Emergency brigade medical care- is structural unit center for emergency medical care and disaster medicine or emergency (ambulance) medical care station, provides emergency medical care to a person in emergency condition directly at the scene of the incident and during transportation of such a person to a health care facility. The number of teams is calculated in accordance with the standards approved by the Ministry of Health. Based on their composition, the teams are divided into medicinal and paramedic teams.
The medical team includes a doctor, a paramedic, nurse, driver. The team leader is a doctor. The paramedic team includes a paramedic, a nurse, and a driver. The team leader is a paramedic. All of its employees are subordinate to the team leader, and he is personally responsible for its work. The brigade is located in the premises of stations, substations, departments, points of permanent or temporary stay. Workplace brigade is determined by the head of the Center, taking into account the need to meet the standard for the arrival of teams at the scene of the incident, information about the need to provide emergency medical care from any individual, or the operator of the emergency medical care system for the population, receives a single order 112, which is received by the operational dispatch service of the Center. The telecommunications operator of the Center determines the routes of calls to the single emergency medical assistance telephone number 103 from persons located within the relevant territory, or messages from operators of the emergency medical assistance system to the population via the single number 112 to the Center's dispatch service.
Monitoring the receipt of calls and responding to them is carried out by the software and hardware complex 103; its electronic system records the time of call receipt and voice recording, which are stored for a set time. The Center's dispatch service has a dispatcher to receive calls, who record the call and fill out the primary medical documentation electronic. This electronic version is transmitted to the dispatcher in the direction. The direction dispatcher's workplace can be located in a single room of the Center's dispatch service, or on the basis of an emergency (ambulance) medical care station or its structural divisions. Receiving from the call manager electronic card, the dispatcher transmits the direction to the head of the EMS team. Electronic card- this is information support at all stages of emergency medical care from the volume emergency assistance before hospitalization in medical institution. The team leader reports to the Center on completion of assistance. The center decides to allocate additional teams in the event of a large number of victims at the scene.
After receiving the call in electronic form, the team transfers it in medical statistical documentation to paper, and also informs the dispatcher about the status of providing emergency medical care to the (victim) patient and the completion of such care.
Persons calling the brigade must answer all questions from the dispatcher receiving the call. In particular, give the exact address of the call (locality, street, house number, apartment, floor, code and entrance number, clarify the access routes to patients). If your passport details are unknown, you must indicate your gender and approximate age, describe your complaints, and tell who is calling the team and from what phone number. If possible, provide the team with unimpeded access to the patient and the necessary conditions for providing assistance. In addition, isolate animals that may complicate the provision of medical care to the patient or cause harm to the health and property of team members. When hospitalizing a patient, it is advisable to have with you any document proving his identity. at aggressive behavior a patient who is in a state of alcoholic, drug, toxic intoxication, or mental disorder and poses a threat to health or life medical workers medical assistance teams and transportation are carried out in the presence of police officers. Accompanying a patient in ambulance transport is carried out by one person with the permission of the team leader. Transportation of children is carried out accompanied by parents. The call dispatcher has the right to refuse to accept calls to patients to carry out scheduled appointments of the local (family) doctor (injections, dressings, etc.), in patients under the supervision of the local (family) doctor, to provide dental care, removing ticks, issuing certificates of incapacity for work, issuing prescriptions, filling out certificates, conducting forensic medical reports, transporting corpses. The standard for the arrival of emergency (ambulance) medical teams at the scene of a call in cities is 10 minutes, outside the city, in populated areas - 20 minutes from the moment the call is received by the dispatcher of the operational dispatch service of the Center for Emergency Medical Care and Disaster Medicine.
If necessary, by decision of the head of the Center, specialized teams in the specialty of psychiatry, cardiology, neurology, pediatrics, neonatology, etc. can be formed from among medical teams, which are subordinate to the order of the operational dispatch service of the Center.
The team is provided with specialized sanitary vehicle, in terms of its technical and medical indicators must comply with the requirements of national standards, as well as medicines and products medical purposes, meeting the equipment sheets approved by the Ministry of Health.
Team members are provided with special work clothing and footwear. In case of work in unfavorable or harmful conditions, team members are provided with special clothing and personal protective equipment.
The main tasks of the brigade are:
Providing emergency medical care to patients and injured people prehospital stage and during their hospitalization in specialized healthcare institutions;
Acceptance Participation in eliminating the consequences of an emergency.
