Main functions (tasks) of an emergency medical aid station. Organization of emergency medical services What types of ambulances are there?

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 during an exacerbation chronic diseases.

Our country has created a nationwide system for organizing emergency medical care, which includes ambulance and emergency care, emergency hospitals (or emergency 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.

The first thing a healthcare worker uses when going to see a patient is the positioning visiting team emergency medical care. 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 ambulance kits are used with less intensity than EMS equipment 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 makes work easier 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 (unlike the order of the Ministry of Health 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 of the drugs listed in the order are available in the regions (their analogues are used) and that the pharmaceutical industry is rapidly developing, with new, more effective drugs 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 (emergency care, home care, disaster medicine, etc.), the requirements may be slightly different. 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

The Village continues to understand how the earnings and expenses of representatives of different professions are structured. In the new episode - a paramedic at an emergency medical station. All emergency personnel are often collectively called doctors, with the majority of them being paramedics. The paramedic has an average medical education, can make diagnoses and carry out healing procedures. Ambulance teams may consist of a doctor and a paramedic, a doctor and a nurse, or two paramedics. We found out from an employee of a Moscow ambulance station how much he earns and how often he has to deal with death, inadequate patients and bored pensioners.

Profession

Paramedic of the resuscitation team

Salary

96,000 rubles

(including bonuses)

Expenses

27,000 rubles

savings

25,000 rubles

products

10,000 rubles

communal payments

10,000 rubles

spending on a child

8,000 rubles

automobile

5,000 rubles

cafes and restaurants

3,000 rubles

entertainment

3,000 rubles

personal care

3,000 rubles

spending on a cat

2,000 rubles

How to become an ambulance paramedic

There are no doctors in my family, except that my cousin taught at medical school. But my mother says that since childhood I loved to play with ambulance cars and read great books. medical encyclopedia, perhaps this somehow influenced the choice of profession. Initially, I was going to go to medical school, but unfortunately I didn’t make it. There was an advertisement on the door of the admissions office about recruiting paramedics to the school, I went there, my points were enough for me to be hired right away. Then I thought that I would finish my studies and then try again to go to college. Medical School I graduated, went to take exams, but again didn’t get in. I went into the army for a year, and then returned and decided that I should get a job and slowly prepare for exams. In the spring I applied again, took the exams - and again failed! After that, I gave up and decided that I would improve my qualifications as a paramedic. In addition, in an ambulance the difference between a doctor and a paramedic is minimal. The doctor has more procedures that he can perform - catheterization central vein, counsel patients and interpret electrocardiograms. Although a person who has worked as a paramedic for two or three years can do this too. And of course, the doctor’s salary is higher.

Now I am 29 years old, since 2010 I have been working as an ambulance, and since 2012 I was accepted into the ranks of the resuscitation team. Plus sometimes I perform functions administrative worker in the position of senior paramedic - I count salaries and fill out schedules.

In Moscow, the ambulance service is mainly staffed by people from nearby regions, not only from the Moscow region, but also from Tula, Vladimir, Kirzhach, and Smolensk. They wake up at one in the morning, arrive at the station at six in the morning, sleep for a couple of hours, work for a day, then return home, sleep there - and go back to work. The reasons here are only economic - they pay much better in Moscow. I myself live on the border of Moscow and the region. You can go to an ambulance station near Moscow or to a Moscow one, even if you have to spend an extra 15 minutes on the road, but the salary is several times higher.

Features of work

In the ambulance, almost no one works at just one rate; almost everyone adds another 50 or 25% of their working time. People do this, again, for money. We have daily and semi-daily shifts. I am in the resuscitation team, which only works 24 hours a day, from nine in the morning until nine in the morning the next day. So I get about seven to eight outputs a month. Of course, it’s hard to work with such a schedule, but we have bonuses for harmfulness. Working in a resuscitation team is considered even more harmful, so I have extended vacation - 52 days. Usually there are two or three people in a team, but it also happens that you work alone - for example, if the second employee suddenly gets sick. There is also an additional charge for this: 100% during the day and 110% at night.

