Emergency brigade medical care- is a structural unit of the 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 calculation of the number of teams is carried out 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, paramedic, nurse, and 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. The team’s workplace 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 directional 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. An electronic card is information support at all stages of emergency medical care, from the volume emergency assistance before hospitalization in a 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. in case of aggressive behavior of a patient who is in a state of alcoholic, narcotic, toxic intoxication, or mental disorder and poses a threat to the health or life of medical workers of the medical care team and transportation is 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 a specialized ambulance vehicle, which in terms of its technical and medical indicators must meet 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 victims at the 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 operational dispatch service of the Center 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 mobile medical team of linear control, and an 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 schedules of medical institutions for the provision of emergency medical care, operational changes regarding the profile and the deployment of additional relevant profiles, needs and prospects regarding bed capacity, interaction with other inpatient medical institutions not included in the health care management system, on the use of bed capacity to provide 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. Item is structural unit SSMP or substations. The service territory is determined by the head of the SSMP.

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 major cities- also emergency medical substations. 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), as well as paramedic teams. The functions of paramedic teams in cities include mainly transporting patients from one medical institution in another, transporting patients from home to a hospital in the direction of local doctors, delivering women in labor to maternity hospitals, as well as providing assistance to patients with various injuries when the need for intensive care is not expected, as well as some others. For example, if the reason for the call is “stumbled, fell, broke an arm (leg)” - this is a call for a 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, it is more advisable to immediately send a specialized team to such a call brigade.

But this is in cities. In rural areas, as already noted, almost all calls are carried out by a paramedic. 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 be proficient in the technique of subcutaneous, intramuscular and intravenous injections, ECG recording, be able to quickly install a system for drip fluid administration, measure blood pressure, count the pulse and number breathing movements, insert the air duct, carry out cardiopulmonary resuscitation. He must also be able to apply a splint and bandage, stop bleeding, and know the rules for transporting patients.

In the case of independent work, the ambulance paramedic is fully responsible for everything, so he must be fully proficient in diagnostic methods at the prehospital stage. 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.

Basic orders regulating work

Order of the Ministry of Health of the Russian Federation No. 100 of March 26, 1999 “On improving the organization of emergency medical care for the population of the Russian Federation.” The main document in accordance with which the work of the ambulance service is based is the order of the Ministry of Health of the Russian Federation No. 100 dated March 26, 1999 “On improving the organization of emergency medical care for the population of the Russian Federation.” Here are some excerpts from this document. “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 3,000 stations and emergency medical departments, employing 20 thousand doctors and over 70 thousand paramedical workers... Every year, the emergency medical service makes from 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, with the preservation of medical teams as intensive care teams and ... other highly specialized teams."

“An emergency medical station is a medical and preventive institution 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 chronic diseases, accidents, injuries and poisonings, complications of pregnancy and childbirth. Ambulance 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 care substations are organized as divisions of stations (calculating 15-minute transport accessibility)... The main functional unit of the substation (station, department) of emergency medical care is a visiting team (paramedic, medical, intensive care and other highly specialized teams)... Teams are created in accordance with staff standards with the expectation of ensuring round-the-clock shift work.”

Appendix No. 10 to the order of the Ministry of Health of the Russian Federation No. 100 dated March 26, 1999 “Regulations on the paramedic of the mobile ambulance team.” General provisions.
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 administration of the station (substation, department), and these Regulations.
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:
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 for the given territory.
Provide emergency medical care to sick and injured people at the scene of an accident and during transportation to hospitals.
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 in the provision of emergency medical services.
Be able to use available medical equipment, master the technique of applying transport splints, bandages and methods of performing basic cardiopulmonary resuscitation.
Master the technique of taking electrocardiograms.
Know the location of medical institutions and station service areas.
Ensure that the patient is carried 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.
If it is necessary to transport a patient in an unconscious state or in a state of alcoholic intoxication, carry out an inspection for documents, valuables, money indicated in the call card, hand them over to the hospital reception department with a note in the direction for signature of the duty personnel.
When providing medical assistance in emergency situations, in cases of violent injuries, act in the prescribed manner (report to the internal affairs authorities).
Ensure infection safety (comply with the rules of sanitary and hygienic and anti-epidemic regime). If a quarantine infection is detected in a patient, provide him with the necessary medical care, observing precautions, and inform the senior shift doctor about the clinical, epidemiological and passport data of the patient.
Ensure proper storage, accounting and write-off of medications.
At the end of duty, check the condition of medical equipment, transport tires, replenish those used up during work medicines, oxygen, nitrous oxide.
Inform the administration of the ambulance station about all emergencies that occurred during the call.
At the request of internal affairs officers, stop to provide emergency medical care, regardless of the location of the patient (injured).
Maintain approved accounting and reporting documentation.
In the prescribed manner, increase your professional level and improve practical skills.

