编号 4 (2022)
Safety in Emergency Environment
Organization of Medical Care for Victims of Emergencies in Medical Treatment Organizations of the Federal Medical and Biological Agency. Message 1
摘要
Summary. The aim of the study is to examine and to analyze infrastructure of medical treatment organizations of the Federal Medical and Biological Agency (FMBA of Russia) in relation to their preparedness to deal with the most likely emergency situations in the facilities and territories served by FMBA of Russia.
Materials and research methods. The subject of the study is the system of medical treatment organizations of FMBA of Russia, their capabilities to provide medical care to victims in various emergencies at facilities and territories served by FMBA of Russia. The objects of the study are structure of regular beds in medical treatment organizations, staffing of their departments with medical specialists and a number of other indicators.
The division of medical treatment organizations into levels was made irrespective of their location and without reference to federal districts. Linking the conditions of medical treatment organizations functioning to the specifics of the enterprise or territory served, was not carried out.
Analytical, sociological (method of expert evaluation) and statistical research methods were used during the study.
The materials of the study are Federal Laws, Resolutions of the Government of the Russian Federation, regulatory and methodological documents of FMBA of Russia, as well as scientific publications on the topic of the study. A card containing 75 questions and 187 sub-questions was developed to survey the state of infrastructure and capabilities of medical treatment organizations of FMBA of Russia to provide medical assistance and medical evacuation of patients and victims in emergencies.
Results of the study and their analysis. We studied and analyzed 66 cards submitted by the surveyed medical treatment organizations, whose share in the total number of medical treatment organizations administered by the Russian Federal Medical and Biological Agency was 47%. In 16 medical treatment organizations (22.6%) there were no documents regulating their activities in preparation for work to eliminate medical and sanitary consequences of emergencies, which indicates a low level of preparedness of these organizations.
The number of beds deployed in the specialized departments of medical treatment organizations of all levels corresponded to the staff list. Additional beds for providing medical care to patients and victims of emergencies can be deployed according to the profiles for which medical treatment organization is specialized for. In some medical treatment organizations it is planned to increase the bed fund by 2-4 times in case of mass admission of patients and victims in emergencies.
Medical specialists in almost all organizations are not fully staffed — in day-to-day activities their deficit is compensated by the increased load on working specialists. If it is necessary to provide medical care in conditions of mass influx of patients and victims of emergencies, this situation will lead to an increase in time for triage and for therapeutic and diagnostic activities, as well as to a significant reduction in volume of medical care provided.
5-12
Comparative Characteristics of Professional Activity of Medical Specialists in Non-Staff Units of Disaster Medicine Service of the Russian Ministry of Health and of the Federal Medical and Biological Agency
摘要
Summary. The aim of the study was to investigate characteristics of professional activity of medical specialists from non-staff units of the Disaster Medicine Service of the Ministry of Health of Russia and from non-staff units of the Federal Medical and Biological Agency — in order to identify and to assess features of their activities both at their main place of work — in the daily activities mode, and as part of non-staff unit — in modes of high readiness and of emergency situations.
Materials and research methods. A sociological study (questionnaire study) of 255 medical specialists working in the non-staff units of the Disaster Medicine Service of the Ministry of Health (n=206) and of the Federal Medical and Biological Agency of Russia (n=49) was conducted. A special questionnaire was developed, the questions in which were composed to evaluate the expert level of medical specialist, to characterize his professional activity at the main place of work and in the non-staff formations in modes of high readiness and emergency situation. Each of respondents gave voluntary consent to process their personal data contained in the questionnaire, applying the procedure established by the legislation of the Russian Federation on personal data and based on the decision of the independent Ethics Committee.
Results of the study and their analysis. General characteristics of medical specialists included in the non-staff units of the Disaster Medicine Service of the Ministry of Health of Russia and in the non-staff units of the FMBA of Russia were studied and presented. Their professional abilities and experience in providing medical aid to the victims of emergencies outside the medical treatment organization were analyzed. It is shown that medical specialists from the non-staff units of the Disaster Medicine Service of the Ministry of Health of Russia participate more often in elimination of medical and sanitary consequences of emergencies directly in the focus of mass sanitary losses. The suggestion on the expediency of the development of the integral index “load index” of a particular emergency area has been made.
13-16
Practical Experience of the Unified Center for Dispatching, Monitoring and Medical Evacuation Functioning as a Part of the Sverdlovsk Regional Center for Disaster Medicine
摘要
Summary. The goal of the study is to show, on the basis of analysis of the experience of the unified center of dispatching, monitoring and medical evacuation in the structure of the Territorial Center for Disaster Medicine of Sverdlovsk region, the efficiency of unified dispatching service, operating on the functional basis in the same information field as the regional emergency medical service.