We have only three paper documents - a call card, an accompanying sheet when we take a person to the hospital, and a death declaration form. The most hemorrhoids are with the call card. Such cards are given to the Mandatory Fund health insurance, and they are studied very carefully there. If something is filled out incorrectly on the card, a fine is imposed, not on a specific employee, but on the entire organization. Then the station receives less money from the fund, and this affects bonuses for employees. For the Compulsory Medical Insurance Fund, calling an ambulance to a patient costs 9 thousand rubles. If the doctor who filled out the call card makes a mistake, a fine of 20 thousand is imposed. We came to the patient, saved the life, took him to the hospital, everyone is alive, healthy and happy, but when the piece of paper is written incorrectly, for example, the wrong date of birth was indicated, we receive a fine. We spend about 25–30 minutes working with a patient, and 20 minutes filling out the card. And it’s impossible to write it between calls in the car on the go, because then you’ll start making mistakes, and you can’t cross out and correct it. So you have to stay after your shift and finish writing, so you can sit over the cards for another hour and a half. We have been promised for a very long time electronic cards call, working with them will be much easier. Even last year they gave out Android tablets, they are very cool, we use them, but we can’t fill out cards yet. All workers under about 40 years of age are simply praying that we switch to an electronic system soon. And those who are older say: “Why do we need this, it’s complicated!”

Sometimes patients complain that the team takes a long time to get to them. But in Moscow the ambulance now arrives even faster than in Europe. We have calls of the first and second urgency, so we will come to a heart attack first, and to someone with a runny nose - only later. On the road, the ambulance is usually missed. Previously, everything was bad with this, but now it’s as if the people have changed. They introduced fines, installed cameras, even though no one really knows the laws, but they are afraid of who knows what, so they will let you through just in case. It happens, of course, that there are 500 meters left, everyone pressed to the right, and one idiot in some Cayenne climbs forward and does not allow us to pass.

I believe that approximately 80% of emergency calls are unfounded. Our people do not understand well when to seek emergency help. There is no education, no one simply invests money in explaining to people that they don’t need to call an ambulance if, roughly speaking, your butt itches. Of course, they try to filter this out even at the call stage, but it doesn’t always work. The patient calls and says: “Something in the shoulder blade hurts,” and it could be a heart attack. We arrive, and it turns out that he was lifting a weight, and at that moment something stabbed. Of course, it also happens that a person applies because of nonsense, and you come and find something more serious, but this is a rare exception to the rule.

Mostly our beloved pensioners call the ambulance. My grandmother woke up in the morning, forgot to take her pills, her blood pressure rose, she called for a consultation, and a team was immediately sent to her. We'll come, give you a pill, and pat you on the head. One manager from our station once wrote a report to city ​​clinic: The pensioner they are monitoring called an ambulance 216 times in a month. Alcoholics also like to call us. They will take it to the chest and complain that it has become bad. Why would you feel good if the three of you drank almost a box of vodka? Often it is not even the drunk themselves who call, but vigilant citizens. Some guy is sleeping on the street, and a classic woman of about 50 walks past, she doesn’t want to get involved, so she calls an ambulance. We come only to wake up this guy, so he will then curse this vigilant citizen again. It happens that they call homeless people, although they don’t feel bad, they just sleep and sleep. I practically don’t smell, and my colleagues often say to me in such situations: “How lucky you are!”

They attack us all the time, although we try to form a brigade so that there is a man and a woman in it. Once one of our doctors, a 60-year-old woman, was stabbed in the arm and stomach. She quit two months later, but says that it was not because of this incident, but simply took it as a sign that it was time to retire. I myself once sewed up a wound at gunpoint in a hotel. One time we came to a call, I opened the door, and from the other end of the corridor a man with an ax was flying at me, I barely managed to slam the door with my foot. Although you have to work with psychos only by pure chance. If even at the call stage it becomes clear that we have to deal with inadequate ones, then specialized psychiatric teams. It happens that a relative calls us to see our grandmother, but she refuses treatment. He says: “I have icons there, now I’ll put them to my heart, and the heart attack will go away.” Then you tell them what all this means, and usually the person immediately agrees to get the injection and go to the hospital.