The brigade is constantly in readiness (standby) mode to carry out orders from the Center's operational dispatch service. Arriving at the scene of an incident upon call, examines and provides emergency medical care to victims in need of it;
Transports patients to healthcare institutions determined by the dispatcher of the operational dispatch service of the Center, or provides transportation by order of the dispatcher of the operational dispatch service of the Center for patients requiring medical support when transported to healthcare institutions at the same time;
Informs the dispatcher of the Center's operational dispatch service about the stages of completing the task on call, as well as about the threat of an emergency;
Transports patients requiring mandatory medical support to inpatient institutions health care by order of the dispatcher of the operational dispatch service of the Center;
Timely reports on the use of medicinal, narcotic and psychotropic drugs, medical products, replenishment and exchange;
Organizes medical triage of victims, attracts additional teams to provide emergency medical care to victims in the event of an emergency;
Interacts on a daily basis with the Center dispatcher, other teams, employees of healthcare institutions, police officers, in particular employees of the State Automobile Inspectorate, personnel of fire departments and emergency rescue services.
The team has the right:
Hospitalize the patient in the event of a sudden threat to his life and health to the nearest health care institution, regardless of subordination and form of ownership, determined by the dispatcher of the operational dispatch service of the Center, in which he can be provided with qualified or specialized emergency medical care;
Receive advice from a senior doctor of the operational dispatch service of the Center for Medical Affairs on the sequence of actions when providing emergency medical care to patients.
The control room (operations department) of the SSMP is formed at the station, starting from the 3rd category (from 201 to 500 thousand population). The operational department includes a central control room, a field medical team line control, advisory and information service. In the event of an emergency, the line control team arrives at the source of the lesion and coordinates the emergency response teams to eliminate the medical and sanitary consequences, maintains contact with the emergency response headquarters, the station, teams, and medical institutions to which the victims are sent.
The structure of the SSMP includes a hospitalization department, which operates only in stations of the first (from 1 million to 2 million population) and second (from 501 thousand to 1 million population) categories, which ensures a constant round-the-clock accounting of the free bed capacity of medical institutions and distributes the flow of patients. The hospitalization department interacts with leading specialists local authorities health department on duty schedule issues medical institutions on the provision of emergency medical care, operational changes regarding the profile and the deployment of additional relevant profiles, needs and prospects regarding the bed capacity, interaction with other inpatient medical institutions not included in the health care management system, on the use of bed capacity for the provision of emergency inpatient medical care. This department interacts with the city’s medical institutions on issues of their readiness for emergency hospitalization of patients, the availability of free beds in them and their additional deployment, hospitalization of patients in the event of emergencies in institutions, violation and failure to comply with the procedure for emergency hospitalization, and others.
In the structure of the SSMP I-II categories is a division of the advisory and information service, providing advice to the population by telephone, as well as advice on first aid.
In order to bring closer the provision of medical care to the population at the prehospital stage, by ensuring the timely arrival of emergency medical services to the patient (victim), temporary bases for emergency medical teams are formed. The points are formed on the basis of a health care institution (rural medical outpatient clinic, local (district) hospital, city clinic located in the territory of the station, substation (department)). The point is opened by a decision of the city (district) authorities after the conclusion of an agreement between the heads of the station (the hospital in whose structure the EMS department operates) and the medical institutions that provide the premises for the location of the point.
In the city, the team is stationed at the point during peak hours (maximum vehicle traffic) and (or) the maximum number of calls received in the territory served by the point. The point is a structural subdivision of the SSMP or substation. The service territory is determined by the head of the SSMP.
Ambulance and emergency medical care (EMS)– a medical organization aimed at providing emergency medical care, as well as specialized medical care for life-threatening accidents and acute serious illnesses both at the scene and along the way. This type of assistance is organized for urgent medical care in case of accidents and sudden serious illnesses that occur at home, on the street, during work and at night, in case of mass poisonings and other threatening conditions.
The concept of “emergency conditions” defines such pathological changes in the human body, which lead to a sharp deterioration in health and can be life-threatening.
“Emergency in medical care” means the urgent elimination of all urgent pathological conditions that arose unexpectedly, which, regardless of the severity of the patient’s condition, require immediate diagnostic and therapeutic activity. It is advisable to distinguish the following main forms of pathological conditions for which emergency care is indicated:
– there is an immediate threat to life, which without timely medical attention can lead to death
– there is no immediate threat to life, but, based on pathological condition, the threatening moment can come at any time
– there is no threat to life, but it is necessary to alleviate the patient’s suffering
– the patient is in a non-life-threatening condition, but urgent assistance is required in the interests of the team.
In the activities of emergency medical services, the preservation of the health of patients and victims depends primarily on the timely arrival of the emergency medical team at the scene of the call and the quality of pre-hospital and medical care.
Basic principles of organizing EMS:
– full accessibility
– efficiency in work, timeliness
– completeness and high quality of assistance provided
– ensuring unhindered hospitalization
– maximum continuity in work.
Currently operating in the Republic of Belarus State system for organizing emergency medical services:
– pre-hospital stage: in cities, emergency medical service stations with substations and branches, trauma centers; in rural administrative areas - departments of the emergency medical service of the central district hospital, in the regions
– hospital stage: emergency hospitals, emergency departments of the general network of hospital institutions
The activities of emergency medical care stations (departments, hospitals) are regulated by the order of the Ministry of Health of the Republic of Belarus “On improving the organization of ambulance and emergency medical care.”
