In July 2023, publications in English and Russian languages regarding operator-assisted first aide training were selected from LIBRARY.RU, Google Scholar and PubMed bibliography databases. No publication date restrictions were applied to the search. Selected publications were included into bibliography review.

Results and analysis. The available publications regarding training emergency operators to provide remotely-assisted first aid counseling to incident witnesses are limited to out-of-hospital cardiac arrest. The publications reveal that other life-threatening health disorders are poorly covered by operator training under consideration. The successful experience of operator training regarding incident witness remote guidance in providing first aid in cardiac arrest settings suggests that such emergency operator training programs contribute to increased frequency of emergency first aid provision by incident witnesses and decrease mortality rate among casualties. To achieve the best results, emergency operator training should include theory and practice, including simulation to enhance the skills of remote stepwise assessment of the victim’s condition, remote first aid counseling, abilities to identify and manage various first aid challenges faced by incident witnesses and provide of guidance and psychological support to incident witnesses performing first aid actions. Practical training for emergency operators shall include mandatory role play simulation for both the operator and the incident witness reproducing the scenario of operator-assisted first aid, followed by discussion analysis (debriefing) to assess actions of the participants. Along with the emergency operator training, mainstreaming basic principles of operator-assisted first aid among the population helps to increase the first aid provision rate by the observers and to improve outcomes for the victims.

Conclusion. Development and validation of operator-assisted first aid training in various health conditions requiring first aid actions is an important, though largely overlooked area of research of great practical importance, given the projected significant increase in first aid provision rates by incident witnesses guided by effective operator support. The organization of the common training among emergency medical services operators regarding operator-assisted first aid shall promote the development of a benchmark training program and dedicated learning materials within the framework of the unified national operator-assisted first aid program. In order to increase the readiness of incident witnesses to first aid provision under remote operator guidance, training among the population is recommended within the framework of operator-assisted first aid, which determines the need to include operator-assisted first aid into existing and newly introduced training programs for various groups of potential first aid providers.

Introduction. Avascular necrosis (M87 according to ICD-10) occurs in young, able-bodied people. Clinical practice has revealed an increase in cases of avascular necrosis in patients who have suffered new coronavirus infection (COVID-19).

The objective is to describe clinical symptoms and treatment strategies in patients with aseptic bone necrosis (osteonecrosis), including those with a history of COVID-19.

Methods. In 2016–2023 132 cases of aseptic bone necrosis were treated, including 115 patients (87.1 %) admitted to the department in 2021–2023 having suffered moderate to severe SARS-CoV-2 infection. International studies were referred to regarding the development of osteonecrosis, including post COVID-19.

Results and analysis. Clinical treatment analysis of patients with a history of COVID-19 was carried out. Most cases showed bilateral aseptic necrosis of the femoral head and condyles. The analysis included 34 (29.6 %) patients over 50 years of age with an average age of 56 years, and 81 (70.4 %) patients under 50 years of age with an average age of 33 years. Clinical observations in patients with identified aseptic necrosis after COVID-19 are considered.

Conclusion. At present, it is impossible to accurately verify the frequency rate of post COVID-19 aseptic bone necrosis, since in Russia aseptic necrosis is not classified as an independent nosological group. Another difficulty is the fact that at this stage there is not enough information about patients who suffered isolated mild COVID-19 with further development of osteonecrosis. There is not sufficient evidence regarding the incidence of osteonecrosis in population and occupational groups. In most cases, osteonecrosis is a caused by multifactorial effects.

Relevance. The Sakhalin region is a northern insular seismic hazard zone at high risk of emergency due to its location and harsh climate. Despite existing emergency response capacities, the data analysis for revocable casualties affected by earlier emergencies suggests the demand for improved treatment, evacuation, and emergency response is still critical in the Sakhalin region.

The objective is to analyze long-term observational data to substantiate predictions regarding revocable casualties in case future emergencies and demand for treatment, evacuation, and emergency response.