Calls have a certain seasonality. In the summer, these are vacationers near ponds, motorcyclists, and children who fall out of windows due to poorly secured mosquito nets. In winter - ice, accidents, colds. Closer to winter, difficult shifts begin, when the team has 20 calls per day. And there is only one reason for this - ARVI. Again, no one calls and says: “It’s hard to breathe through my nose because I have a runny nose,” everyone complains that they are suffocating, and this is a call of the first urgency. We often visit our children because we are afraid of missing a serious infection. But sometimes, in order to bring down the temperature, it is enough to simply take the child out from under three blankets.

Often patients' hearts can't handle the peak of sexual pleasure. And older men also like to indulge in various kinds of drugs that increase potency. If the same drugs are taken in therapeutic doses, for which they were invented, then they have a good effect on the heart muscle. Well, if you switch to doses that are needed to raise morale, there will be a heavy load on the heart.

You have to respond to an accident, and these are difficult challenges. In addition to providing assistance, it is necessary to engage in medical triage, that is, classify all victims according to the severity of their condition and call other teams, and sometimes even helicopters. We, as a resuscitation team, usually take on the most difficult ones - unconscious, with severe injuries.

You have to deal with death quite often, and this leaves its mark on the worldview. We see not only old people dying, but also young people and children. We have an unofficial concept called resuscitation for social reasons. This is when it is no longer possible to resuscitate a person, but something needs to be done so that others see that we are trying to save him, and not just come, look, and leave. When you arrive and the child is already lying cold in the crib, we cannot tell the father that he has been dead for a long time, but we carry out all the necessary procedures. They say that the biggest cynics and alcoholics work in the ambulance. I don’t know about alcoholism; we drink no more and no less than other people, but cynicism is our professional trait. You see abandoned pensioners, degraded drug addicts, and women who try to commit suicide because of unhappy love. If you worry about everything, you'll just go crazy. Those who cannot stand it usually move to quieter places. But if you worked for three years, it means you’re used to it.

Income

The average amount of my earnings is 96 thousand rubles, including all bonuses and allowances. Without them, I get about 60–70 thousand a month. The bonuses are called quarterly, but they are usually towards the end of the year. They are distributed based on the points awarded, which are calculated based on many indicators: the quality of documentation, how quickly you arrive on calls, whether you work additionally at the administrative level.

Patients often call the station to thank us, sometimes they come and give something. One patient once brought several bags of food and cakes. Sometimes on calls they also give gifts or give money. The main rule is not to take money if the patient offers it right away, because this will be followed by some requests. For example, an alcoholic wants us to put him on an IV. No matter how much money he offers, no one will do this, simply because we have neither the authority nor the time - the dispatcher will start calling and asking what we are doing there. I will not get involved with drugs for any money. Any fraud with them will result in prison, but I have a family, why do I need it? Of course, I look at the person to see if it’s possible to take money from him, even if it’s simple gratitude. When a decrepit grandmother puts in a thousand, I will never take it.

Expenses

My wife and I have been doing home accounting for quite some time. When we started living together, we immediately agreed that we needed a common budget and expense planning. My wife is now on maternity leave for up to one and a half years, so the main expenses are on me. A lot of money is spent on a child. Diapers alone are already 5 thousand rubles, and also clothes, water, developmental courses, so on average it turns out to be at least 10 thousand. We bought our first stroller on Avito, a new one would have cost about 40 thousand, but we bought it for 20 thousand in excellent condition. When the child grows up, we also sell children's clothes online.