Emergency medical care station (department) is a healthcare facility that provides emergency and emergency medical care to adults and children in case of life-threatening conditions, accidents, acute severe diseases and exacerbations chronic diseases both at the scene of the incident and along the route.
Tasks of the NSR station:
1. Providing maximum short time after receiving a call for ambulance and emergency medical care for sick and injured people who are outside health care facilities and during their transportation to hospitals.
2. Transportation of patients in need of emergency care, victims, women in labor, premature babies together with their mothers at the request of doctors and hospital administration.
The SMP station provides the following:
1. Emergency medical care:
A) in case of sudden diseases that threaten the patient’s life (acutely developing disorders of the cardiovascular system, central nervous system, respiratory organs, abdominal organs)
B) in case of accidents (various types of injuries, wounds, burns, electric shock and lightning, foreign bodies respiratory tract, frostbite, drowning, poisoning, suicide attempts)
C) during births that took place outside specialized institutions
D) in case of mass disasters and natural disasters.
2. Emergency care: during exacerbations of various chronic diseases, when the reasons for contacting do not relate to paragraph 1a) of this provision, as well as when acute diseases children, especially the first year of life.
SSMP categories are established depending on the number of trips performed per year: non-category - over 100 thousand trips per year, category I - from 75 thousand to 100 thousand, category II - from 50 thousand to 75 thousand, category III - from 25 thousand to 50 thousand, IV category - from 10 thousand to 25 thousand, V category - from 5 thousand to 10 thousand. An emergency medical station is organized in cities with a population of over 50 thousand and is an independent health care facility or, according to by decision of local health authorities, it is part of the city emergency hospitals as its structural unit. In cities with smaller populations, emergency departments are organized at city, central district and other hospitals. Each city has only one emergency medical service station or department. Servicing of the rural area is carried out by the city emergency medical service or the emergency medical service department at the central district hospital. IN major cities As part of the SSMP, substations were organized within 15 minutes of transport accessibility in a city administrative area with a population of 75-200 thousand inhabitants. In rural areas, ambulance posts operate to ensure 30-minute availability.
In accordance with the standards, one ambulance is allocated for every 10 thousand residents and 0.8 medical or paramedic teams are approved. The ambulance response time is up to 4 minutes, according to emergency care– up to 1 hour.
Documentation of emergency medical care stations (departments):
1) a log or card for recording an emergency medical call
2) card for calling ambulance and emergency medical services
3) accompanying sheet with a tear-off coupon
4) diary of the work of the ambulance station
5) station report
Call cards and emergency medical call logs are stored for 3 years. SSMP does not issue sick leave certificates, forensic medical reports, or conduct examinations of alcohol poisoning.
SSMP is an independent institution and is subject to the orders and instructions of higher authorities of the Zoo, and enjoys the right legal entity and has a stamp and seal indicating its name.
Emergency Hospital (EMS)– a multidisciplinary specialized medical facility for providing round-the-clock emergency inpatient medical care to the population in case of acute diseases, injuries, accidents, poisoning, as well as in case of mass casualties, catastrophes, and natural disasters.
The main tasks of the emergency hospital:
– provision of emergency specialized medical care to patients with life-threatening conditions requiring resuscitation and intensive care using means and methods of express diagnostics and treatment at the level modern achievements medical science and practice
– implementation of organizational, methodological and advisory assistance treatment and preventive institutions of the region in activities related to the organization of emergency medical care
– implementation of measures to ensure the constant readiness of the hospital to work in emergency conditions during mass admissions of victims in the city (region, republic)
– ensuring effective continuity and relationship with all medical and preventive institutions of the city in providing medical care to patients in pre-hospital and hospital stages
– analysis of the quality of emergency medical care and assessment of the efficiency of the hospital and its structural divisions
– analysis of the population’s need for emergency medical care at all stages of its organization
– carrying out health education and hygiene education population on the formation of a healthy lifestyle, providing self- and mutual assistance in case of accidents and sudden illnesses, etc.
Emergency hospitals are organized in settlements with a population of at least 250 thousand. The hospital is managed by chief physician.
Structural divisions of emergency hospital:
– administrative and management part
– organizational and methodological department with a medical statistics office
– hospital
– reception and diagnostic department with reference and information service
– specialized clinical emergency departments (surgical, traumatological, neurosurgical, urological, burn, gynecological, cardiological, emergency therapy, etc.)
– Department of Anesthesiology, Resuscitation and Intensive Care
– blood transfusion department
– department of physiotherapy and exercise therapy
– pathological service with histological laboratory
– medical archive
– other departments: pharmacy, library, catering department, economic and technical department, computer center.
