Emergency medical care is one of the guarantees of medical and social assistance to citizens.

- emergency medical care for sick and injured people life-threatening and human health conditions and injuries that occur at the scene of the incident (on the street, in public places, institutions, at home and along the way of the sick person to the hospital).

Ambulance appears in cases acute diseases, in case of mass disasters, natural disasters, accidents, childbirth and disruption of the normal course of pregnancy, in places public use, on the street and at home.

Urgent Care turns out to be sick at home with exacerbation of chronic diseases.

Our country has created a nationwide system for organizing emergency services. medical care, which includes ambulance and emergency stations, emergency hospitals (or emergency hospitalization departments of the general network hospital facilities), air ambulance.

Organizing the work of an ambulance and emergency aid station

Ambulance and emergency aid stations are designed to provide emergency medical care. Ambulance stations do not provide systematic treatment; they are intended to provide emergency care prehospital stage(see order of the Ministry of Health of the Russian Federation dated March 26, 2000 No. 100). They are not issued at ambulance stations. sick leave, certificates and other written documents to patients or their relatives.

Hospitalization of patients is carried out by emergency hospitals and emergency departments of the general network of hospital institutions.

Ambulance stations are equipped with specialized ambulance transport, equipped with equipment for urgent diagnosis and treatment of life-threatening conditions. The work of ambulance stations is organized in teams. There are linear teams (a doctor and a paramedic), specialized (a doctor and two paramedics), and linear paramedics (usually used for the targeted transportation of patients). IN major cities Usually the following specialized teams operate: resuscitation, neurological, infectious diseases, pediatric intensive care, psychiatric, etc. All work of the teams is documented, the team doctor fills out call cards, which after duty are handed over to the senior shift doctor for control, and then for storage and statistical processing in organizational and methodological department. If necessary (at the request of doctors in the general network, investigative authorities, etc.), you can always find the call card and find out the circumstances of the call. If the patient is hospitalized, the doctor or paramedic fills out an accompanying sheet, which remains in the medical history until the patient is discharged from the hospital or until the patient’s death. The hospital returns the tear-off coupon of the accompanying sheet to the station, which makes it possible to keep a record of the ambulance crew's errors, thereby improving the quality of work of the ambulance crews.

At the scene of the call, the ambulance team carries out necessary treatment in the maximum available volume (as well as on the way when transporting the patient). In providing assistance to the sick and injured, the main responsibility rests with the team doctor, who supervises the actions of the team. IN difficult cases the doctor consults with the senior shift doctor by telephone. Most often, the senior shift doctor, at the request of the line team doctor, sends a specialized team to the place of call. Patients in need of emergency assistance, transported to long distances air ambulance planes, helicopters.

Emergency medical care (EMS) is one of the types of primary health care. Emergency medical services institutions annually carry out about 50 million calls, providing medical assistance to more than 52 million citizens. Emergency medical care is round-the-clock 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.

general characteristics

The characteristic features that fundamentally distinguish emergency medical care from other types of medical care are:

the immediate nature of its provision in cases of emergency medical care and the delayed nature in case of emergency conditions(emergency medical care);

trouble-free nature of its provision;

free procedure for the provision of emergency medical services;

diagnostic uncertainty under time pressure;

pronounced social significance.

Conditions for providing emergency medical care:

outside medical organization(at the place where the brigade is called, as well as in the vehicle during medical evacuation);

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

inpatient (in conditions that provide round-the-clock observation and treatment).

Guiding Documents

Government Decree Russian Federation dated October 22, 2012 No. 1074 “On the Program of State Guarantees for the provision of free medical care to citizens for 2013 and for the planning period of 2014 and 2015.”

Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation.”

Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation.”