Materials and research methods. Sources of information and materials on the research theme: normative and methodological documents regulating order and organization of the Disaster Medicine Service and emergency medical aid; publications in “Disaster medicine”, “Emergency Medical Aid” journals; reports of heads of joint centers and independent territorial disaster medicine centers. Research methods: analytical, statistical, method of direct observation, method of logical and informational modeling.
Research results and their analysis. The work of three departments of unified center of dispatching, monitoring and medical evacuation was analyzed: operative-dispatching department, department of consultation and monitoring of intensive care patients, department of monitoring of ambulance calls.
It is concluded that this model of a single dispatch service is financially inexpensive, efficient and can be recommended to the regions of Urals, Siberia and the Far East, where there are strong territorial disaster medicine centers and specialized resuscitation and consultative centers.
17-20
Public Health and Healthcare
Decade of Problems and Solutions: to the Anniversary of the Chair of Emergency Medicine and Injury Surgery of the First Saint Petersburg State Medical University named after acad. I.P. Pavlov
摘要
Summary. The history of the creation and activity of the Chair of Emergency Medicine and Injury Surgery of the First St. Petersburg State Medical University named after acad. I.P. Pavlov is presented. The main stages of the development of the chair are considered, the scientific potential of the chair and the work of its staff in the creation of the system of emergency and urgent medical care for the population of the city are discribed. It is noted that starting from 2012 the members of the chair in cooperation with the specialists of St. Petersburg Scientific Research Institute of Emergency Care named after I.I. Dzhanelidze made a significant contribution to solving scientific and practical, organizational and methodological problems in the field of emergency medical care in the Russian Federation.
21-28
Rationale for Teaching Medical Students to Apply Humanitarian Principles in their Work Practices
摘要
Summary. It has been noted that an increasing number of people in the world are becoming victims of humanitarian crises, and the application of basic humanitarian principles can improve the quality of medical care, including medical care in emergencies. Therefore, training future physicians in the application of humanitarian principles in practice becomes a crucial task, since without this it is impossible to imagine achieving the goal of universal health care coverage, including in emergencies. The article presents the experience of teaching medical students to comply with legal obligations when providing medical care in various emergency situations.
29-33
Clinical Aspects of Disaster Medicine
Analysis of the Results of Treatment of Pelvic Injuries with Reproductive System Damage in Women in Conditions of Local Armed Conflict
摘要
Summary. The aim of the study was to analyze the results of treatment of pelvic gunshot wounds with damage to the reproductive system organs in women in a local armed conflict.
Materials and research methods. A retrospective analysis of the results of treatment of 86 patients with pelvic gunshot wounds with genital damages was performed. All the patients were members of the general population. Treatment was carried out at Grozny City Clinical Hospital in 1997-2005. The mean age of patients was (25±7) years. Female patients of fertile age with gunshot wounds in the pelvic area with damages of reproductive organs were included in the study. The following patients were excluded: patients younger than 18 and older than 45 years; patients with concomitant injuries of the chest, head, limbs, and patients in agonal state.
Study results and their analysis. The results of the study showed that most of the women had severe injuries, which resulted in bleeding, pain syndrome and shock as a consequence. Severe injuries were often combined with pelvic injuries and required wide laparotomy and revision of the abdominal cavity organs. The signs of peritonitis due to concomitant injuries at the moment of admission limited the choice of tactics.
In the nearest postoperative period the complications were related mainly to the purulent-inflammatory processes in 24.4% of cases. Nineteen patients died (22.1%). The main causes of lethal outcome were: shock in 15.1% of cases; purulent-septic complications in 6.9% of cases.
It has been concluded that severe gunshot wounds of the pelvic organs in women, accompanied by the reproductive system injuries, are characterized by a severe postoperative course, a great number of lethal outcomes and require urgent hospitalization in a multidisciplinary hospital.
34-38
Provision of First Aid and Medical Assistance to Injured and Sick at Ski Resorts
摘要
Summary. The aim of the study is to analyze causes, level and structure of traumatism and exacerbation of diseases among tourists at ski resorts in Russia and abroad; to consider problems of providing first and medical aid to injured and sick people and of conducting their medical evacuation at ski resorts in Russia.
Materials and research methods. Normative and empirical base of the scientific research consisted of analytical materials of Russian and foreign scientists, devoted to traumatism and non-traumatic accidents in tourists, as well as of materials on the organization of first and medical care to the injured and sick at ski resorts. In addition, normative legal acts on rendering first and medical aid to the injured and sick, contained in two departmental orders, were analyzed.