Emergency hospital provides:
– 24-hour provision of timely and on-time high level emergency medical care for patients with sudden illnesses, accidents
– development and improvement organizational forms and methods of providing emergency medical care to the population
– coordination, continuity and interaction of medical and preventive institutions of the city to provide emergency medical care to the population;
– conducting examinations of temporary disability of workers and employees, issuing certificates of incapacity for work, recommendations on the transfer of discharged patients to another job for health reasons
– notification of the relevant authorities about all emergencies and accidents in accordance with special instructions and orders of the Ministry of Health of the Republic of Belarus
The emergency hospital hospitalizes patients for emergency indications, delivered by an emergency medical service station, sent by outpatient clinics and other treatment and preventive institutions, as well as those who sought emergency care directly at the reception and diagnostic department. In the case of hospitalization of non-core patients, after removing them from a life-threatening condition, the hospital has the right to transfer them to other hospitals in the city according to their profile for further treatment. To ensure a 100% probability of hospitalization of emergency patients in a specialized bed, reserve beds are provided (5% of the bed capacity), which are not taken into account when drawing up the statistical plan, but are funded.
The emergency hospital is under the direct authority of the city health department. It is an independent healthcare institution and has at its disposal buildings with a designated territory, equipment, and inventory. BSMP enjoys the rights of a legal entity, has a round seal and a stamp indicating its full name.
The ambulance service is one of the most important links in the healthcare system in our country. The volume of medical care provided to the population by medical and paramedic teams is constantly growing.
In rural areas, emergency medical departments have been established at the Central District Hospital.
Calls to the population there are almost universally served by paramedic teams.
Stations have been created in cities, and emergency medical substations have also been created in large cities. They include line medical teams serving the majority of a wide variety of calls, specialized teams (intensive care, trauma resuscitation, pediatric intensive care, toxicology, psychiatric, etc.), as well as paramedic teams. The functions of paramedic teams in cities mainly include transporting patients from one medical institution to another, transporting patients from home to the hospital in the direction of local doctors, delivering women in labor to maternity, as well as providing assistance to patients with various injuries when the need for resuscitation care is not expected, as well as some others. For example, if the reason for the call is “tripped, fell, broke an arm (leg)” - this is a call for the paramedic team, and if it is known in advance that the victim fell out of a seventh floor window or was hit by a tram, then it is more advisable to immediately send to such a call specialized team.
But this is in cities. In rural areas, as already noted, almost all calls are carried out by paramedics. In addition, in real work conditions, it is sometimes impossible to determine in advance what actually happened, and a paramedic working independently must be prepared for any, most unexpected situations.
When working as part of a medical team, the paramedic is completely subordinate to the doctor during the call. His task is to carry out all assignments clearly and quickly. Responsibility for decisions made lies with the doctor. The paramedic must master the technique of subcutaneous, intramuscular and intravenous injections, ECG recording, be able to quickly install a system for drip fluid administration, measure arterial pressure, count the pulse and number breathing movements, insert the air duct, carry out cardiopulmonary resuscitation etc. He must also be able to apply a splint and bandage, stop bleeding, and know the rules for transporting patients.
When independent work The ambulance paramedic is fully responsible for everything, so he must be fully proficient in pre-hospital diagnostic methods. He needs knowledge of emergency therapy, surgery, traumatology, gynecology, and pediatrics. He must know the basics of toxicology, be able to independently deliver a child, evaluate neurological and mental condition patient, not only register, but also roughly evaluate the ECG.
Emergency care is the pinnacle of medical art, which is based on fundamental knowledge from various fields of medicine, combined with practical experience.