Order of the Ministry of Health of the Russian Federation dated March 26, 1999 N 100 “On improving the organization of emergency medical care for the population of the Russian Federation”

Order of the Ministry of Health and Social Development of the Russian Federation dated November 1, 2004 N 179 “On approval of the Procedure for providing emergency medical care”

Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation.” It is significant for the transfer of powers of the Russian Federation in the field of compulsory medical insurance to government bodies of the constituent entities of the Russian Federation, as well as the inclusion of emergency medical care (with the exception of specialized - sanitary and aviation) in the compulsory medical insurance system throughout the Russian Federation from January 1, 2013 . The transition to financing in the compulsory health insurance system is an important stage in the development of the emergency medical care system in the Russian Federation. Emergency medical care (with the exception of specialized medical care) is provided within the framework of the basic compulsory medical insurance program. Financial support for emergency medical care (with the exception of specialized - sanitary-aviation) is carried out at the expense of compulsory medical insurance from January 1, 2013

Main functions

Emergency medical care is provided to citizens in conditions requiring urgent medical intervention (accidents, injuries, poisoning and other conditions and diseases). In particular, emergency medical care stations (departments) carry out:

24-hour provision of timely and high-quality medical care in accordance with standards of medical care sick and injured people who are outside medical institutions, including during catastrophes and natural disasters.

Implementation of timely transportation(as well as transportation at the request of medical workers) of patients, including infectious diseases, injured people and women in labor in need of emergency hospital care.

Providing medical care to sick and injured people who seek help directly at the emergency medical station, in the office for receiving outpatients.

Notice municipal health authorities about all emergencies and accidents in the service area of ​​the ambulance station.

Ensuring uniform staffing of mobile emergency medical teams with medical personnel across all shifts and their full provision in accordance with the approximate list of equipment for the mobile emergency medical team.

Along with this, the ambulance service can transport donated blood and its components, as well as transportation of specialized specialists for emergency consultations. The emergency medical service carries out scientific and practical (there are a number of research institutes for ambulance and emergency medical care in Russia), methodological and sanitary educational work.

Forms of territorial organization

Ambulance station

Emergency Department

Emergency Hospital

Emergency Department

Ambulance station

The ambulance station is headed by chief physician. Depending on the category of a particular ambulance station and the volume of its work, he may have deputies for medical, administrative, technical, and civil defense and emergency situations.

Most large stations They consist of various departments and structural units.

The ambulance station can operate in 2 modes - daily and in mode emergency. In an emergency situation, management of the station passes to the Regional Center disaster medicine.

Operations department

The largest and most important of all departments of large ambulance stations is operations department . The entire operational work of the station depends on his organization and management. The department negotiates with people calling an ambulance, accepts or refuses calls, transfers orders for execution to field teams, controls the location of teams and ambulance vehicles. Heads the department senior duty doctor or senior shift doctor. In addition to this, the division includes: senior dispatcher, dispatcher in direction, hospitalization manager And medical evacuators. Senior duty doctor or senior shift doctor manages the duty personnel of the operational department and the station, that is, all operational activities of the station. Only a senior doctor can decide to refuse to accept a call to a particular person. It goes without saying that this refusal must be motivated and justified. The senior doctor negotiates with visiting doctors, doctors of outpatient and inpatient medical institutions, as well as with representatives of investigative and law enforcement agencies and emergency response services (firefighters, rescuers, etc.). All issues related to the provision of emergency medical care are resolved by the senior doctor on duty. Senior dispatcher supervises the work of the control room, manages dispatchers according to directions, selects cards, grouping them by area of ​​receipt and by urgency of execution, then he hands them over to subordinate dispatchers to transfer calls to district substations, which are structural divisions of the central city ambulance station, and also monitors the location of field ambulances brigades Dispatcher for directions communicates with the duty personnel of the central station and regional and specialized substations, transmits call addresses to them, controls the location of ambulance vehicles, the working hours of field personnel, keeps records of the execution of calls, making appropriate entries in call records. Hospitalization manager distributes patients to inpatient medical institutions, keeps records of available beds in hospitals. Medical evacuators or ambulance dispatchers receive and record calls from the public, officials, law enforcement agencies, emergency services, etc., the completed call registration cards are handed over to the senior dispatcher; if any doubt arises regarding a particular call, the conversation is switched to the senior shift doctor. By order of the latter, certain information is reported to law enforcement agencies and/or emergency response services.

Department of Hospitalization of Acute and Somatic Patients

This structure transports sick and injured people at the request (referrals) of doctors from hospitals, clinics, emergency rooms and managers health centers, to inpatient medical institutions, distributes patients to hospitals. This structural unit is headed by a doctor on duty; it includes a reception desk and a dispatch service, which supervises the work of paramedics transporting sick and injured people.