Research methods: literary-analytical and statistical methods, method of direct observation. Their use allowed a comprehensive analysis of the subject of research, also it allowed to make theoretical generalizations and to formulate conclusions.
Results of the study and their analysis. The results of the study have shown the need for further study of the specific conditions of first aid and medical assistance to injured and sick in the conditions of ski resorts, as well as the need to improve organizational measures to provide injured and sick with first aid and medical evacuation.
39-43
Influence of Organizational Factors on the Formation of Mental Maladaptation in Medical Workers during the Pandemic of a New Coronavirus Infection Covid-19
摘要
Summary. The aim of the study is to analyze the modern foreign and domestic scientific literature devoted to the influence of production factors on the formation of mental maladaptation in medical workers, as well as possible methods of its prevention and curing.
Materials and research methods. Scientific studies of negative psychological reactions and manifestations of mental disorders in medical workers of various profiles in the COVID-19 pandemic were analyzed. The search protocol included the use of various databases, including PubMed; Russian information and analytical portal in science, technology, medicine, and education — eLIBRARY.ru; open-access statistical reporting data; and official websites of scientific journals on the subjects under study.
Study results and their analysis. The results of the study showed that most medical professionals experienced stress caused by organizational factors such as a lack of personal protective equipment (PPE), fears of not being able to receive quality medical care if they were sent to work elsewhere, fears of rapidly changing context, lack of access to current information and communication, lack of special medications, shortage of ventilators and beds in intensive care units
In the conditions of regular health care work, most of the professionals noted tension in the process of performing professional duties, exceeding their physical and mental capacities, which was one of the main reasons for anxiety, nervousness or stress at work.
44-49
Organization of Training in the Basics of Tactical Medicine with Citizens of the Orenburg Region Called Up for Military Service as Part of Partial Mobilization
摘要
Summary. The aim of the study is to analyze practical training in the basics of tactical medicine with citizens called up for military service in the framework of partial mobilization.
Materials and research methods. In the course of practical classes on the basics of tactical medicine were used: individual medical kits — AIM-3S, cloak tents, sanitary straps, improvised means. The exercises included training in: methods of applying a tourniquet for external bleeding; ways of immobilizing limbs if they are injured; performing anti-shock measures; applying bandages on a wound and the order of evacuation of wounded to a safe area. All practical exercises were conducted in the field conditions.
Study results and their analysis. Classes with citizens called up for military service as part of partial mobilization were conducted on the training range of the training center responsible for manning the military unit of territorial defense. The servicemen learned necessary skills of first aid in self- and mutual aid modes in the red, yellow and green danger zones. Various methods of evacuating wounded to a safe zone were practiced. The training program was executed completely, learning goal was achieved.
50-52
Actual Problems of Medical Evacuation
Peculiarities of Medical Evacuation of Patients under Conditions of Temporary Restrictions of Civil Aviation Flights, Including from Abroad, at the Federal Level
摘要
Summary. The aim of the study is to analyze and to substantiate alternative ways of solving problematic issues of medical evacuation of patients and casualties in conditions of temporary restriction of civil aviation flights.
Materials and research methods. Materials of the study: practical experience of the specialists of the Center of sanitary aviation and emergency medical care of “Zashchita” Disaster Medicine Center of Federal Medical Biophysical Center named after A.I.Burnazyan of the Federal Medical and Biological Agency of Russia, as well as LLC “Medaero-Service”; statistical data on the field work of teams of the Center of sanitary aviation and emergency medical care on medical evacuation of patients from closed airspace areas; data from the official websites of the Federal Air Transport Agency, of Government and Ministry of Foreign Affairs of the Russian Federation, of Border Service, of Federal Tourism Agency, and assistance companies; electronic database of regulatory legal documents.
Research methods: analytical, method of direct observation, comparison, description.
Results of the study and their analysis. Results of the study, characterizing the problematic issues of medical evacuation of patients and victims in conditions of temporary restriction of civil aviation flights regime, are presented. The main ways of optimization of medical evacuation of patients and victims at the federal level during the period of air traffic limitation have been suggested and substantiated.
53-57
Problematic Issues in Organization and Conduct of Air Ambulance Evacuation of Patients and Victims in Emergency Situations
摘要
Summary. The aim of the study is to investogate the current state of organization and of sanitary aviation evacuation of patients and victims in emergency situations at regional level.
Materials and research methods. The study was conducted in 2022 in the Federal Center for Disaster Medicine of the National Medical and Surgical Center named after N.I. Pirogov of the Ministry of Health of Russia. Materials of the study — publications in scientific journals; questionnaire data on the factors affecting the conduct of air ambulance evacuation using helicopters in the regions of the Russian Federation.