Rights. A paramedic of a mobile emergency medical team has the right to:
If necessary, call an emergency medical team for help.
Make proposals to improve the organization and provision of emergency medical care, improve working conditions for medical personnel.
Improve your qualifications in your specialty at least once every 5 years. Pass certification and recertification in accordance with the established procedure.
Take part in medical conferences, meetings, seminars held by the administration of the institution.

Responsibility. The paramedic of the mobile ambulance team is responsible in the manner prescribed by law:
For the carried out professional activity in accordance with approved industry norms, rules and standards for emergency medical technician paramedics.
For illegal actions or inaction that resulted in damage to the patient’s health or death.

In accordance with the 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- a doctor, a paramedic (sometimes also a paramedic) and a driver, a specialized team - a doctor, two paramedics and a driver, paramedic team- paramedic and driver (maybe also an orderly). In the case of independent work, the paramedic is the driver’s direct superior during the call, and therefore must also represent his rights and obligations.

Appendix No. 12 to the order of the Ministry of Health of the Russian Federation No. 100 dated March 26, 1999 “Regulations on the driver of an emergency medical team.” General provisions.
The driver is part of the emergency medical team and is an employee who provides driving of the ambulance service "03".
A 1-2 class vehicle driver who has a special training according to the program of providing first aid to victims and trained in the rules of their transportation.
During a call, the driver of the emergency medical team is directly subordinate to the doctor and paramedic, and is guided in his work by their instructions, orders and these Regulations...
The appointment and dismissal of the driver is made by the head of the emergency medical service station or the chief physician of the hospital, the structure of which includes the emergency medical service unit, and when using cars on a contractual basis - by the head of the vehicle fleet.

Responsibilities.
The driver of the ambulance team is subordinate to the doctor (paramedic) and carries out his orders.
Monitors the technical condition of the ambulance and promptly refills it with fuel and lubricants. Performs wet cleaning of the vehicle interior as necessary, maintaining order and cleanliness.
Ensures that the brigade immediately responds to a call and that the vehicle moves along the shortest route.
Contains in functional condition special alarm devices (siren, flashing light), search light, portable spotlight, emergency interior lighting, entrenching tool. Performs minor repairs to equipment (locks, belts, straps, stretchers).
Together with the paramedic(s), he provides carrying, loading and unloading of sick and injured people during their transportation, assists the doctor and paramedic in immobilizing the limbs of victims and applying tourniquets and bandages, transfers and connects medical equipment. Provides assistance to medical personnel accompanying mentally ill patients.
Ensures the safety of property, monitors the correct placement and securing of on-board medical devices.
It is strictly prohibited to store any items other than approved service equipment inside the vehicle.
Strictly follows the internal regulations of the emergency medical service station (substation, department), knows and observes the rules of personal hygiene.
The driver must know: the topography of the city; location of substations and healthcare facilities.

Rights. The driver of an ambulance team has the right to advanced training in the prescribed manner.

Responsibility. The ambulance driver is responsible for:
Timely and high-quality execution functional responsibilities according to the job description.
Safety of medical equipment, instruments and sanitary property located in the ambulance vehicle.

