Nº 1 (2022)

Abstract. The need to protect the population of the territories and personnel of the facilities serviced by the Federal Medical and Biological Agency in emergency situations by medical treatment organizations and mobile medical formations sets them an important task — to provide timely emergency and urgent medical care to victims in an emergency in accordance with modern principles of medical evacuation routing.

The aim of the study is to analyze and to evaluate the main results of the activities of the All-Russian Center for Disaster Medicine “Zaschita” as a part of Federal Medical and Biophysical Center named after A.I. Burnazyan of the Federal Medical and Biological Agency of the Russian Federation, to develop proposals and to define objectives for further development and improvement of the system to organize medical care and medical evacuation in emergencies at facilities and territories served by FMBA of Russia.

Materials and research methods. Materials: regulatory, legal and methodological documents governing the procedure for providing medical aid to the victims of emergencies; reports of the structural units of the All-Russian Center for Disaster Medicine “Zaschita”, including special exercises held in 2021; scientific papers on topical issues of medical support to the population in emergencies.

Research methods: analytical, statistical, method of direct observation.

Results of the study and their analysis. The results of the first year of operation of the the All-Russian Center for Disaster Medicine “Zaschita” as a part of Federal Medical and Biophysical Center named after A.I. Burnazyan of the Federal Medical and Biological Agency of the Russian Federation in 2021are presented. The following results are considered and analyzed: special trainings of the Field Multidisciplinary Hospital and Consolidated medical detachment; work on medical support of mass events — “Tavrida” Forum of Young Culture and Arts Workers and “Silk Road” international rally.

The work of the laboratory of scientific and methodical problems of medical support in emergency situations established in the All-Russian Center for Disaster Medicine “Zaschita” within the past year was characterized. Decrease of the Center of sanitary aviation and ambulance services abroad activities due to borders closing, caused by COVID-19 pandemic, is highlighted.

The activities of the All-Russian Center for Disaster Medicine “Zaschita” in the field of civil defense in the interests of FMBA of Russia, are listed. The main tasks for the All-Russian Center for Disaster Medicine “Zaschita” for 2022 are formulated.

Abstract. The objectives of the study are: to analyze the experience of organizing medical assistance and medical evacuation of victims during terrorist acts committed with the use of conventional means of destruction; to determine standard options for creating a group of medical forces and means, their possible composition and the main tasks to be solved in the implementation of medical and evacuation support.

Materials and research methods. Materials of the research: normative and methodical documents regulating the order of medical aid rendering and carrying out medical evacuation of wounded at acts of terrorism; reports of territorial disaster medicine centers on liquidation of medical and sanitary consequences of acts of terrorism classified as emergencies; data of expert evaluation maps on the research theme; scientific works and publications devoted to the organizationa of medical aid rendering and of carrying out medical evacuation.

The following scientific methods were applied: content-analysis, expert estimation, logic and information modeling, analytical method.

Research results and their analysis. The results of the study of the basic principles of creating a grouping of medical forces and means intended to provide medical assistance and evacuation of victims of terrorist acts with the use of conventional means of destruction are presented.

Substantiated propositions on creation of standard variants of echelon grouping of medical forces and means at liquidation of medical and sanitary consequences of terrorist acts were made; composition of medical forces and means, included in each echelon of the grouping, and their main tasks were defined.

The results of the research have shown that medical organizers and specialists of the Disaster Medicine Service of the Russian Ministry of Health experience difficulties when creating and determining the order of functioning of a group of medical forces and means involved in medical and evacuation support of injured, especially during large-scale terrorist attacks. It is conditioned by: insufficient knowledge of peculiarities of modern terrorist acts and of factors, influencing the organization of medical aid and medical evacuation; insufficient practical experience of medical specialists; shortcomings in generalization of experience of public health management bodies, medical organizations and formations, participating in liquidation of consequences of such emergency situations; imperfection of normative and methodical base. 

Abstract. The objective of the study was to analyze the effectiveness of the “Monitoring” program for patients with new coronavirus infection and to evaluate its preparedness to work in emergency situations, as well as to substantiate the effectiveness of the program as a monitoring tool for patient care management in level 1 and level 2 medical treatment organizations when there is a shortage of intensive care beds at level 3 medical institutions.

Materials and research methods. Materials of the research: normative legal documents regulating the order of application of telemedicine technologies in Russia and Kuzbass, including in the field of the Disaster Medicine Service, scientific publications, personal work experience in the organization of remote consultations.

The research was based on the data on the provision of consultative medical care to the patients with the diagnoses “new coronavirus infection” and “community-acquired pneumonia”, who were hospitalized in the intensive care departments of level 1 and level 2 medical treatment organisations.

Research results and their analysis. The retrospective analysis of the calls to the monitoring center from the patients in severe condition, being treated in level 1 and level 2 medical treatment organizations for the diagnoses of new coronavirus infection and pneumonia, who needed monitoring by the specialists of the consulting center (mainly by intensive care specialists), was performed.

Inclusion criteria in the study: adult patients with new coronavirus infection and pneumonia; receipt of call to the monitoring center during the study period – 01.11.2020-31.01.2022; availability of patient counseling using “Monitoring” program.

Conclusion was made, that the system, linking major hospitals with local hospitals, which have the maximum load in periods of peak morbidity, through conducting emergency and urgent telemedicine consultations was created in Kuzbass. The analysis of the obtained data testifies to the effective work of the monitoring center for severe patients as a type of telemedicine tool when working in high alert mode.