Utility bills, internet and Cell phones- that's another 10 thousand rubles. I have a car, a foreign car made in 2013, which costs an average of 8 thousand rubles a month, not counting maintenance costs. We spend 25–30 thousand on groceries. We shop at the same place and go to a hypermarket near our home. We have a Maine Coon cat, we spend 3 thousand rubles a month on him. I track my expenses in a special mobile application, according to the article “Cafes and restaurants” 5 thousand rubles are spent per month. Although this is not a restaurant, but rather a food court in mall, where we ran to have a snack before the child woke up.

There are also all sorts of little things: personal care, gifts, my wife’s and my haircut. All this costs about 5 thousand rubles. We now spend very little on entertainment, simply because now our main entertainment is to put the child to bed, watch some TV series, drink a bottle of wine and go to bed. So this expense item costs about 3 thousand rubles, and this also includes my subscriptions to various services. Although we used to have more varied leisure time: we went to the cinema or could break away in the evening and fly to St. Petersburg. My wife is a philologist by training, but works as a flight attendant, so we have good discounts on flights. For example, a business class flight to Thailand cost us the same as a charter flight to Turkey.

We quite often buy furniture from Ikea in installments - for example, we recently bought a sliding wardrobe for 80 thousand rubles. In principle, we have this money, but it’s one thing to give it away right away, and another thing to stretch out the payment over six months. But as a matter of principle, we never get involved with loans. Only once in my life did I take out a loan, but then there was a question about my father’s health. I had to take out 900 thousand rubles, and only recently I said goodbye to this loan. I would never borrow from banks for furniture, electronics, and especially vacations. I just can’t understand the logic of people who fly off to relax and then pay for it for six months. If you don't have money for the Maldives, go along the Golden Circle.

Everything that is not spent goes on deposit at 8%. Times are turbulent, so you have to have at least some money in reserve. We have a lot of financially illiterate people who don’t know how to manage money at all. They do not keep their own home books, do not create individual accounts, and do not invest their savings. Although I’m also not ready to invest with risks yet. Until I understand everything thoroughly, I won’t get involved in this.

There are several types of emergency medical teams on the territory of the Russian Federation:

• · emergency, popularly referred to as a doctor and a driver (generally, such teams are assigned to district clinics);
• · medical - a doctor, two paramedics and a driver;
• · paramedics - two paramedics and a driver;
• · obstetrics - obstetrician (midwife) and driver.

IN separate brigades may include two paramedics or a paramedic and a nurse. The obstetric team may include two obstetricians, an obstetrician and a paramedic, or an obstetrician and a nurse.

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

Line brigades.Line brigades go to the simplest cases (increased arterial pressure, minor injuries, minor burns, abdominal pain, etc.).

Despite the fact that these teams respond to simple cases, in accordance with regulatory requirements, their equipment must ensure the provision of resuscitation care in critical conditions: portable electrocardiograph and defibrillator, devices for artificial ventilation lungs and inhalation anesthesia, electric suction, oxygen cylinder, resuscitation kit (laryngoscope, endotracheal tubes, air ducts, probes and catheters, hemostatic clamps, etc.), a kit for assistance during childbirth, special splints and collars for fixing fractures of the limbs and neck, several types of stretchers (folding , cloth drags, wheelchair). In addition, the car must have wide range medicines, which are transported in a special storage box.

There are line teams of doctors and paramedics. Ideally (by order), the medical team should consist of a doctor, 2 paramedics (or a paramedic and a nurse), and a driver, and paramedic team- of 2 paramedics or a paramedic and a nurse (nurse) and a driver.

To provide timely specialized medical care directly at the scene of the incident and during transportation of victims, specialized teams have been organized intensive care, traumatological, cardiological, psychiatric, toxicological, pediatric, etc.

