№ 2 (2023)

Summary. The aim of the study is, on the basis of research and analysis of current normative and methodological documents, to develop proposals for the improvement of regulation and methodological support of the system for the organization of medical assistance to victims and their medical evacuation in emergencies at facilities and territories served by the Federal Medical and Biological Agency (FMBA of Russia).

Study materials and methods. Materials of the study include legislative acts and regulatory documents in force in the field of healthcare in the country, including the system of FMBA of Russia, on the problem under study; orders and guidelines of FMBA of Russia on the organization of medical care to victims and their medical evacuation in emergencies; scientific papers and publications devoted to current issues of regulation and methodological support of medical and evacuation support of victims in emergencies.

The following methods were applied: historical; methods of content analysis and expert review, logical and information modeling; analytical method.

Results of the study and their analysis. The article presents the results of the study and analysis of the principal regulatory and methodological documents governing the organization of medical aid and medical evacuation of the victims of emergencies at the facilities and territories served by the Federal Medical and Biological Agency and the medical forces and facilities of the Functional Subsystem of the Federal Medical and Biological Agency. The backlogs of these documents are demonstrated. Proposals for further improvement of legal regulation and methodological support of activities of the functional subsystem of FMBA of Russia are made.

 Summary. The aim of the study is to investigate problematic issues of organizing the elimination of medical and sanitary consequences of emergency situations in Sakhalin region; to analyze the state of provision of medical services to the population.

Study materials and methods. Materials of research: scientific works and publications, normative and methodical documents, statistical data, exercise materials, etc. When performing the study, methods of logical and information modeling, comparison, description were used.

Results of the study and their analysis. The mechanism and sequence of actions during elimination of medical and sanitary consequences of emergencies in Sakhalin oblast were studied. The provision of medical services to the population in emergencies has been analyzed. Proposals for further improvement of medical and evacuation support of the population in emergencies have been made.

 Summary. The work of the training department of the Moscow Territorial Scientific and Practical Center for Disaster Medicine of Moscow Health Care Department on first aid training courses under conditions of a special military operation is presented. The importance of forming stable first aid skills in the combat operations zone was shown. The question about the need to expand the list of first aid measures in the area of special military operation is raised; the question about the need to revisie and to expand the first aid training program is raised.

Summary. The experience of teaching the “First aid” subject with 2nd year students at the emergency and disaster medicine chair of Ryazan State Medical University named after acad. I.P. Pavlov.

It is noted that “First aid” is taught with several goals in mind, the main of which is to teach practical skills and to check their mastering by each student. The author considers three variants of teaching “First Aid”, stipulates lessons themes and the list of activities (16 lessons in a semester).

Summary. Pancreatic trauma is an infrequent injury of abdominal organs in patients with severe combined trauma, characterized by severe course and high mortality. In its treatment timely diagnosis and correctly chosen treatment tactics are of paramount importance. The experience of successful non-surgical treatment of a 34-year old patient with closed abdominal trauma including pancreas injury (incomplete rupture in the isthmus area — AAST III), obtained after falling from the 11th floor is described.

Summary. The aim of the study is to identify problems in the organization of medical triage and medical care in trauma centers of different levels at mass simultaneous admission of victims in emergency situations and to determine possible ways to solve them.

Study materials and methods. We analyzed the results of treatment of 136 emergency patients in Saratov and Saratov region trauma centers in 2010-2021. All patients were delivered by emergency medical teams (EMTs). Road traffic accidents (RTA) were the most frequent cause (76.0%) of traumatization of the patients, in the remaining cases (24.0%) carbon monoxide poisoning and burns caused by fires were the most common. The mean age of the victims was (39±7) years, of whom 71 (52.2%) were men, and 65 (47.8%) were women.

The study was a total retrospective study, using patient medical histories as primary documentation. Patients older than 18 years were included in the study. Victims, who were delivered to trauma centers in addition to ambulance teams, were excluded from the study.

Results of the study and their analysis. The results of the study show that of 136 accident victims delivered to trauma centers in Saratov and Saratov region, 76 cases (55.9%) proved to have errors in the organization of medical triage and medical care to the victims.