Orders regulating work with OOI

During his work, an ambulance paramedic may meet with patients in particular dangerous infections(OOI). His actions in this case are defined by the following document:
Ministry of Health of the USSR, Main Directorate of Quarantine Infections, Main Directorate of Treatment and Preventive Care. “Instructions for carrying out initial measures when identifying a patient (corpse) suspected of having plague, cholera, or contagious viral hemorrhagic fevers.” Moscow - 1985. (excerpts).
"...When establishing preliminary diagnosis and carrying out primary measures for these diseases, be guided by the following deadlines incubation period: plague - 6 days; cholera - 5 days; Lassa fever, Ebola, Marburg disease - 21 days; monkeypox - 14 days.
In all cases of identification of a patient (corpse), immediate information to the authorities and healthcare institutions according to their subordination must contain the following information:
date of illness;
preliminary diagnosis, who made it (name of doctor or paramedic, position, name of institution), based on what data (clinical, epidemiological, pathological-anatomical);
date, place and time of identification of the patient (corpse);
where he is currently located (hospital, plane, train, ship);
last name, first name, patronymic, age (year of birth) of the patient (corpse);
name of the country, city, region (territory) from where the patient (corpse) arrived, what type of transport (number of train, car, plane flight, ship), time and date of arrival;
address of permanent residence, nationality of the patient (corpse);
brief epidemiological history, clinical picture and severity of the disease;
whether you took chemotherapy drugs or antibiotics in connection with this disease;
whether you received preventive vaccinations;
measures taken to localize and eliminate the outbreak of the disease (the number of identified persons who were in contact with the patient (corpse), carrying out specific prevention, disinfection and other anti-epidemic measures;
what kind of help is needed: consultants, medicines, disinfectants, transport, protective suits;
signature under this message (full name, position held);
the name of the person who transmitted and received this message, the date and hour of the message.”

The paramedic of the emergency medical team must transfer this information to the senior doctor of the shift, and if it is impossible to do this, to the dispatcher for further transmission to the authorities.

“A health care professional should suspect plague, cholera, GVL, or monkeypox based on clinical picture diseases and epidemiological history... Often the decisive factor in establishing a diagnosis is the following data from the epidemiological history:
arrival of a patient from an area unfavorable for these infections for a time equal to the incubation period;
communication of the identified patient with similar patients along the route, at the place of residence or work, as well as the presence there of any group diseases or deaths of unknown etiology;
staying in areas bordering countries unfavorable for these infections, or in exotic territory for the plague.

It should be borne in mind that these infections, especially during the initial manifestations of the disease, can give pictures similar to a number of other infectious and non-infectious diseases. So, similar symptoms can be observed:
for cholera - with acute intestinal diseases (dysentery, other acute diseases), toxic infections of various natures; poisoning with pesticides;
with plague - with various pneumonias, lymphadenitis with elevated temperature, sepsis of various etiologies, tularemia, anthrax;
for monkeypox - with chickenpox, generalized vaccine and other diseases accompanied by rashes on the skin and mucous membranes;
for Lassa fever, Ebola, Marburg disease - with typhoid fever, malaria. In the presence of hemorrhages, it is necessary to differentiate from yellow fever, Dengue, Crimean-Congo fevers.”

If a sick person or a corpse suspicious for OI is detected at the scene of the call, the following measures must be taken:
The patient (corpse) is temporarily isolated in the room (apartment) where he lived or was discovered. Isolate contacts in adjacent rooms.
If you suspect a disease with plague, GVL, or monkeypox, your mouth and nose should be temporarily covered with a towel or mask before receiving protective clothing; if not, make one out of a bandage or scarf.
Transfer the information collected according to the above scheme (Scheme No. 1) to the senior shift doctor or dispatcher by phone. In his absence, without leaving the premises through a closed door or window, ask neighbors or other persons to invite your driver (do not let him into the premises), tell him the collected information and ask him to send a team of epidemiologists and protective clothing to help you. At the same time, you should prevent the spread of panic among others.
In the room where the patient and the ambulance team are located, all windows and doors are tightly closed, the air conditioning is turned off, and the ventilation holes are sealed (except in cases of cholera). The patient is not allowed to use the sewer system and the necessary containers are found on site to collect secretions, which are disinfected. The EMS brigade is equipped with special means for this purpose (diagram No. 2).
Any contact of outsiders with the patient is prohibited. When compiling lists of contacts, contacts in premises connected through ventilation ducts are taken into account (except for cases of cholera).
At the same time, the patient begins to receive the necessary medical care.
After the arrival of the epidemiological team, the paramedic and other team members put on protective suits and are at the disposal of the arriving medical specialist.
The patient and the ambulance team are hospitalized in a hospital specially designated for the isolation of patients with acute respiratory infections in accordance with the orders of local health authorities.