Department of Hospitalization of Maternity Women and Gynecological Patients

This unit carries out both the organization of provision, direct provision of emergency medical care and hospitalization, as well as the transportation of women in labor and patients with “acute” and exacerbation of chronic “gynecology”. It accepts applications both from doctors in outpatient and inpatient medical institutions, and directly from the public, representatives of law enforcement agencies and emergency response services. Information about “emergency” women in labor flows here from the operational department. The outfits are performed by obstetrics (the team includes a paramedic-obstetrician (or, simply, an obstetrician (midwife)) and a driver) or obstetric-gynecological (the team includes an obstetrician-gynecologist, a paramedic-obstetrician (paramedic or nurse (nurse)) and a driver) located directly at the central city station or district or at specialized (obstetrics and gynecology) substations. This department is also responsible for delivering consultants to gynecological departments, obstetric departments and maternity for emergency surgical and resuscitation interventions. The department is headed by a senior doctor. The department also includes registrars and dispatchers.

Infectious diseases department

This department provides emergency medical care for various acute infections and transports infectious patients. He is in charge of the distribution of beds in infectious diseases hospitals. Has its own transport and visiting teams.

Department of Medical Statistics

This division keeps records and develops statistical data, analyzes the performance indicators of the central city station, as well as regional and specialized substations included in its structure.

Communications Department

He carries out maintenance of communication consoles, telephones and radio stations of all structural units of the central city ambulance station.

Inquiry Office

Faik

or, otherwise, information desk, information desk intended for issue reference information about sick and injured people who received emergency medical care and/or who were hospitalized by ambulance teams. Such certificates are issued by a special telephone number “ hotline»or during a personal visit of citizens and/or officials.

Other divisions

An integral part of both the central city ambulance station and regional and specialized substations are: economic and technical departments, accounting, personnel department and pharmacy. Direct emergency medical care for sick and injured people is provided by mobile teams (See below Types of teams and their purpose) both from the central city station itself and from district and specialized substations.

Ambulance substation

District (city) ambulance substations, The staff of large regional substations includes manager, senior shift doctors, senior paramedic, dispatcher. defector, sister-hostess, nurses And field staff: doctors, paramedics, paramedics-obstetricians. Manager carries out general management of the substation, controls and directs the work of field personnel. They report on their activities to the chief physician of the central city station. Senior substation shift doctor carries out operational management of the substation, replaces the manager in the absence of the latter, monitors the correctness of the diagnosis, the quality and volume of emergency medical care provided, organizes and conducts scientific and practical medical and paramedic conferences, and promotes the implementation of the achievements of medical science into practice. Senior paramedic is the leader and mentor of the nursing and maintenance personnel of the substation. His responsibilities include:

drawing up a duty schedule for a month;

daily staffing of field teams;

maintaining strict control over the correct operation of expensive equipment;

ensuring the replacement of worn-out equipment with new ones;

participation in organizing the supply of medicines, linen, furniture;

organization of cleaning and sanitation of premises;

control of the timing of sterilization of reusable medical instruments and equipment, dressings;

keeping records of working hours of substation personnel.

Along with production tasks, the responsibilities of the senior paramedic also include participation in organizing the everyday life and leisure of medical personnel, and timely improvement of their qualifications. In addition, the senior paramedic participates in the organization of paramedic conferences. Substation Manager receives calls from the operational department of the central city station, departments of hospitalization of acute surgical, chronic patients, department of hospitalization of women in labor and gynecological patients, etc., and then, in order of priority, transfers orders to visiting teams. Before the start of the shift, the dispatcher informs the operational department of the central station about the vehicle numbers and personal data of the members of the field teams. The dispatcher records the incoming call on a special form and enters brief information into the dispatch service database and via intercom, invites the team to leave. Control over the timely departure of teams is also entrusted to the dispatcher. In addition to all of the above, the dispatcher is in charge of a reserve cabinet with medicines and instruments, which he issues to the teams as needed. There are often cases when people seek medical help directly at an ambulance substation. In such cases, the dispatcher is obliged to invite a doctor or paramedic (if the team is a paramedic) of the next team, and if emergency hospitalization of such a patient is necessary, obtain an order from the dispatcher of the operational department to take place in the hospital. At the end of duty, the dispatcher draws up a statistical report on the work of the field teams over the past 24 hours. If there is no staffing position for a substation dispatcher or if this position is vacant for some reason, his functions are performed by the responsible paramedic of the next brigade. Pharmacy defect takes care of the timely supply of field teams with medicines and instruments. Every day, before the start of the shift and after each departure of the team, the defector checks the contents of the storage boxes and replenishes them with missing medications. His responsibilities also include sterilizing reusable instruments. To store the stock of medicines, dressings, instruments and equipment specified by the standards, a spacious, well-ventilated room is allocated for the pharmacy. If there is no defector position or if his position is vacant for some reason, his duties are assigned to the senior paramedic of the substation. Sister-hostess is in charge of issuing and receiving linen for staff and service contingent, monitors the cleanliness of instruments, and supervises the work of nurses.