Main regulatory documents:
1) Constitution Russian Federation;
2) the federal law dated November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”;
No. 856 “On the Program of State Guarantees for Providing Free Medical Care to Citizens of the Russian Federation for 2012”;
4) Order of the Ministry of Health of the USSR dated March 25, 1976 No. 300 “On the standards for equipping healthcare institutions with sanitary transport and on the operating mode of sanitary transport”;
5) Order of the Ministry of Health of the Russian Federation dated April 8, 1998 No. 108 “On emergency psychiatric care»;
6) Order of the Ministry of Health of the Russian Federation dated March 26, 1999 No. 100 “On improving the organization of emergency medical care for the population of the Russian Federation”;
7) Order of the Ministry of Health of the Russian Federation and social development RF dated 02/05/2004 No. 37 “On interaction on issues of ensuring sanitary protection of the territory of the Russian Federation and carrying out measures to prevent quarantine and other especially dangerous infections”;
8) Order of the Ministry of Health of the Russian Federation and Social Development of the Russian Federation dated November 1, 2004 No. 179 “On approval of the procedure for providing emergency medical care”;
9) Order of the Ministry of Health of the Russian Federation and Social Development of the Russian Federation dated December 1, 2005 No. 752 “On equipping sanitary transport”;
10) Order of the Ministry of Health of the Russian Federation and Social Development of the Russian Federation dated September 24, 2008 No. 513n “On organizing the activities of the medical commission of a medical organization”;
11) Resolution of the Chief State Sanitary Doctor of the Russian Federation dated 06/09/2009 No. 43 “On approval of sanitary and epidemiological rules SP 3.1. 1.2521-09";
12) Order of the Ministry of Health of the Russian Federation and Social Development of the Russian Federation dated August 19, 2009 No. 599n “On approval of the procedure for providing planned and emergency medical care to the population of the Russian Federation for diseases of the circulatory system of the cardiological profile”;
13) Order of the Ministry of Health of the Russian Federation and Social Development of the Russian Federation dated December 2, 2009 No. 942 “On approval of the statistical tools of the station (department), emergency hospital”;
14) Order of the Ministry of Health of the Russian Federation and Social Development of the Russian Federation dated December 15, 2009 No. 991n “On approval of the procedure for providing planned and emergency medical care to victims with combined, multiple and isolated injuries accompanied by shock”;
15) Order of the Ministry of Health of the Russian Federation and Social Development of the Russian Federation dated June 11, 2010 No. 445n “On approval of requirements for the supply of medicines and medical products visiting team emergency medical services."
The main document in accordance with which the work of the ambulance service is based is Order of the Ministry of Health of the Russian Federation dated March 26, 1999 No. 100 “On improving the organization of emergency medical care to the population of the Russian Federation.”
In the Russian Federation, a system of providing emergency medical care to the population with a developed infrastructure has been created and is functioning. It includes over 3 thousand emergency medical care stations and departments, staffed by 20 thousand doctors and over 70 thousand paramedics.
Every year, the emergency medical service carries out 46 to 48 million calls, providing medical care to more than 50 million citizens. It is envisaged to gradually expand the scope of emergency medical care provided by paramedic teams, while retaining medical teams as intensive care teams and other highly specialized teams.
An ambulance station is a treatment facility designed to provide round-the-clock emergency medical care to adults and children, both at the scene of an incident and on the way to the hospital in conditions that threaten the health or life of citizens or those around them, caused by sudden diseases, exacerbation of chronic diseases, accidents, injuries and poisonings, complications of pregnancy and childbirth.
Emergency medical care stations are created in cities with a population of over 50 thousand people as independent treatment and preventive institutions.
In settlements with a population of up to 50 thousand, emergency medical departments are organized as part of city, central district and other hospitals.
In cities with a population of more than 100 thousand people, taking into account the length of the settlement and the terrain, emergency medical substations are organized as subdivisions of stations (calculating 15-minute transport accessibility).
The main functional unit of an ambulance substation (station, department) is the mobile team (paramedic, medical, intensive care and other highly specialized teams). Brigades are created in accordance with staff standards, with the expectation of providing round-the-clock shift work.
Appendix No. 10 to the Order of the Ministry of Health of the Russian Federation dated March 26, 1999 No. 100 “Regulations on the paramedic of the mobile ambulance team”
A specialist with secondary medical education in the specialty “General Medicine”, having a diploma and an appropriate certificate.
When performing emergency medical care duties as part of a paramedic team, the paramedic is the responsible performer of all work, and as part of a medical team, he acts under the direction of a doctor.
The paramedic of the mobile ambulance team is guided in his work by the legislation of the Russian Federation, regulatory and methodological documents of the Ministry of Health of the Russian Federation, the Charter of the emergency medical care station, orders and instructions of the station administration (substation, department).
A paramedic of a mobile emergency medical team is appointed to a position and dismissed in accordance with the procedure established by law.
Responsibilities
The paramedic of the mobile ambulance team is obliged to:
1) ensure the immediate departure of the brigade after receiving a call and its arrival at the scene of the incident within the established time standard in the given territory;
2) provide emergency medical care to sick and injured people at the scene of an incident and during transportation to hospitals;
3) administer to sick and injured people medications for medical reasons, stop bleeding, carry out resuscitation measures in accordance with approved industry norms, rules and standards for paramedic personnel to provide emergency medical care;
4) be able to use the available medical equipment, master the technique of applying transport splints, bandages and methods of conducting basic cardiopulmonary resuscitation;
5) master the technique of taking electrocardiograms;
6) know the location of medical institutions and station service areas;
7) ensure the carrying of the patient on a stretcher, and, if necessary, take part in it (in the working conditions of the team, carrying a patient on a stretcher is regarded as a type of medical care). When transporting a patient, be next to him, providing the necessary medical care;
8) if it is necessary to transport the patient to unconscious or condition alcohol intoxication carry out an inspection for documents, valuables, money indicated in the call card, hand them over to emergency department hospital with a mark in the direction against the receipt of the duty personnel;
9) when providing medical assistance in emergency situations, in cases of injuries of a violent nature, act in the prescribed manner (report to the internal affairs bodies);
10) ensure infection safety (comply with the rules of the sanitary and hygienic and anti-epidemic regime). If a quarantine infection is detected in a patient, provide him with the necessary medical care, observing precautionary measures, and inform the senior shift doctor about the clinical, epidemiological and passport data of the patient;
11) ensure proper storage, accounting and write-off of medicines;
12) at the end of duty, check the condition of medical equipment, transport tires, replenish medicines, oxygen, nitrous oxide consumed during work;
13) inform the administration of the ambulance station about all emergencies that occurred during the call;
14) at the request of internal affairs officers, stop to provide emergency medical care, regardless of the location of the patient (injured);
15) maintain approved accounting and reporting documentation;
16) in the prescribed manner, improve your professional level and improve practical skills.