The procedure for putting on an anti-plague suit.
Overalls (pajamas).
Socks (stockings).
Boots (galoshes).
Hood (large headscarf).
Anti-plague robe.
Respirator (mask).
Glasses.
Gloves.
Towel (placed behind the waistband of the robe on the right side).
If it is necessary to use a phonendoscope, it is worn in front of a hood or a large scarf.
If the paramedic's own clothes are heavily contaminated with the patient's secretions, they are removed. In other cases, an anti-plague suit is worn over clothing.

The procedure for removing the anti-plague suit. They take off the suit very slowly. Wearing gloves, wash your hands in a disinfectant solution (5% carbolic acid solution, 3% chloramine solution, 5% Lysol solution) for 1–2 minutes, then:
They take out a towel from their belt.
Boots or galoshes are wiped from top to bottom with a cotton swab moistened with a disinfectant solution. A separate tampon is used for each boot.
Take out the phonendoscope (without touching open parts skin).
They take off their glasses.
They take off the mask.
Undo the ties of the collar of the robe, belt, and sleeve ties.
Remove the robe by folding it with the outer (dirty) side inward.
Remove the scarf by rolling it from the corners to the center with the dirty side inward.
Take off gloves.
Boots (galoshes) are washed again in a disinfectant solution and removed without touching them with your hands.

All parts of the suit are immersed in a disinfectant solution. After removing the suit, wash your hands with warm water and soap.

Installation for collecting native material from a patient with suspected cholera (for non-infectious hospital institutions, emergency medical care stations, outpatient clinics, SKP, SKO) - scheme No. 2.
Sterile jars of at least 100 ml - wide-necked with lids or ground-in stoppers - 2 pcs.
Sterile spoons (sterilization period 3 months) - 2 pcs.
Plastic bags - 5 pcs.
Gauze napkins - 5 pcs.
Referral for analysis (forms) - 3 pcs.
Adhesive plaster - 1 pack.
Simple pencil - 1 pc.
Bix (metal container) - 1 pc.
Instructions for collecting material - 1 pc.
Chloramine in a bag of 300 g per 10 liters of 3% solution and dry bleach in a bag at the rate of 200 g per 1 kg of discharge.

If cholera is suspected, stool and vomit should be laboratory research must be taken immediately when a patient is identified and always before treatment with antibiotics. The secretions in a volume of 10–20 ml are transferred with spoons into sterile jars, which are closed with lids and placed in plastic bags. Samples are delivered to the laboratory in a container or in metal containers (boxes). Each test tube, jar or other container in which material from the patient is placed is tightly closed with lids, and the outside is treated with a disinfectant solution. After this, they are placed in bags and sealed with adhesive tape or tied tightly.

Job orders

In addition to the orders, excerpts from which were given above, the emergency medical technician must be guided in his work by the following documents:
Order of the USSR Ministry of Health No. 408 dated July 12, 1989 “On measures to prevent viral hepatitis.”
OST 42–21–2–85 (from 1985) “Disinfection, pre-sterilization cleaning and sterilization of medical products.”
Order of the Ministry of Health of the Russian Federation No. 295 of 1995 - “On the implementation of the rules for conducting mandatory medical examination for HIV and the list of workers in certain professions, industries, enterprises, institutions and organizations who undergo mandatory medical examination for HIV.” This document lists the groups of people subject to mandatory HIV testing, the rules for conducting this testing, as well as a list clinical manifestations, on the basis of which AIDS can be suspected in a patient.
Order of the Ministry of Health of the Russian Federation No. 375 of December 23, 1998 “On measures to strengthen epidemiological surveillance and prevention meningococcal infection and purulent bacterial meningitis." The clinical picture of meningitis and treatment tactics for the patient are outlined.
Order No. 171 of the USSR Ministry of Health dated April 27, 1990 “On epidemiological surveillance of malaria.”
Order of the Ministry of Health of the Russian Federation No. 330 of November 12, 1997 “On measures to improve the accounting, storage, prescribing and use of narcotic drugs.”
Order of the Ministry of Health of the Russian Federation No. 348 of November 26, 1998 “On strengthening measures to prevent epidemic typhus and combat lice.” The clinical picture of epidemic typhus and Brill's disease, the mechanism of infection, complications and treatment are described.
Certain other orders and instructions and orders and instructions from local health authorities. The significance of these documents is periodically checked at the workplace by representatives of the relevant commissions, as well as by the heads of medical institutions.