Methods. The analysis of academic papers, regulatory documents, statistics, and guidelines allowed to produce a forecast regarding emergency response capacities and efficiency of dedicated command and tactical drills. Logical and information data modeling was applied in the study.

Results and discussion. The paper presents a study of medical, geographic, social, economic, and climatic characteristics of the Sakhalin region with regard to projected number of casualties and various region-specific emergency risks, as well as research data and recommendations for the demanded comprehensive treatment, evacuation, and emergency response actions.

Conclusion. The Sakhalin region is impregnated with a high risk of emergency associated with significant revocable casualty losses and requires improvement of existing emergency response system in the region.

Introduction. Inhalation of toxic compounds at firefighting operations is associated with the onset of various diseases, including immune-mediated disorders. Exposure to adverse occupational factors is exacerbated by smoking.

The objective of the study is to reveal occupational impact, strain and smoking addiction affecting officers of the EMERCOM firefighting squads of Russia, manifest by cellular and humoral immunity markers.

Methods. The study examined Russia’s EMERCOM firefighting officers authorized to wear insulated personal respiratory protective equipment (n=81, mean age of men 31 y., work experience 1–22 y., 31 % smokers). Peripheral blood and nasal secretion tests were performed. Flow cytometry was used to count subpopulations of monocytes, T-, NK-cells, and T-lymphocytes 2. Total serum immunoglobulin E (IgE) was studied using chemiluminescence assay and enzyme immunoassay was used to evaluate secretory immunoglobulin A (sIgA) in mucosa sample.

Results and their analysis. Smokers showed significant distortions in numerous immunity parameters (low levels of T-lymphocytes and sIgA concentration; elevated Th2 and non-classical monocytes), associated with upregulated inflammation, including systemic response. The smoking factor not considered, due to age, longer occupational exposure and labor intensity,

firefighters showed exaggerated type 2 immune response, expressed as upregulated Th 2 count and IgE synthesis, stimulated erythropoiesis in the bone marrow and higher incidence of lower or most commonly elevated sIgA concentrations in nasal secret, caused by unfavorable occupational impacts on the immune system parameters.

Conclusion. Firefighters authorized to wear respiratory protective equipment should undergo an in-depth examination, involving laboratory tests and visualization to evaluate the health of immune system. To prevent immunity-mediated diseases and ensure prompt detection of severe complications, IgE and Th2 shall be a priority consideration as markers of immune response.

Relevance. Conducted large-scale studies have shown that more than 40 % of conscripts are practically unable to adapt to military service environment in terms of physical and mental development. Usually, their diseases are of adaptive origin. Initially, professional activity of the military involves risk to health or even life; however, even greater impact is caused by violation of accommodation hygiene, improper nutrition and training set-up, especially during professional military missions in field scenarios. At initial stages of service, decreased functional reserves and increased general morbidity, involving temporary disability, are revealed. In a healthy organism, stress-related oxidative stress is a critical common mechanism of adaptation to extreme conditions.

The objective is to assess availability of fat-soluble vitamins and polyunsaturated fatty acids in military conscripts by the end of initial military training.

Methods. A comprehensive clinical and laboratory examination was performed in 173 military males conscripted for military service in the Leningrad Region. The average age is (19.3 ± 0.8) years. Malondialdehyde, fat-soluble vitamins (A, E, D₃), polyunsaturated fatty acids (omega 3 and 6) were measured in blood plasma from examined patients, using chromatography with mass-spectrometry.

Results and discussion. Serum malondyaldehyde concentration was within reference in 100 % of the conscripted military. Serum 25-OH-D₃ was close to the lower reference threshold, with deficiency revealed in 43 % of examined conscripts. Vitamin E concentration was close to the lower reference threshold, with 25 % showing deficiency. Arachidonic and linoleic acids (omega-6) were 1.6 and 2 times below reference, respectively. Concentrations of polyunsaturated fatty acids (omega-3) were below reference in 50 % of conscripts.