A paramedic of a mobile ambulance team has the right to:
1) call an emergency medical team for help if necessary;
2) make proposals to improve the organization and provision of emergency medical care, improve working conditions for medical personnel;
3) improve your qualifications in your specialty at least once every 5 years. Pass in
certification and recertification in accordance with the established procedure;
4) take part in medical conferences, meetings, seminars conducted by the administration of the institution.
Responsibility
The paramedic of the mobile ambulance team is responsible in the manner prescribed by law:
1) for the carried out professional activity in accordance with approved industry norms, rules and standards for emergency medical technician paramedics;
2) for illegal actions or inaction that resulted in damage to the patient’s health or death.
In accordance with Order of the Ministry of Health of the Russian Federation No. 100, visiting teams are divided into paramedic and medical teams. The paramedic team consists of two paramedics, an orderly and a driver. The medical team includes a doctor, two paramedics (or a paramedic and a nurse anesthetist), an orderly and a driver.
However, the order further states that “the composition and structure of the team is approved by the head of the station (substation, department) of emergency medical care.” Practically in real working conditions (for reasons understandable in our economic living conditions) medical team- this is a doctor, a paramedic (sometimes also a paramedic) and a driver, a specialized team - a doctor, two paramedics and a driver, a paramedic team - a paramedic and a driver (maybe also a paramedic).
When a person’s life and health are in danger as a result of an accident, emergency or, for example, acute condition in case of a fracture or injury, he requires emergency medical care. This is a type of assistance that is provided to citizens around the clock who require urgent medical intervention at the scene of an incident and on the way to a medical facility. Usually these problems are solved by special departments at medical institutions in cities and villages. What functions do these departments perform and how the process is organized will be discussed below.
Description of the problem
Emergency medical care is urgent assistance to victims who are in life-threatening and health-threatening conditions or have serious injuries, it is provided medical staff at the scene of the incident, for example in a public place or on the street. Also, such medical assistance is provided in case of acute pathologies, mass disasters, accidents, childbirth or natural disasters.
It is organized based on the characteristics of the locality, in particular, its location, density and composition of the population, location of hospitals, condition of roads and other points. Such assistance to victims guarantees the provision of medical and social assistance to people.
Legislation
All over the world, emergency medical care is provided free of charge. Since the end of the nineteenth century, private and public organizations, such as the Red Cross, have had this privilege. Relatively recently, the first government agencies for the provision of emergency services, which initially had an orderly and a paramedic, and over time - medical personnel.
A little later, the first ambulance units were created in Russia, but they did not have documentation that regulated their activities. The creation of the Medical Care Act, which described the first legal norms, formed the basis for future bills, including the one currently being followed. Today, emergency medical care standards have been developed that guide doctors.
Characteristic
The main features that distinguish this type medical aid, speak:
- Free provision of it and the procedure for providing health care.
- Its trouble-free implementation.
- Diagnostic risk assessment when there is not enough time.
- Great social significance.
- Providing assistance outside of a medical facility.
- Transportation to the clinic, provision of treatment and round-the-clock monitoring.
Functions
According to the approved standards for emergency medical care, it carries out:
- 24-hour assistance to injured and sick people who are outside the hospital.
- Transportation and transportation of patients, including women in labor.
- Reliable provision of emergency medical care to people who turned to the EMS station.
- Notifying the relevant authorities about emergencies and accidents in places where victims are served.
- Ensuring that the team is fully staffed with medical personnel.
An ambulance team can also transport donated blood and specialists of a narrow profile if necessary. SMP also conducts health education and research work.
One of the effective components of the healthcare system - emergency medical care - in some large cities also transports the remains of people who died in public places to the morgue. In this case, special teams and vehicles with refrigeration units, which are popularly called hearses, respond to the call. In small towns, such teams are part of the city morgue.