Specialized teams. Resuscitation vehicle based on GAZ-32214 Gazelle. Specialized teams directly at the scene of the incident and in the ambulance perform blood transfusions, stop bleeding, tracheotomy, artificial respiration, closed heart massage, splinting and other emergency measures, and also perform the necessary diagnostic studies(taking an ECG, determining the prothrombin index, duration of bleeding, etc.). The ambulance transport, directly in accordance with the profile of the ambulance team, is equipped with the necessary diagnostic, treatment and resuscitation equipment and medications. Increasing the volume and improving the quality of medical care at the scene of an incident and during transportation has increased the possibility of hospitalization of previously intransportable patients, reduced the number of complications and deaths during transportation of sick and injured people to hospitals. emergency medical care law

Specialized teams carry out medical and advisory functions and provide assistance to medical (paramedic) teams.

Specialized teams are only medical.

Specialized teams are divided into:

• Cardiological - designed to provide emergency cardiac care and transportation of patients with acute cardiopathology ( acute heart attack myocardium, ischemic disease heart, hypertensive and hypotensive crisis, etc.) to the nearest hospital medical institution;
• · intensive care units - designed to provide emergency medical care in borderline and terminal conditions, as well as to transport such patients (victims) to the nearest hospitals;
• · pediatric - designed to provide emergency medical care to children and transport such patients (victims) to the nearest children's hospital (in pediatric (children's) teams, the doctor must have the appropriate education, and the equipment of ambulances implies greater variety medical equipment"children's" sizes);
• · psychiatric - intended for providing emergency psychiatric care and transporting patients with mental disorders(For example, acute psychoses) to the nearest psychiatric hospital;
• · drug treatment - intended to provide emergency medical care to drug treatment patients, including delirium delirium and prolonged binge drinking;
• · neurological - intended to provide emergency medical care to patients with acute or exacerbation of chronic neurological and/or neurosurgical pathology; for example: brain tumors and spinal cord, neuritis, neuralgia, strokes and other cerebral circulatory disorders, encephalitis, epileptic attacks;
• · traumatological - intended to provide emergency medical care to victims of various kinds injuries to limbs and other parts of the body injured as a result of a fall from a height, natural disasters, man-made accidents and motor vehicle accidents;
• · neonatal - intended primarily for providing emergency care and transporting newborn babies to neonatal centers or maternity;
• · obstetric - intended to provide emergency care to pregnant women and those giving birth or those who gave birth outside medical institutions women, as well as for transporting women in labor to the nearest maternity hospital;
• · gynecological, or obstetric-gynecological - intended both to provide emergency care to pregnant women and women giving birth or who have given birth outside of medical institutions, and to provide emergency medical care to sick women with acute and exacerbation of chronic gynecological pathology;
• · urological - intended to provide emergency medical care to urological patients, as well as male patients with acute and exacerbation of chronic diseases and various injuries their reproductive organs;
• · surgical - intended to provide emergency medical care to patients with acute and exacerbation of chronic surgical pathology;
• · toxicological - intended to provide emergency medical care to patients with acute food, chemical, and pharmacological poisoning.

The profession of an emergency physician can perhaps be called one of the most difficult and responsible among all medical specialties. After all, he must have a good knowledge of not only theory, but also be fluent in many practical skills. There are often situations when an emergency doctor has only a few minutes to make a diagnosis and does not have the opportunity to use laboratory or instrumental methods diagnosis, consult with your colleagues. Therefore, he must perfectly know such medical specialties such as therapy, neurology, surgery, gynecology and obstetrics, resuscitation, be familiar with the pathology of the ENT and visual organs.

What qualities should an emergency physician have?

Based on the characteristics of the work, any ambulance and emergency doctor must have the following qualities:

• Good physical and mental health;
• Excellent medical observation and logic;
• Quick reaction and ability to remain calm in any situation;
• Knowledge of basic emergency conditions, the ability to diagnose and treat them at the prehospital stage;
• The ability to find contact both with the patient himself and with his relatives. Indeed, in some cases, they may also need to consult an emergency doctor;
• Modesty, discipline, decency, cleanliness;
• Ability to maintain authority among all team members.