Smaller and smaller stations and substations have a simpler organizational structure, but perform similar functions .

Types of emergency medical teams and their purpose

In Russia there are several types of emergency medical services brigades:

urgent, popularly called “ambulance” - doctor and a driver (as a rule, such teams are attached to district clinics);

medical - doctor, two paramedic, orderly and driver;

paramedics - two paramedics, an orderly and a driver;

obstetric - obstetrician (midwife) and driver.

Some teams may include two paramedics or a paramedic and nurse. The obstetric team may include two obstetricians, an obstetrician and a paramedic, or an obstetrician and a nurse.

Teams are also divided into linear (general-profile) - there are both medical and paramedic teams, and specialized (medical only).

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 inpatient 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. Approximate organizational structure emergency medical aid 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 paramedic and nurse- anesthetist), orderly and 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 medical doctors 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 be provided necessary help 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 patient and related medical documentation 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 emergency medical care duties as part of paramedic team The paramedic is the responsible executor, and as part of the medical team he acts under the direction of the doctor.

Paramedic visiting team emergency medical services are 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 necessary funds communications with all structural units of the EMS station, substations, field teams, medical institutions, as well as direct communications 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;

Exercising control over the timely delivery of patients, women in labor, victims of emergency departments 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 aid station (substation, department) does not issue documents certifying temporary disability and forensic medical reports, and does not conduct examinations. 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.

Providing specialized emergency and planned advisory assistance patients undergoing treatment in municipal healthcare institutions (central, city, district, district hospitals) are entrusted with 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. Medical workers emergency medical services 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;

Specific Gravity 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 specific gravity repeat calls, the proportion of successful resuscitations and the proportion of deaths. Recommended values ​​of these indicators are 1%, 10%, 0.06%, respectively.

The legal culture of the population can be indirectly judged by indicator of the proportion of “false” calls. According to the emergency medical services of individual constituent entities of the Russian Federation, its value fluctuates in the range of 1-3%.

The ability to correctly calculate and analyze statistical indicators characterizing various aspects of the activities of the emergency medical service has great importance in the practical activities of paramedics and nurses, working at stations (substations, departments) of the NSR.

The first thing a healthcare worker uses when heading to a patient is to position the mobile emergency medical team. The team takes this equipment with them to any call or uses it when providing assistance both in the emergency medical service salon and on the street, road, or at home.

From the design of the installation, composition and availability of investments (which includes medicines and products medical purposes) efficiency and quality largely depend primary diagnosis and providing emergency medical care to the patient.

For definiteness, we will agree to call the deployment of a mobile emergency medical care team “laying up an emergency medical service,” as was historically customary in the Russian Federation. All other sets are specialized; we will call them “SMP sets” in accordance with their specialization.

Currently, the use of packing and kits in ambulances of three basic classes and specialized emergency medical vehicles based on them is regulated by Order of the Ministry of Health and Social Development No. 752 of December 1, 2005 “On equipping ambulance vehicles.”

According to this order, the packing of a mobile ambulance team is included in the package of all ambulances as a basic one, supplemented, depending on the purpose of the ambulance, with specialized emergency medical kits.