Work organization
As a rule, emergency medical care is provided by emergency medical services stations, which do not provide continuous therapy, but are intended to provide assistance before hospitalization of patients in accordance with Order of the Ministry of Health No. 100 of March 26, 2000. At such stations, sick leave certificates, certificates, and other documents are not given to patients and their relatives. Hospitalization of victims is carried out in the city clinical emergency hospital.
At such stations there is specialized transport, which is equipped with diagnostic and therapeutic equipment, which is used for emergency diagnosis and treatment of pathologies.
Ambulance crews
Any clinical Hospital emergency medical services includes mobile teams. It can be:
- Linear teams, when a doctor and one paramedic work.
- Specialized, when a doctor and two paramedics travel.
- Linear paramedics who provide transportation of victims.
In large cities, there are usually such ambulance teams as intensive care, infectious diseases, pediatric, psychiatric, and so on. The activities of each of them are documented in special cards, which are then handed over to the chief emergency physician, and then to the archive for storage. If necessary, you can always find such a map and study the circumstances of calling the brigade. When a victim is hospitalized, the doctor fills out a special sheet, which he inserts into his medical history.
Emergency medical assistance is called by telephone number “03”. At the call site, the joint venture team conducts necessary treatment, the doctor who coordinates the actions of the employees bears all responsibility. He can also provide emergency treatment in an ambulance if necessary.
Types of ambulance teams
EMS teams are:
- Line emergency medical teams are a mobile group of doctors that provide medical care for non-life-threatening and health-threatening conditions, for example, changes in blood pressure, hypotensive crises, burns and injuries. They transport victims of fires, mass accidents, disasters, and so on. To carry out the activities of the field team, a class A or B vehicle is used.
- Resuscitation teams provide emergency medical care in ambulances, which are equipped with diagnostic and treatment equipment, as well as medications. The team at the scene is conducting a blood transfusion, artificial respiration, splinting, stopping bleeding, cardiac massage. It is also possible to carry out emergency procedures in the car. diagnostic measures, for example, ECG. This approach makes it possible to reduce the risk of complications in victims, as well as reduce the number of deaths during transportation of patients to medical institutions. The ambulance resuscitation team also includes an anesthesiologist and a resuscitator, nurses and a nurse. To carry out the activities of the field team, a class C vehicle is used.
- Specialized teams provide assistance in a specific narrow profile. These could be psychiatric, pediatric, advisory, or aeromedical teams.
- Emergency team.
Urgent measures
There are many cases that require calling an ambulance. The main reasons for which a call is inevitable include:
- The need for a doctor to arrive urgently.
- Hospitalization and transportation of the victim to a medical facility.
- Serious injuries, burns and frostbite.
- Pain in the heart, stomach, increased blood pressure.
- Loss of consciousness and convulsive syndrome.
- Development respiratory failure, suffocation.
- Arrhythmia, hyperthermia.
- Incessant vomiting and diarrhea.
- Intoxication of the body in any pathology.
- Exacerbation of chronic diseases.
- State of shock, thromboembolism.
It is also the responsibility of the staff to conduct an alcohol intoxication examination.
NSR station
The head of the city emergency medical service station is the chief physician. He may have several deputies who are responsible for the technical part, economic, administrative, medical, and so on. Large stations may include different departments and divisions.
The largest is the operational department, which manages the operational work of the entire station. Employees of this department talk with people who call emergency services, receive and record calls, and transmit information to ambulance teams for execution. This division includes:
- An on-duty doctor who negotiates with visiting doctors, law enforcement agencies, fire departments, and so on. The doctor resolves all issues related to emergency care.
- Dispatchers (senior, by referral, by hospitalization) transfer calls to regional substations, monitor the localization of field teams, record the execution of calls, as well as keep track of available beds in medical institutions.
The hospitalization department for victims transports patients at the request of doctors from various medical institutions. This unit is headed by the doctor on duty, it also includes a reception desk and a control room that coordinates the activities of paramedics and transports victims.
The hospitalization department for pregnant women, as well as those with acute gynecological pathologies, transports women in labor and sick people. The unit receives calls from the public, medical institutions, law enforcement and fire services. Obstetricians, paramedics, and gynecologists respond to calls. This department also delivers specialized specialists to gynecology departments and maternity hospitals for urgent surgical interventions.
Also city Hospital emergency medical services has an infectious diseases department that provides assistance in cases of poisoning, acute infections, transports patients to the infectious diseases department.
Also, the departments of the ambulance station include statistics, communications, information desk, as well as accounting and human resources departments.
Calling an ambulance
Emergency medical care is urgent assistance to victims, which can be called by telephone number “03” by adults and children under fourteen years of age. The rules for calling an ambulance should help improve the quality of care for victims and ensure the timeliness of medical care. For all citizens, this type of medical care is free, regardless of insurance or registration. This order was issued by the Ministry of Health No. 388 of 2013.