Conclusion. The obtained data suggest vitamin 25-OH-D₃ and E deficiency, whereas its resolution suggests another important tool for disease prevention in the military. To overcome polyunsaturated fatty acids deficiency, balanced nutrition is required that would include vegetable oils, nuts, fatty fish and seafood. A promising solution for omega-3 deficiency is additional intake of omega-3 supplements. The study is critical to ensure prevention and correction of disorders in the conscripted military.

Relevance. The study of tools allowing to model the possible number of individuals rescued in the area of terrorist attacks until 2030 is justified by the demand for effective deployment of forces, capacities, and resources in response to terrorist threats. Dedicated research based on statistics for terrorist attacks, military and irretrievable losses allows to develop more accurate and reliable calculations and approaches to enhance planning and organization of preventive measures, as well as life-saving rescue operations.

The objective is to justify the positive value of various prognostic tools that allow to predict the number of individuals to be rescued in the area of terrorist attacks.

Methods. This study is based on a comprehensive expert database of 1970-2020 terrorist attacks and their consequences. The retrospective analysis covers over 220,000 cases of terrorist action and relies on the following main parameters: terrorist attack tactics, object and tools. The MS EXCEL software was utilized for data analysis to design a predictive model and enhance the accuracy of investigated parameters. The obtained results reflect average values of irretrievable losses across all forecasts.

Results and discussion. The study results show that predicted measurements regarding the number of individuals rescued in the area of terrorist attacks are above the trend level, except for the confidence interval lower threshold. The average measures obtained for all forecasts show a moderate growth of 38 % from 2021 to 2030. Moreover, our results justify the need for more profound medical training and more resilient protective equipment for individuals at rescue, especially in case of specific injuries associated with particular tactics of terrorist attacks.

Relevance. Wars and military conflicts are always associated with the impact on the military of a large number of pathogenic combat factors, predominantly of stressful origin, with a significantly higher intensity of exposure in combat missions. It is no coincidence that today combat stress and its consequences remain one of the most urgent issues both for the military personnel and civilians, directly or indirectly involved in the armed conflict.

The objective of the paper is to analyse of the content of papers on combat stress published by foreign investigators from 2005 to 2021, using the adapted results of the VOSviewer study.

Methodology. With an ever-increasing flow of scientific publications devoted to various aspects of combat stress, a comprehensive independent analysis of their content becomes very problematic. With this in mind, we used a special analytical software VOSviewer. 5428 publications on combat stress, published from 2005 to 2021 and indexed in the PubMed abstract database, were analyzed. With 10 repetitions of keywords across 10 papers, published by investigators individually or in co-authorship, 390 keywords and 11 main scientific co-authorships were produced. However, the VOSviewer software does not perform semantic analysis of keywords. The paper suggests to group keywords similar meaning into generalized concepts in order to provide for a more adequate independent analysis of the cluster content. The resulting keywords were combined into 38 generalized concepts. Based on the total link strength, the contribution of keyword and co-authorship clusters to the total array of publications was calculated.

Results and discussion. The combined concepts were divided into 4 clusters. Cluster 1 includes papers focused mainly on acute and chronic stress disorders and their manifestations in combat veterans. The total link strength of keywords was 36.8 % of the structure in the total array of publications. Cluster 2 comprises papers relying on evidence-based medicine to investigate health disorders in the military engaged in armed conflicts and exposed to combat stress, with a total link strength of 36.5 %. Cluster 3 represents papers with a minimal focus on combat disorders in favor of first aid, accessibility and promptness of medical services, as well as other healthcare organization parameters, including military medicine, psychotherapeutic and combination therapy, with a total link strength of 14.3 %. Papers in Cluster 4 contained the group of keywords on psychological adaptation of respondents exposed to combat stress, with a total link strength of 12.4 %. Most papers were published by US scientists working in the institutions of the United States Department of Veterans Affairs.

Conclusion. As a result, the analysis allowed to show high consistency of content between foreign and domestic publications on combat stress. Foreign scientific publications stand out for a solid evidence-based framework of research, wider coverage of international combat conflicts, references to a broad scope of papers by fellow investigators from different countries, and intensive focus on combat stress disorders in the wounded or the military with combined trauma and other pathologies.