The exception was class “A” EMS vehicles, where paramedic kits were used instead of deploying a visiting team. Taking into account the increasing role of paramedics in the EMS service, we propose to use EMS units in class “A” vehicles. Then for all three classes of machines the following specialized sets remain:

• obstetric kit;
• resuscitation kit for adults and children over 7 years old for ambulance;
• Pediatric resuscitation kit up to 7 years of age (supplementary resuscitation kit for adults and children from 7 years of age);
• resuscitation kit for newborns;
• anti-burn kit;
• trauma kit for ambulance;
• toxicology kit.

Considering the importance of laying the EMS as a basic element of the remote equipment of an ambulance vehicle, the Ministry of Health and social development The Russian Federation, by order of June 11, 2010 No. 445n, determined the composition of the installation and the list of investments. In connection with the publication of this order, Appendix No. 13 of Order M3 of the Russian Federation dated March 26, 1999 No. 100, which until recently defined “ Sample list equipping the mobile emergency medical team”, including the composition “Medical box-stacking main”.

Let's take a closer look at the setup of a mobile emergency medical team (EMS setup), taking into account the above regulatory documents and experience in operating equipment in the emergency medical service.

Requirements for materials and design

Let us note the requirements for materials and design of the installation of emergency medical equipment, which is perhaps the most intensively used product from the set of medical and technical equipment of emergency medical equipment. On average, during 1 year of operation, the installation of SMP is used several thousand times. In this case, up to 50 thousand opening-closing cycles are performed.

Bags made of fabric with zippers and Velcro, including those with a metal frame, traveling bags made of leather and leatherette and other glued and painted products under such operational load do not always provide the required service life.

Painted metal cases and bags are heavy, and the paintwork quickly loses its appearance.

Structures made of light alloys and aluminum are practical, but, as a rule, are much more expensive due to the high cost of raw materials and manufacturing technology.

Modern plastics can serve as optimal materials that provide acceptable weight, the required service life under conditions of intensive use and a low price, subject to strict requirements for disinfection and sanitation. When dyed in bulk, plastics practically do not lose appearance for the entire period of operation.

Plastic sets and kits better solve the problem of hygiene and disinfection due to fewer hard-to-reach places and hidden cavities and pockets. They are easy to clean both outside and inside. inside and do not require long drying. The latter is especially relevant when using the laying of SMP outdoors, when working at traffic accidents, in industrial premises.

Intensive work on a 24-hour basis without crews returning to the substation places increased demands on the simplicity and efficiency of sanitary and hygienic procedures to maintain in working order an EMS installation that has been at the scene of an incident on a dirty roadside or an oily workbench.

Specialized kits included in the kit of ambulances are used with less intensity than the packing of EMS, and can be made in the form of a case or bag made of waterproof, durable, washable synthetic fabric. The operational load on their locking devices is much less than on locking devices for laying SMP, which allows the use of zipper and Velcro fasteners.

However, in some ambulances, such as ambulances of a specialized team to provide assistance to victims of a road accident (based on a class C ambulance) and in other operational mobile medical complexes, where the kits operate in difficult conditions (dirt, sediments), it is advisable to manufacture them, as well as laying SMP, from plastic to ensure easy washing both outside and inside, without long drying.

When laying the SMP, it should be located lodgment, providing, according to the order of the Ministry of Health and Social Development of the Russian Federation No. 445n, the placement of at least 170 ampoules, including: 1-2 ml - 120 places, 5-10 ml for 20-30 places, as well as bottles - 6 places.

The design of the cradle must ensure reliable fixation of the ampoules (without “ringing” of the ampoules in the seats and excluding their contact with each other). For ease of use of the packaging, it is necessary to include self-adhesive labels with designations of medicinal attachments in the package.

The design of the laying of the SMP should include manipulation table, providing space for preparation medical manipulations, with sides or recesses for ampoules, syringes, instruments that prevent them from rolling off.

In working condition, the tray for ampoules and the open-laying manipulation table should be at a height of at least 20 cm from the base, which facilitates the work of medical personnel and reduces the risk of dirt getting in when working on the ground and asphalt.

The SMP installation body should not contain hard-to-reach places and internal cavities, preventing sanitation and disinfection.

The main structural elements of the installation that are subject to the greatest loads during operation (handle, locks, hinges) must provide the required strength and ergonomics while maintaining an acceptable weight of the empty installation.

Laying weight with a support, without medical attachments should not exceed 2.5 kg. At the same time, the weight of a fully equipped SMP installation, taking into account the labor protection requirements for women, should not exceed 7 kg.