When calling an ambulance, you must clearly answer all the dispatcher’s questions, give the victim’s name, age, call address, as well as indicate the reason for the call and leave your contact information. Doctors may need them if clarification questions arise. The person who called the EMS team must:
- Organize a team meeting.
- Ensure unobstructed access to the victim and conditions for providing assistance.
- Report the incident accurately and clearly.
- Provide availability information allergic reactions, taking medications, alcohol.
- Isolate pets, if any.
- Provide necessary help doctors in transporting the patient to the car.
The question of hospitalization is decided only by the doctor. Relatives have the right to consent to medical intervention, refusal of hospitalization with written confirmation in a special card of health workers.
Ambulance and reality
Many people are familiar with cases when an ambulance arrives at a place very late, and sometimes it has to be called several times. Why is this happening?
The ambulance arrival limit is up to ten minutes. This limit is observed in cities, but incidents often occur outside the city. This is due to the fact that the dispatcher directs the crews using the GPS system, which is why confusion arises. Sometimes, when calling an ambulance, the dispatcher sends a team that is not located at the substation in the corresponding area, but a regional one, which takes much longer to travel. Also, the speed of arrival is influenced by weather conditions, road conditions, etc. It also happens that all teams are busy at the time they are called. But this is often due to the fact that people call an ambulance for any reason, even the most insignificant.
What to do if a person becomes ill?
People often make mistakes when providing first aid. It is strictly forbidden to do the following actions:
- Give the victim medications, as he may be allergic to the drug, which will worsen his situation.
- Give, water and spray water, especially in case of an accident. This is due to the fact that the victim may be damaged internal organs, and such action may lead to fatal outcome. If a person is conscious and asks for a drink, he needs to moisten his lips with water. You should also not splash water, especially if the person is lying on his back and unconscious. Water may enter the respiratory tract and a person may choke.
- Shake and hit on the cheeks. The injured person may have internal organs damaged or a broken spine. Impacts can cause vertebral displacement and damage the spinal cord. A person can receive such serious injuries even if he falls from his own height.
- Trying to sit up a person who is unconscious. In this case, the victim’s brain does not receive enough oxygen, and blood circulation is impaired. In this case, the victim must be placed on his side in order to prevent tongue retraction and aspiration of vomit.
- Put something under your head to raise it. In an unconscious person, the facial muscles are relaxed, so the tongue may sink, which will lead to suffocation. The victim can breathe best when his chin is facing up.
Results
The ambulance department has several teams, among which one is a general one, which makes calls to in case of emergency. When all teams are busy and a call is received, the first available medical team is dispatched; in some cases, a specialized team from the city EMS service may be dispatched.
In large cities, every day the ambulance station receives about two hundred calls, usually one hundred of them are dispatched. Medical transport is equipped with radio communications, modern diagnostic and treatment equipment, for example, electrocardiographs and defibrillators, medications, which make it possible to provide quick assistance to victims.
All calls from people arriving at the station are received by the dispatch service, they are sorted by direction, urgency, priority, and then transferred to the teams for execution. To properly provide assistance to an injured person who called an ambulance, it is necessary:
- Objectively assess the need for a call based on the patient’s condition.
- Clearly state information about what happened, what worries the victim, the patient’s address, contact information.
Before the arrival of the EMS team, it is necessary to follow the recommendations given by the dispatcher. When hospitalizing the victim, it is necessary to collect a change of clothes and linen, toiletries, and shoes. If there are pets in the room, they must be isolated so that they do not interfere with doctors performing medical procedures.
Ambulance service personnel must perform the following tasks:
- Providing primary care.
- Making a preliminary diagnosis.
- Relief of emergency conditions.
- Hospitalization of the victim to the clinic.
SMP does not issue sick leave, certificates, and also does not prescribe treatment and does not leave any documents, except for directions for funeral service workers. A request for documentation can only be submitted by the patient who received medical care.
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.
Separate teams 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 They go for the simplest cases (high blood 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), a medical team should consist of a doctor, 2 paramedics (or a paramedic and a nurse), and a driver, and a paramedic team should consist of 2 paramedics or a paramedic and a nurse and a driver.
To provide timely specialized medical care directly at the scene of the incident and during transportation of victims, specialized intensive care teams, traumatology, cardiology, psychiatric, toxicology, pediatric, etc., have been organized.
Specialized teams. Resuscitation vehicle based on GAZ-32214 Gazelle. Specialized teams directly at the scene of the incident and in the ambulance carry out blood transfusions, stop bleeding, tracheotomy, artificial respiration, closed heart massage, splinting and other emergency measures, and also carry out 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, and has made it possible to reduce the number of complications and deaths during transportation of sick and injured patients 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 inpatient medical facility;
- · 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 a greater variety of medical equipment of “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 hospitals;
- · obstetrics - designed to provide emergency care to pregnant women and those giving birth or giving birth outside medical institutions, 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 to 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.