Emergency provided to citizens in conditions requiring urgent medical intervention(in case of accidents, injuries, poisoning and other conditions and diseases). It is carried out immediately by medical and preventive institutions, regardless of territorial, departmental subordination and form of ownership, by medical workers, as well as by persons obliged to provide it in the form of first aid. Emergency medical care is provided by a special emergency medical service of the state or municipal healthcare system in the manner established by the Ministry of Health of the Russian Federation. Emergency medical care for citizens of the Russian Federation and other persons located on its territory is provided free of charge at the expense of budgets of all levels. If a citizen’s life is threatened, medical workers have the right to use free of charge any available type of transport to transport the citizen to the nearest medical facility. In case of refusal official or the owner of the vehicle to fulfill the legal requirement of a medical worker to provide transport for transporting the victim, they bear responsibility established by the legislation of the Russian Federation.

Ambulance is provided by emergency medical services (EMS).

In rural areas, pre-hospital dental emergency care is provided medical personnel paramedic and obstetric stations (FAPs). Medical care is provided by dentists at local and regional medical institutions. Ambulance stationis a medical and preventive institution 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 extent of the settlement and the terrain, substations of a general emergency medical care station are organized as its divisions.

The ambulance station is headed by chief physician, which is guided in its activities 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 higher health care management body.

The chief physician of the emergency medical care station carries out the current management of the station’s activities on the principles of unity of command on issues within his competence.

The main functional unit of an emergency medical care station is the mobile team (paramedic, medical, intensive care and other highly specialized teams).

The teams are created in accordance with staffing standards with the expectation of providing round-the-clock shift work.

The structure of the emergency medical aid station includes:

— operational (dispatching) department;

— communications department;

— department medical statistics with archive;

—room for receiving outpatients;

- storage room medical equipment teams and preparation for operation of medical units;

—a room for storing a supply of medicines, equipped with fire and security alarms;

— rest rooms for doctors, paramedics, drivers of ambulances;

—room for eating by staff on duty;

— administrative, utility and other premises;

—garage, covered parking boxes, fenced area with hard surface for parking vehicles, corresponding in size to the maximum number of vehicles operating simultaneously. If necessary, helipads are equipped.

Other divisions may be included in the station structure. The communications department organizes communications between all subdivisions of the ambulance station. The station must be provided with city telephone communication at the rate of 2 inputs per 50 thousand population, radio communication with mobile teams and direct communication with medical institutions.

The emergency medical service station operates in both daily operation and emergency mode.

Station tasks in daily operation:

—organization and provision of emergency medical care to sick and injured people at the scene of the incident and during their transportation to hospitals;

—carrying out systematic work to improve professional knowledge, practical skills of medical personnel;

—development and improvement of organizational forms and methods of providing emergency medical care to the population, introduction of modern medical technologies, improving the quality of work of medical personnel.

The station operates in emergency modeBy instructions from the Territorial Center for Disaster Medicine(republican within the Russian Federation, regional, regional, district, city), which is guided by the documents of the headquarters (department, committee) for civil defense and emergency situations.

Main functions of an ambulance station:

1. Round-the-clock provision of timely and high-quality medical care to sick and injured people who are outside medical institutions during disasters and natural disasters.

2. Timely transportation (as well as transportation at the request of medical workers) of patients, including infectious diseases, victims and women in labor in need of emergency hospital care.

3. Providing medical care to sick and injured people who sought help directly at the station.

4. Ensuring continuity in work with medical and preventive institutions of the city to provide emergency medical care to the population.

5. Organization of methodological work, development and implementation of measures to optimize the provision of emergency medical care at all stages.

6. Interaction with authorities local authorities, police department, traffic police, fire departments and other operational services of the city.

7. Carrying out measures to prepare for work in emergency situations, ensuring a constant, irreducible supply of dressings and medicines.