The design of the stowage must eliminate the risk of spilling the contents of the stowage when lifting it with unlocked locks. To work on uneven surfaces and in moving vehicles, the installation must be sufficiently stable in the working position.

The design of the installation of SMP must provide for the possibility of working on limited area, and convenient access to investments should be provided. It is advisable not to occupy the bottom of the stack with ampoules holders, so as not to limit access to the ampoules with other attachments.

The guaranteed service life of the SMP installation must be at least 2 years, or up to 100 thousand opening-closing cycles.

Equipment for laying out the mobile emergency service team

Let’s take a closer look at the equipment for laying out the EMS mobile team. It should be noted that in the order of the Ministry of Health and Social Development of the Russian Federation dated June 11, 2010 No. 445n “On approval of requirements for equipment medicines and medical products for laying the mobile ambulance team”, the list of medicines and medical products is mandatory (in contrast to the order of the Ministry of Health of the Russian Federation dated March 26, 1999 No. 100).

An analysis of the list of medicines shows that it is not without certain shortcomings. In particular, it is advisable to consider changing medications or medical products for similar ones and determining their quantity within the framework of the necessary and mandatory requirements of the order, depending on the specifics of the region and the preparedness of specialists.

This proposal is largely determined by the fact that not all drugs listed in the order are available in the regions (their analogues are used) and that pharmaceutical industry is developing rapidly, new, more effective drugs are appearing.

One of the ways to improve the medicinal composition of the mobile emergency medical team could be the mandatory designation of only pharmacotherapeutic groups of drugs (if necessary, with the indication “for special teams”), as well as the exclusion of some antibiotics and other non-emergency drugs from the list.

The specific names of medicines and their quantity in this case will be of a recommendatory nature. Equipping packaging with drugs that will not be used will lead to additional financial costs for the disposal of expired drugs.

On the other hand, it is advisable to consider the possibility of expanding the list of medicines depending on the specifics of the region, economic opportunities, and qualifications of teams. So, for example, it seems appropriate to include in the list: ammonia, glucose, dibazol, analgin, strophanthin, sodium sulfacyl, Corvalol (or analogs).

At the same time, the listed eight bottles of solutions for transfusion, each at least 200 ml (or even 400-500 ml) and weighing about 450-800 g in a glass container, are more rationally placed in a special thermal container for solutions, and can be left in the stack one bottle of sodium chloride.

It is not recommended to store narcotic drugs in a bag - the consequences if they are lost or damaged are too great. Their place is in a special pocket in the medical worker’s overalls. The same should apply to muscle relaxants and anesthetic drugs.

The situation is similar for medical products. In this case, it is rational to remove from the list:

• the tripod is collapsible (it is present as a separate item in the list of equipment for all machines, compact holders for infusion bottles are specified in the packaging, the tripod does not fit into any packaging at all);
• An ENT diagnostic kit, as a non-core one, is expensive and voluminous;
• urological catheters (urethral catheters are available);
• systems for blood transfusion (systems for intravenous infusions are sufficient);
• endotracheal tubes (they are included in the resuscitation kit together with the laryngoscope);
• ampoule ampoule AM-70 is not necessary, you need a holder for a large number of ampoules.

At the same time, it is advisable to include in the list of investments:

• scissors for cutting clothes;
• insulin syringe (due to the presence of insulin in the list of medicines).