Responsibilities of an emergency physician

Before starting duty, the emergency doctor must personally take the necessary medical instruments and medicines.

The responsibilities of the emergency physician include monitoring the condition of all team members. If during duty the doctor notices signs in any of them alcohol intoxication or ill health, he is obliged to immediately remove them from work and inform the manager and dispatcher about this.

After receiving a call, the emergency doctor must check with the dispatcher the patient’s name, age and address. Departure is carried out within one minute from the moment of its receipt. It is prohibited to turn off radio communications during the entire trip.

If it is impossible to respond to a call on time, the ambulance doctor is obliged to immediately inform the dispatcher about this, which allows the call to be transferred to another team in a timely manner.

The responsibilities of an emergency physician include:

• Conducting and providing competent and free medical care to patients;
• Transportation of injured and sick people to hospital;
• Ability to evaluate correctly general state patient and choose the most optimal method of carrying and transportation for him. Carrying a patient on a stretcher is one of the types of medical care and, accordingly, is another responsibility of the emergency physician;
• If you refuse hospitalization, take all measures to convince both the patient and his relatives of its necessity. If this cannot be done, then provide necessary help, make a record of refusal of hospitalization in the call card and inform the dispatcher about this to transfer the active call to the local doctor of the clinic;
• While en route and in the event of an accident, the ambulance doctor is obliged to stop the car, inform the dispatcher about it and begin providing assistance;
• When providing medical assistance, he must act decisively and quickly, providing it in full. If necessary, the emergency doctor has the right to call a specialized team to the patient;
• Consultation with an emergency physician can only be provided orally. He does not have the right to issue any certificates or conclusions to patients, their relatives or any officials.

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Comments on the material (30):

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I quote Nadezhda:

Hello! How can you thank the ambulance crew? The ambulance doctor was the only one out of 5 doctors who made the correct diagnosis for the child, which was later confirmed by a blood test. Unfortunately, I didn’t ask the doctor’s name, I only know the date and time when they came to us. (there was a temperature of 39 and a rash)

Hello, Nadezhda.
You can call an ambulance and convey your gratitude, describing the time and place of the team’s arrival. You can write a letter of gratitude to the address of the ambulance station from where the team came to you.

Nadezhda doctor / Feb 27, 2018, 11:47 pm

I quote Elena:

On February 25, 2018, I called emergency help for my husband (born 1952). ...
What kind of team came, what was the result, what measures did they take, what recommendations? Isn't it natural to know? As it turns out, it’s natural not to know! It seems that such an order allows assistance to be reduced to nothing.

The emergency team is called in case of life-threatening conditions.
As for blood pressure, the doctor told you correctly, the upper figure of 140 (systolic pressure) is still normal. Even if it's high blood pressure for your husband compared to his worker, then it is not critical.

I quote Galina:

The son lost consciousness and the vomit partially entered the Airways. The ambulance doctors saved him, of course. And they decided that he had consumed something, hence poisoning. Since my son was beaten three months ago, he had open accident, we asked you to pay attention to the head. The doctor didn’t listen, he said it would happen later. They took him to toxicology. After 10 hours the operation was performed. After three days of coma, the son died. 31 year. Why don’t emergency doctors want to hear from relatives? Is it their fault that they were delivered to the wrong department? Time has passed. The diagnosis is acute non-traumatic subdural hemorrhage. If the operation is performed after 4-6 hours, then there is an 80% chance of survival.

Hello.
No, the emergency doctor is not to blame, because he cannot and should not expose accurate diagnosis, he does not have the capabilities for this. An emergency doctor may suggest a diagnosis, but in the hospital it is confirmed or refuted, where the diagnostic possibilities are different.

I quote SERGEY:

Good day! Please tell me, if I trained as a paramedic, can I become a therapist or emergency medical technician?

Good day, Sergey.
If you have trained as a paramedic, you can work as a paramedic. To work as a doctor, you need to study to become a doctor.

1 2

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