8. Notifying the health authorities of the administrative territory and the relevant authorities about all emergencies and accidents in the station service area.

9. Uniform staffing of mobile teams with medical personnel across all shifts and their full provision according to the equipment sheet.

10. Compliance with the norms and rules of sanitary-hygienic and anti-epidemic regimes.

11. Compliance with occupational safety and health regulations.

12. Control and accounting of the work of sanitary vehicles.

Organization of work of the emergency medical service station:

1. Calls are received and transferred to field teams by a paramedic ( nurse) for receiving and transmitting calls from the operational department (dispatcher) of the emergency medical aid station.

2. Victims (patients) delivered by mobile teams of the emergency medical aid station must be immediately handed over to the duty personnel of the hospital’s reception department with a note in the “Call Card” the time of their arrival.

3.In order to coordinate treatment and preventive work and improve continuity in patient care, the station administration holds regular meetings with the management of treatment and preventive institutions located in the service area.

4. Ambulance station does not issue documents certifying temporary disability and forensic medical reports, and does not conduct an examination of alcohol intoxication.

5.Gives oral information when contacting the population in person or by telephone about the location of the sick and injured. If necessary, issues free-form certificates indicating the date, time of application, diagnosis, examinations performed, assistance provided and recommendations for further treatment.

6. For round-the-clock provision of emergency dental care in large cities, special dental clinics and departments are allocated emergency care for adults and children, providing 24-hour outpatient services on regular days, weekends and holidays and in some cases traveling to the patient on house calls with portable equipment.

7.Emergency dental care is provided during the daytime in dental clinics for adults and children, in dental offices, medical units and health centers, emergency medical services, dental offices in schools, higher and secondary educational institutions, hospital admissions departments.

Emergency conditions include traumatic injuries, bleeding, sharp pain and etc.

The need for emergency care is approximately 5 to 15% of the city's population.

Emergency dental care appears in dental centers at large clinics and hospitals that operate around the clock. Home service is carried out using special ambulance transport.

The field of emergency medical care is perhaps the most critical branch of medicine. For an emergency physician, it is important not only to correctly diagnose a patient’s life-threatening condition, but also to respond very quickly, select the necessary resuscitation measures or emergency therapy to remove an acute threat to life, and all this so that the affected person can survive or survive the process of transportation to medical institution - after all, the ambulance team works on the road, in the absence of the necessary set of medications and medical devices. The life of the patient directly depends on how quickly and correctly the treatment measures the doctor takes.

Paramedic and emergency doctor - what's the difference?

Many ordinary people, without going into the subtleties of the differences in medical professions, believe that paramedics work in the ambulance, and it is they who provide medical care to the victims. In fact, a paramedic can work in an ambulance, but this is not the only possible job for him.

Emergency doctor - a doctor with a special higher education, who provides qualified medical care and consultation, has the right to decide on emergency resuscitation measures.

A paramedic, like an emergency doctor, can diagnose a patient, determine the diagnosis and prescribe treatment. However, unlike a doctor, a paramedic has a secondary specialized education - this can be a diploma from a medical college or technical school. Most often, he provides first aid.

This specialist can work not only in an ambulance brigade, but also in military units, at an ambulance substation, on a river or sea vessel, at a medical center at a railway station or at an air terminal, as well as in towns and villages at a paramedic and obstetric station.

In places where access to qualified medical care is difficult for the population, the skills and knowledge of a paramedic should be sufficient to perform the functions of a doctor. For example, he participates in the medical examination of patients, in the absence of an obstetrician on staff, observes pregnant women and participates in childbirth, observes children under 2 years of age, conducts physical therapy according to the doctor’s indications, and monitors the timeliness of vaccinations and immunizations.

If an ambulance team has one doctor, it is called linear. A specialized team is one that specializes in working with a specific pathology, for example, cardiological or psychiatric. A team where a doctor is not included in the staffing table is called a paramedic.

In the absence of a doctor, a paramedic can, if necessary, carry out:

• cardiac defibrillation;
• tracheotomy;
• cardiopulmonary resuscitation;
• birth reception.

Thus, the difference between a paramedic and an emergency physician is mainly one of skill level.

What does an emergency doctor do?