List of medical products

1. Mechanical tonometer – 1 pc.
2. Phonendoscope – 1 pc.
3. Medical maximum glass mercury thermometer – 1 pc.
4. Female urethral catheter, single use, sterile – 2 pcs.
5. Male urethral catheter, single-use, sterile – 2 pcs.
6. Female urological catheter, single use, sterile – 2 pcs.
7. Urethral catheter for children, single use, sterile – 2 pcs.
8. Female urological catheter, single use, sterile – 2 pcs.
9. Oropharyngeal air ducts, size 1 – 1 pc.
10. Oropharyngeal air ducts, size 4 – 1 pc.
11. Hemostatic tourniquet – 1 pc.
12. Hypothermic package – 1 pc.
13. Sterile medical dressing bag – 1 pc.
14. Mouth retractor – 1 pc.
15. Tongue holder – 1 pc.
16. Straight medical hemostatic clamp – 1 pc.
17. Curved medical hemostatic clamp – 1 pc.
18. Medical tweezers – 2 pcs.
19. Medical scissors – 1 pc.
20. Sterile disposable scalpel – 2 pcs.
21. Sterile therapeutic spatula – 1 pc.
22. Sterile wooden spatula – 10 pcs.
23. Absorbent cotton wool 1 pack. 50 gr. - 1 PC.
24. Medical sterile gauze bandage 7 m X 14 cm – 2 pcs.
25. Medical sterile gauze bandage 5 m X 10 cm – 2 pcs.
26. Medical gauze napkins, sterile, 16 X 14, pack. - 3 pcs.
27. Rolled adhesive plaster no less than 2 X 250 cm – 1 pc.
28. Bactericidal adhesive plaster 2.5 x 7.2 cm – 10 pcs.
29. System for infusion, transfusion of blood, blood substitutes and infusion solutions – 2 pcs.
30. Catheter (cannula) for peripheral veins G 22 – 1 pc.
31. Catheter (cannula) for peripheral veins G 14 – 2 pcs.
32. Catheter (cannula) for peripheral veins G 18 – 2 pcs.
33. Infusion catheter “butterfly” G 18 – 2 pcs.
34. Infusion catheter “butterfly” G 23 – 1 pc.
35. Tourniquet for intravenous manipulation – 1 pc.
36. Holder for 200 ml infusion bottles with bracket – 1 pc.
37. Holder for 400 ml infusion bottles with bracket – 1 pc.
38. Single use injection syringe 2 ml with 0.6 mm needle – 3 pcs.
39. Single-use injection syringe 5 ml with 0.7 mm needle – 3 pcs.
40. Single-use injection syringe 10 ml with 0.8 mm needle – 5 pcs.
41. Single-use injection syringe 20 ml with 0.8 mm needle – 3 pcs.
42. Disposable pre-injection disinfectant wipe with alcohol solution – 20 pcs.
43. Sterile surgical gloves – 6 pcs.
44. Non-sterile surgical gloves – 10 pcs.
45. Medical mask – 4 pcs.
46. Case for dressing materials – 1 pc.
47. Case for tools – 1 pc.
48. Plastic bag – 5 pcs.
49. Children's disposable rectal gas outlet rubber tube – 1 pc.
50. Disposable endotracheal tube No. 5, No. 7, No. 8 – 3 pcs.
51. Diagnostic flashlight – 1 pc.
52. Portable diagnostic tool kit for emergency otorhinoscopy with kit Supplies- 1 PC.
53. Collapsible stand for infusions – 1 pc.
54. Ampoule holder AM-70 (for 70 ampoules) – 1 pc.
55. Emergency medical doctor's bag (box) – 1 pc.

It is obvious that the appearance of the order of the Ministry of Health and Social Development of the Russian Federation dated June 11, 2010 No. 445n “On approval of requirements for the provision of medicines and medical products for the packing of a mobile ambulance team” is an incentive for the development of new types of EMS packing.

Let's analyze the domestic market for mobile emergency medical equipment. Due to the current lack of a single generally accepted integral criterion for evaluating SMP installations, we will try to evaluate the given models based on the ratio of the main parameters given above, as well as quality characteristics, such as design reliability, ease of operation and availability of investments, ease of sanitation, and service life.

LLC "Medplant", Russia Packing bag, impact-resistant plastic
Concertina(Concertina) Bollmann, Germany. Travel bag, leather Weinmann, Germany. Case, aluminum alloy
Medplant LLC, Russia. Frame bag, waterproof fabric
Omnimed PPITs LLC, Russia. Frame bag, waterproof fabric

Today, the UMSP-01-Pm/2 installation has the best price/consumer parameters ratio. The spread of this model, like its predecessor UMSP-01-Pm, is facilitated by its relatively low cost and consumer qualities that are at the level of the best modern analogues.

For other applications ( urgent Care, home care, disaster medicine, etc.) requirements may differ slightly. For example, where the annual average call intensity is not so high and there is no need to work in field (street, road) conditions, the EMS installation can be made in the form of a case or bag made of waterproof, durable, washable synthetic fabric or leather.