Research methods — literary-analytical method and method of expert evaluations.
Literary and analytical method was used to study problems and opportunities for the use of air transport for medical purposes in the Russian Federation and abroad.
The method of expert evaluations was based on opinions and experience of specialists in evaluating factors affecting organization of air ambulance evacuation in the regions and of the need for its implementation.
The object of the study is the system of organization and conduct of the sanitary aviation evacuation of patients and victims in emergencies in the regions of the Russian Federation.
Study results and their analysis. Domestic and foreign experience of medical care to the patients and victims in emergencies using air ambulance evacuation is presented.
The basic problematic questions of organization and execution of sanitary aviation evacuation of patients and victims in extreme situations have been analyzed.
58-63
Provision of Medical Assistance to Patients and Injured with the Use of Air Ambulance in the Republic of Crimea
摘要
Summary. The aim of the study is to evaluate the work of aviation medical teams of the Territorial Disaster Medicine Center of the Republic of Crimea in the field of sanitary aviation evacuation and rendering emergency consultative medical aid to the patients and victims of emergencies.
Materials and research methods. Materials of the study — service documentation on the work of the department of the emergency consultative medical aid of the territorial disaster medicine center of the Republic of Crimea in 2019-2021. Research methods – analytical and statistical.
Results of the study and their analysis. Sanitary aviation evacuation of patients and victims of emergencies in the Republic of Crimea is performed on the Ansat helicopter by a full-time aviation medical team of resuscitation profile with attraction — if it is necessary — of other specialists. The results of the work of the sanitary aviation of the Republic of Crimea in 2019-2021 are presented.
Based on the results of the study, proposals were made to improve the quality of air ambulance evacuations. Among them: organization of short-term courses on acquainting aviation medical teams members with basics of aviation medicine, aviation ergonomics and psychophysiology of flight crews’ activity; training of flight crew (pilot, navigator) in basics of air ambulance evacuation; conducting “on the ground” with non-members of aviation medical teams instructional lessons and trainings on the rules of airborne medical equipment operation, etc.
64-67
In Order of Discussion
Peculiarities of Modern Local Wars and Armed Conflicts and Problems of Medical Care in Prehospital Period
摘要
Summary. The aim of the study is to investigate the peculiarities of modern local wars and armed conflicts, their influence on the structure of sanitary and non-return losses among population on the basis of scientific publications analysis. It also aims to define the principal problems of organization and rendering medical aid to wounded, sick and injured under these conditions and to outline the possible ways of their solution. Materials and research methods Materials of research — domestic and foreign publications, which analyze modern local wars and armed conflicts and assess their striking effect on vital functions and vitality of population. Method of research — review-analytical. Results of the study and their analysis. The features of modern local wars and armed conflicts, their impact on the structure of combat and non-combat losses among the population are highlighted. The inefficiency of the present system of medical and evacuation measures for urgent and emergency medical indications in the prehospital period was presented, especially in the conditions of combat operations. There were defined both advantages and problems of wide and effective application of capabilities, forces and means of the Disaster Medicine Service and ambulance service for rendering first and medical (emergency and urgent) aid to the population in regions of military actions and in extreme situations. A variant has been suggested to combine forces and means of medical service of civil defense, ambulance and emergency medical service into a united universal branch system called “operative-tactical medicine” aimed at optimization and increase of effectiveness of medical aid rendering to population in prehospital period both in conditions of everyday activity and in extreme conditions of modern local wars, armed conflicts and other emergency situations.
68-72
Need to Expand Official List of Conditions for which First Aid is Provided in the Russian Federation
摘要
Summary. The objectives of the study were to determine the general spectrum of critical conditions in which timely and correctly rendered first aid can contribute to the preservation of life; to assess the feasibility of expanding the official list of conditions in which first aid is rendered in the Russian Federation.
Research materials and methods. The study materials are national and international recommendations for first aid; data of official statistics; legal acts of the Russian Federation regulating first aid; domestic and foreign scientific publications. Bibliographic databases Google Scholar, Pubmed/Medline and Russian Science Citation Index (RSCI) were used to search for scientific publications. The materials were searched and analyzed in July-August 2022.
Study results and their analysis. The results of the analysis of international and national recommendations and relevant scientific publications on first aid, undertaken to identify the general spectrum of life-threatening conditions in which timely and properly provided first aid can determine a favorable outcome for the patient or victim are presented. The official list of conditions for which first aid is provided, approved in 2012, does not include a number of widespread and life-threatening health disorders, including acute coronary syndrome and stroke — conditions that cumulatively cause the largest number of deaths among adult population of the country. The article substantiates the expediency of expanding the official list of conditions for which first aid is provided in Russia.
73-78