The doctor’s scope of competence includes providing emergency qualified medical care to victims who urgently need it.

The first task this specialist faces is making a diagnosis, correct definition disease or condition requiring medical intervention. In this case, it is necessary to take into account, firstly, time constraints, and secondly, the lack of many necessary equipment and devices that are available in a hospital medical institution.

It depends on the ambulance team whether the victim will reach the hospital, whether he will live to intensive care unit whether the doctors will have time to provide him with full assistance. Therefore, it would not be entirely correct to say that emergency doctors treat diseases. If the patient has a condition where his life is in danger, the emergency doctor is obliged to take all measures aimed at reducing it or completely eliminating it, therefore, in this case It's more about treatment dangerous symptoms and manifestations.

Doctors of this specialty are the first to deal with victims of disasters and accidents; they come to calls if the person’s condition does not leave him the opportunity to get to the emergency room on his own. medical institution.

In addition, the doctor provides symptomatic therapy, for example, assistance to cancer patients who suffer from severe pain attacks (special painkilling injections), patients with disorders blood pressure, they are called to children if there are signs of fever or acute infectious lesions.

The responsibilities of an emergency doctor are:

• provision of qualified medical care to patients;
• transportation of victims to a hospital medical facility;
• grade general condition the patient and the choice of the most suitable method of transportation and transfer of the affected person;
• if the patient refuses hospitalization, if necessary, take all possible measures in relation to the patient himself and his relatives in order to convince him;
• while on the road, if you encounter an accident or breakdown, inform the dispatcher and begin providing assistance to the victims.

The doctor must have good physical and mental health, medical logic, observation, speed of reaction and the ability to quickly make decisions, knowledge about the main pathological conditions and skills in providing pre-hospital care when they occur, the skills and experience of a diagnostic specialist.

Organs, organ systems and mental phenomena with which the emergency doctor works

The doctor on duty working in the ambulance team must understand such branches of medicine as gynecology, pediatrics, surgery, obstetrics, neurology, general therapy, rheumatology, resuscitation, traumatology, ophthalmology, otolaryngology. In the course of his medical practice, an emergency doctor encounters disruptions in his work:

• heart, blood vessels;
• brain;
• organs of the gastrointestinal tract;
• organs of the genitourinary system;
• eye;
• nervous system;
• spine, joints, bones;
• body parts: head, torso, limbs;
• ENT organs.

A specialized psychiatric ambulance team is called in the following cases:

• psychotic or acute psychomotor agitation(hallucinations, delusions, pathological impulsivity);
• depression, which is accompanied by suicidal behavior;
• socially dangerous behavior of a mentally ill person (aggression, death threats);
• manic states with gross violation of public order and socially dangerous behavior;
• acute affective reactions accompanied by aggression, agitation;
• acute alcoholic psychoses;
• suicide attempts in persons who were not previously registered as psychiatric patients.

Diseases and injuries treated by emergency physicians

This specialist provides assistance to patients in any difficult situations that threaten life and health.

According to the nature of the diseases, and, accordingly, medical events services that ambulance teams can provide, they are all divided into:

• intensive care (they work, most often, with victims of road accidents and disasters, specializing in the most severe cases of damage to the human body);
• pediatric (it employs specialists with specialized education in pediatrics who provide emergency care to the youngest patients, for example, in acute febrile conditions, pain attacks, burn injuries);
• cardiological (these doctors are sent to save people with such dangerous conditions such as attacks of acute heart failure or heart attack);
• traumatological (specialize in providing assistance and transporting victims with injuries and polytraumas of any nature);
• psychiatric (dealing with emergency treatment and transportation to appropriate medical institutions of patients with acute mental disorders, people who, due to their illness, can threaten themselves and others with their behavior);
• general qualification teams (teams working with various injuries, burns, diseases, feverish conditions).