Requirements for the composition of medicines and medical products may also vary depending on the area of ​​application, although it is still necessary to take as a basis the requirements prescribed for the basic installation of an emergency medical service team.

Currently, a lot of work is also being done to standardize the attachments of specialized EMS kits used in ambulances in accordance with the annexes to the order of the Ministry of Health and Social Development No. 752 of December 1, 2005 “On equipping ambulance vehicles.”

A. G. Miroshnichenko, D. I. Nevsky, L. F. Orlova, A. A. Rybalov

Emergency care can be provided in pre-hospital and hospital stages. In the first case, an ambulance team goes to the scene of the call. In the second - providing assistance directly to medical institution medical staff. We will talk about the first type.

Free

Federal Mandatory Fund health insurance guarantees that emergency and emergency medical care (ambulance) is provided:

• for free
• all citizens, including foreigners
• regardless of the presence of a passport and insurance medical policy.

Moreover, you have the right to receive free medical care throughout the Russian Federation, regardless of the place of permanent registration or issue of a medical insurance policy.

Availability

Ambulance is based at special ambulance stations or in hospital departments as structural unit. Ambulance stations are divided into categories according to the following principle:

• 1st category, if more than 75 thousand calls are made per year;
• 2nd category (from 50 to 75 thousand calls per year);
• 3rd category (from 25 to 50 thousand calls per year);
• 4th category (up to 25 thousand calls per year).

Stations of the 1st and 2nd categories are independent and subordinate to the city health authority, 3rd and 4th categories - exist under city and district hospitals and report directly to the management of the medical institution.

In cities with a population above 100 thousand people, ambulance stations are organized based on 20-minute transport accessibility in the service area of ​​a particular station. The coverage of the zone, of course, depends on the number of residents, building density, availability industrial enterprises and traffic on the roads. But the boundaries of the work zone of a particular ambulance station are conditional - teams can be sent on calls to other areas of the city.

The number of vehicles provided to a particular category of ambulance station depends on the number of residents in the serviced area - for every 10,000 residents there is one vehicle fully equipped with all the necessary equipment.

Ambulance teams that arrive when citizens call, include paramedics and doctors. The first consists of two paramedics, an orderly and a driver. A medical team consists of a doctor, two paramedics (or a paramedic and a nurse), an orderly and a driver. If obstetric medical care is required, a midwife and a nurse are sent on call. The so-called “emergency”, or emergency teams ambulances usually consist of a doctor and a driver.

Ambulance time

The procedure for providing emergency medical care is regulated at the legislative level, in particular, by the order of the Ministry of Health and Social Development “On approval of the procedure for providing emergency medical care.”

But on the same day, the department’s press service reported that it had no plans to cancel the standards, and the draft document, which supposedly excludes this standard, was posted on the ministry’s website due to a technical error.

So the current rules are:

1. Dispatchers (paramedics for receiving calls) are required to receive calls from the public around the clock, register them and promptly dispatch ambulance teams to the addresses of the calls. According to the standards, call transfer is up to 4 minutes.

2. The time elapsed after departure until the ambulance team arrives at the patient, according to the standards, is 20 minutes. Ambulance staff make a diagnosis, provide emergency medical care and send the person to a medical facility. The regulations do not define the time for providing assistance to the patient. It depends on the severity of the patient’s condition and other factors. The average time is about 30-40 minutes.

3. If the patient is in serious condition and is unable to move independently, he is transported on a stretcher by an ambulance to the car. One relative or legal representative is allowed to be present in the ambulance as an accompanying person during transportation to a medical facility. In this case, transportation of children under 14 years of age must be carried out in the presence of their parents. The time for transporting a patient to a medical facility is also not determined by regulations.

4. Hospitalized patients are transferred medical personnel, and the emergency doctor within 10 minutes draws up a “Covering Sheet”, which indicates information about the patient, diagnosis, assistance provided and the time of the patient’s admission to the hospital. The patient or his relatives or legal representatives must provide a passport and insurance policy upon hospitalization, but their absence is not a reason for refusal of medical care in a hospital.

5. The patient, in accordance with the disease (injury), is assigned to one or another department of the hospital and is provided with further medical care.

Who to call if the ambulance hasn't arrived?