Most of the errors can be conditionally divided into 2 large groups. The first group included 52 observations (38.2%) related to the organization of the admission of injured persons who arrived from the emergency area.

The second group included cases of underestimation of the patient’s condition severity, wrong diagnosis, incompletely performed antishock or infusion therapy. The authors designated these errors as therapeutic — they occurred less frequently and were noted only in 9 cases (6.6%) — all these errors were made only in Level III trauma centers.

Analysis of the study results showed that the main problem encountered by the management of trauma centers in Saratov region during mass simultaneous admission of victims in emergencies was the incorrect involvement of medical specialists in medical triage, which led to an increase in the timing of its implementation and in the timing of medical care — for example, the involvement of therapeutic specialists in the medical triage of surgical patients.

To solve this problem, the authors propose to reverse the involvement of anesthesiology, surgery, and neurology medical specialists in the emergency departments of medical treatment organizations with their subsequent return to their departments as the workload in the emergency departments decreases.

Summary. The aim of the study is to investigate and to systematize world experience in the organization of measures to prevent technogenic emergencies (ES), as well as the experience of timely measures to eliminate their medical and sanitary consequences, to ensure safety of the population, to provide medical care and reduce the damage caused to national economy.

Study materials and methods. Various databases were used, including PubMed; Russian information-analytical portal in the field of science, technology, medicine and education — scientific electronic library eLIBRARY.RU; open access statistical reporting data and also official sites of scientific journals on the specified subjects.

Results of the study and their analysis. It is noted that most countries, including the Russian Federation, have accumulated a lot of experience and developed a large number of regulatory documents governing algorithms and a necessary amount of activities in the field of protection of population and territories from man-made emergencies.

In the event of such emergencies there are extremely urgent tasks to reduce or to prevent potential sanitary losses among civil population, as well as to ensure the uninterrupted operation of medical facilities. To solve them a whole complex of measures on medical and psychological protection of the population and employees of medical institutions is carried out.

A specific peculiarity of professional activity of specialists of rescue services and medical workers, providing liquidation of medical and sanitary consequences of technogenic emergencies, is work in special conditions and under the influence of a considerable quantity of stressogenic factors.

Organization of medical support of the victims of man-made emergencies also includes the creation of mobile forces, capable of ensuring the timeliness of medical care to victims.

Most European countries have created joint rapid response forces, which are represented by mobile medical brigades and detachments, organized on the basis of large multidisciplinary medical treatment organizations. Their main task is to assess medical situation in the affected area: number of victims, severity of injuries and their preferential localization, need for specialized medical care, dislocation of the available medical forces and facilities and their capabilities.

Domestic and international experience of organization of medical aid rendering to victims of technogenic emergencies shows that high levels of stress, anxiety, depression, professional burnout occur among the specialists of rescue services and medical workers, which may have long-term consequences. New methods and approaches to the organization of medical care in man-made emergencies are being developed and implemented all over the world and ways to support specialists of rescue services and medical workers taking part in the liquidation of man-made emergencies are being improved.

Summary. The aim of the study is to determine approaches to sanitary aviation evacuation of seriously ill people and victims in emergency situations (ES) under the conditions of a megalopolis on the example of Moscow.

Study materials and methods. Materials of the study were the data of the accompanying sheets, medical records and morphological studies conducted in deceased patients.

Research methods: analytical, statistical, methods of direct observation, logical and informational modeling.

Results of the study and their analysis. It has been noted that emergencies in megalopolises are extremely diverse, unpredictable and of a larger scale than in the Russian Federation as a whole. A mass simultaneous admission of victims in a serious condition to the specialized departments of the specialized hospitals is typical for large-scale emergencies in megapolises. The speed of hospitalization of such patients to provide them with primary medical and specialized, including high-tech, medical care is of fundamental importance. In these conditions the first priority is given to the sanitary and aviation evacuation of the injured and seriously ill with the use of air ambulance helicopters.

The article presents the data on the air ambulance evacuation of emergency victims and seriously ill people using air ambulance helicopters in Moscow in 2018-2022.

The approaches and principles of air ambulance evacuation, etc. are considered.