When to contact emergency doctors

The reason for calling an ambulance is the patient’s condition in which he needs urgent medical care, otherwise his life and health are in serious danger. There are a number of so-called threatening conditions in which it is necessary to contact ambulance teams:

• electric shock, significant burn injuries, poisoning;
• Road accidents and disasters in which victims suffered fractures, ruptures, bleeding and other life-threatening injuries;
• difficulty breathing (regardless of the etiology, this condition can lead to suffocation and death);
• symptoms acute fever: severe fever that is not relieved by antipyretics, convulsions, suffocation, headaches;
• acute pain in the abdominal cavity, which literally deprives a person of the ability to move (these may be signs of peritonitis, appendicitis, acute pancreatitis, ulcerative lesions of the stomach and intestines);
• sharp pain in chest which can radiate to the shoulder, back, neck, jaw, arm;
• in the presence of signs of stroke and heart attack (numbness of the limbs, dizziness, loss of consciousness, temporary loss of vision, numbness of half the face, nausea and vomiting, severe pain in the chest, shortness of breath, weakness, sudden causeless increase in temperature).

There are cases when calling an emergency doctor is not necessary. The ambulance does not handle calls to carry out the attending physician’s prescriptions (injections, IVs, dressings), to issue sick leave and certificates for the provision of dental care, for assistance with exacerbation of chronic diseases, if the patient’s condition does not require emergency medical intervention, as well as for transporting the deceased to the morgue.

Today, you can get emergency medical care from both ambulance teams and public hospitals, and from private clinics.

Examination and treatment methods used by emergency physicians

The specificity of this doctor’s work is that he is very limited in time and in the means of diagnostics. The main methods he uses to determine the causes of the patient’s lesions are external examination, palpation of the abdomen (palpation and pressure in the abdominal area), listening to the heart and lungs using a stethoscope, measuring blood pressure and body temperature, electrocardiography. If the patient is conscious, the doctor questions him.

After checking the body’s vital signs and analyzing the information received, the physician decides on the need for emergency resuscitation measures or urgent transportation of the victim to a medical facility. If the doctor determines that breathing and cardiac function have stopped, he begins defibrillation of the heart, artificial respiration and pumping of the heart.

If the victim is diagnosed with injuries (fractures, ruptures, dislocations), the doctor takes measures to immobilize him and transport him to the hospital.

Doctor applies medicinal methods providing assistance (injections, droppers, sprays, tablets), in some cases may provide surgical intervention eg tracheotomy.

The medical team doctor must be a qualified specialist with lightning-fast acumen, the ability to quickly respond and make decisions. His competence includes providing assistance to patients with an immediate threat to life. It is this specialist who is the first to arrive at the scene of an accident, catastrophe, electric shock, or poisoning. All these threatening conditions, in the absence of quick and adequate medical intervention, can cause disability or death, so emergency doctors bear a huge responsibility.

Emergency medical care (EMS) is one of the types of primary health care. Emergency medical services institutions annually carry out about 50 million calls, providing medical assistance to more than 52 million citizens. Emergency medical care is round-the-clock emergency medical care for sudden illnesses that threaten the patient’s life, injuries, poisonings, intentional self-harm, childbirth outside medical institutions, as well as accidents and natural disasters.

general characteristics

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

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

trouble-free nature of its provision;

free procedure for the provision of emergency medical services;

diagnostic uncertainty under time pressure;

pronounced social significance.

Conditions for providing emergency medical care:

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

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

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

Guiding Documents

Decree of the Government of the Russian Federation of October 22, 2012 No. 1074 “On the Program of State Guarantees for Free Medical Care to Citizens for 2013 and for the Planning Period of 2014 and 2015.”

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

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

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

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

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

Main functions

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

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

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

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

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

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

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

Forms of territorial organization

Ambulance station

Emergency Department

Emergency Hospital

Emergency Department

Ambulance station

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

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

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

Operations department

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

Department of Hospitalization of Acute and Somatic Patients

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

Department of Hospitalization of Maternity Women and Gynecological Patients

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

Infectious diseases department

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

Department of Medical Statistics

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

Communications Department

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

Inquiry Office

Faik

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

Other divisions

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

Ambulance substation

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

drawing up a duty schedule for the month;

daily staffing of field teams;

maintaining strict control over the correct operation of expensive equipment;

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

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

organization of cleaning and sanitation of premises;

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

keeping records of working hours of substation personnel.

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

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

Types of emergency medical teams and their purpose

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

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

medical - doctor, two paramedic, orderly and driver;

paramedics - two paramedics, an orderly and a driver;

obstetric - obstetrician (midwife) and driver.

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

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