Abstract. The aim of the study is to determine approaches to investigate the impact of COVID-19 pandemic stress on the professional preparedness of a physician.

Materials and research methods. Working hypothesis of the research is based on K. Maslach’s model of three-dimensional structure of professional burnout. The physicians of Volgograd medical organizations took part in the study — N=112, mean age — (40,2±1,4) years, mean length of service — (6,2±1,7) years. As psychodiagnostic testing methods “Diagnosis of psychological rigidity” and “Determination of neuropsychological resistance and risk of maladaptation to stress” (“Prognoz”) were used. The express interview, in which physicians of Volgograd city and Volgograd region, whose professional activity is connected with rendering of medical aid to patients with COVID-19 took part, was conducted on the basis of Google electronic platform using Google Forms (N=236). An additional questionnaire was developed for the model group of doctors, the purpose of which was to subjectively assess the respondents’ opinion on the necessity of determining the preparedness of physicians for professional activity in extreme conditions.

Research results and their analysis. The results of the research showed the relevance of socio-psychological support of physicians working under extreme conditions in order to improve the quality of medical care.

Abstract. The aim of the study is to systematize data on modern opportunities for correction of circadian rhythm disorders.

Materials and research methods. The domestic and foreign literature on the prevention and treatment of desynchronosis was analyzed. The search was performed using electronic databases MEDLINE, Embase, Scopus, Web of Science, and eLIBRARY for 2012-2021. The keywords “desynchronosis”, “treatment”, “prevention” and their combinations were used for the search.

Research results and their analysis. The results of the research showed that the following methods of correction of circadian rhythm disturbances are currently available: diet, taking melatonin, changing sleep regime, changing physical activity schedule. It was noted that when forming an optimal training schedule, it is important to take into account the chronotype of the athlete. Exogenous melatonin can be used to normalize sleep, but turning off artificial light 1.5-2 hours before sleep and not eating at night is considered a better option. This approach will allow the athlete to maximize his/her potential, to achieve better athletic performance and to prevent desynchronosis.

Abstract. Medical and psychological support of professional activity of firefighters does not take into account their chronic poisoning by toxic products of burning. Such diagnoses are made to the firefighters of the State Fire Service of the Federal Fire Service of EMERCOM of Russia only in case of acute poisoning. Insufficient attention paid to the impact of fire-specific toxicants, including dioxins, does not allow timely detection of disturbances in the regulation of physiological systems of firefighters’ organisms, which leads to the emergence of diseases.

The aim of the study was to determine the effect of dioxins on the state of the microbiota.

Materials and research methods. The study involved 246 male patients, of whom 121 were employees of the State Fire Service of the Federal Fire Service of EMERCOM of Russia and 125 were civilians and rescuers of EMERCOM of Russia.

Research results and their analysis. The data obtained in the study of the blood microbiota by chromatography-mass spectrometry of microbial markers indicate a pronounced intestinal dysbiosis in firefighters with non-alcoholic fatty liver disease due to decreased number of microbial markers of the normal microbiota along with increased total number of microbial markers and opportunistic microorganisms.

The dysbacteriosis revealed in the firefighters having no health complaints can be a predictor of liver pathology development that testifies to necessity of control and timely correction of microecological status.

Abstract. The objectives of the study are to develop a structural and functional model, principles and algorithms of organizational and methodological support of helicopter evacuation of patients to specialized medical organizations of megapolis; to evaluate their effectiveness analysing the results of treatment of patients with significant urgent pathology.

Materials and research methods. The results of treatment of 241 patients with urgent pathology at the treatment facilities of the Moscow Health Department — City Clinical Hospital No.15 named after O.M. Filatov, S.S. Yudin State Clinical Hospital  and N.S. Sklifosovskiy Research Institute of Emergency Medicine in 2016-2019 — were analyzed. Inclusion criteria: patients with bleeding (isolated or in combination with acute trauma) requiring surgical intervention; with acute coronary syndrome (unstable angina pectoris, myocardial infarction with and without ST-segment elevation); with vascular pathology of central nervous system or craniocerebral trauma, requiring emergency hospitalization of the patient in a specialized medical institution — provided that the time of delivery of all these patients to the hospital was at least 30 minutes from the time of call.

Exclusion criteria: patients with mental illness, infectious-inflammatory processes, severe comorbid somatic diseases in decompensation stage (established by anamnesis, examination or autopsy reports); incurable cancer patients and any urgent patients whose delivery time to the specialized hospital was less than 30 minutes from the time of call.

All patients included in the study were divided into 2 groups:

The main — 1st group — included 112 patients delivered to the profile medical institution of the megapolis on a medical helicopter.

The comparison group — 2nd group — consisted of 129 patients with similar urgent pathology, hospitalized to the specialized hospitals of the city by ground ambulance transport.

Research results and their analysis. The analysis of the study results showed:

– performance of air medical teams is comparable to or exceeds that of ground ambulance teams;

– number of total bed-days in the group hospitalized by air ambulance was higher than in the comparison group;

– inpatient outcomes and long-term outcomes were comparable in both groups;

– pilot study of the use of mobile diagnostic ultrasound in providing emergency and urgent medical care allows us to consider this method as a promising one, but it requires further evidence accumulation.

Thus, the performance of medical aviation is not inferior to the performance of ground ambulance teams, and in some aspects, even exceed them, which confirms the high potential of its use in megapolis conditions and in remote and hard-to-reach areas.