Tasks of emergency medical care. Structure and organization of activities of the emergency medical service Specialized emergency medical care

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 conditions or have serious injuries, it is provided by medical personnel 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 to provide Ambulance, who initially had an orderly and a paramedic, and over time, medical staff.

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 Law, which described the first legal norms, formed the basis for future bills, including the one that is currently being followed. Today, emergency medical care standards have been developed that guide doctors.

Characteristic

The main features that distinguish this type of medical care are:

• 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:

1. 24-hour assistance to injured and sick people who are outside the hospital.
2. Transportation and transportation of patients, including women in labor.
3. Reliable provision of emergency medical care to people who turned to the EMS station.
4. Notifying the relevant authorities about emergencies and accidents in places where victims are served.
5. Ensuring that the team is fully staffed with medical personnel.

Also, the emergency medical team can transport donor blood and specialized specialists 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 emergency hospital 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:

1. 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.
2. 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 diagnostic measures in the car, for example, an 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.
3. Specialized teams provide assistance in a specific narrow profile. These could be psychiatric, pediatric, advisory, or aeromedical teams.
4. Brigade emergency care.

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, high 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 information about the presence of allergic reactions, taking medications, and 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 and refuse hospitalization with written confirmation in a special medical card.

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. The following actions are strictly prohibited:

1. Give the victim medications, as he may be allergic to the drug, which will worsen his situation.
2. Give, water and spray water, especially in case of an accident. This is due to the fact that the victim’s internal organs may be damaged, and such an action can 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 get into Airways and a person may choke.
3. 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.
4. 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.
5. 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 in emergency cases. 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, and medications that 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’ medical manipulations.

Ambulance service personnel must perform the following tasks:

• Providing primary care.
• Staging preliminary diagnosis.
• Relief of emergency conditions.
• Hospitalization of the victim to the clinic.

The ambulance service does not issue sick leave certificates, 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.

), who found himself helpless in the face of disaster. He could not provide effective and appropriate assistance to the people randomly lying in the snow. The very next day, Dr. J. Mundi began to create the Vienna Voluntary Rescue Society. Count Hans Gilczek (German) Johann Nepomuk Graf Wilczek ) donated 100 thousand guilders to the newly created organization. This Society organized a fire brigade, a boat brigade and an ambulance station (central and branch) to provide urgent assistance to victims of accidents. In the first year of its existence, the Vienna Ambulance Station provided assistance to 2,067 victims. The team included doctors and medical students.

Soon, like the Vienna one, a station in Berlin was created by Professor Friedrich Esmarch. The activities of these stations were so useful and necessary that in a short period in a number of cities European countries Similar stations began to appear. The Vienna station played the role of a methodological center.

The appearance of ambulances on Moscow streets can be dated back to 1898. Until this time, victims, who were usually picked up by police officers, firefighters, and sometimes cab drivers, were taken to emergency rooms at police houses. The medical examination required in such cases was not available at the scene of the incident. Often people with severe injuries were kept in police houses for hours without proper care. Life itself demanded the creation of ambulances.

The Ambulance Station in Odessa, which began operating on April 29, 1903, was also created on the initiative of enthusiasts at the expense of Count M. M. Tolstoy and was distinguished by a high level of thoughtfulness in the organization of assistance.

It is interesting that from the very first days of the work of the Moscow Ambulance, a type of team was formed that has survived with minor changes to the present day - a doctor, a paramedic and an orderly. There was one carriage at each Station. Each carriage was equipped with a stowage bag containing medicines, instruments and dressings. Only officials had the right to call an ambulance: policeman, janitor, night watchman.

Since the beginning of the 20th century, the city has partially subsidized the operation of ambulance stations. By mid-1902, Moscow within the Kamer-Kollezhsky Val was served by 7 ambulances, which were located at 7 stations - at Sushchevsky, Sretensky, Lefortovo, Tagansky, Yakimansky and Presnensky police stations and the Prechistensky fire station. The service radius was limited to the boundaries of its police unit. The first carriage for transporting women in labor in Moscow appeared at the maternity hospital of the Bakhrushin brothers in 1903. Nevertheless, the available forces were not enough to support the growing city.

In St. Petersburg, each of the 5 ambulance stations was equipped with two double carriages, 4 pairs of hand stretchers and everything necessary to provide first aid. At each station there were 2 orderlies on duty (there were no doctors on duty), whose task was to transport victims on the streets and squares of the city to the nearest hospital or apartment. The first head of all first aid stations and the head of the entire matter of first aid in St. Petersburg under the Committee of the Red Cross Society was G.I. Turner.

A year after the opening of the stations (in 1900), the Central Station arose, and in 1905 the 6th First Aid Station was opened. By 1909, the organization of first (ambulance) care in St. Petersburg was presented in the following form: The central station, which directed and regulated the work of all regional stations, it also received all calls for emergency assistance.

In 1912, a group of doctors of 50 people agreed to go free of charge when called by the Station to provide first aid.

Since 1908, the Emergency Medical Aid Society has been established by enthusiastic volunteers using private donations. For several years, the Society unsuccessfully tried to reassign police ambulance stations, considering their work insufficiently effective. By 1912, in Moscow, the Ambulance Society, using collected private funds, purchased the first ambulance, equipped according to the design of Dr. Vladimir Petrovich Pomortsov, and created the Dolgorukovskaya ambulance station.

Doctors - members of the Society and students of the Faculty of Medicine worked at the station. Help was provided in public places and on the streets within the radius of Zemlyanoy Val and Kudrinskaya Square. Unfortunately, the exact name of the chassis on which the vehicle was based is unknown.

It is likely that the car on the La Buire chassis was created by the Moscow carriage and automobile factory of P. P. Ilyin - a company known for its quality products, located in Karetny Ryad since 1805 (after the revolution - the Spartak plant, where the first Soviet NAMI small cars were subsequently assembled -1, today - departmental garages). This company was distinguished by a high production culture and mounted bodies of its own production on imported chassis - Berliet, La Buire and others.

In St. Petersburg, 3 ambulances from the Adler company (Adler Typ K or KL 10/25 PS) were purchased in 1913, and an ambulance station was opened at Gorokhovaya, 42.

The large German company Adler, which produced a wide range of cars, is now in oblivion. According to Stanislav Kirilets, even in Germany it is very difficult to find information on these machines before the First World War. The company's archives, in particular the sales sheets, where all sold cars were recorded with the addresses of customers, burned down in 1945 during American bombings.

During the year, the Station completed 630 calls.

With the outbreak of the First World War, the personnel and property of the Station were transferred to the military department and functioned as part of it.

In days February Revolution In 1917, an ambulance detachment was created, from which Ambulance and Ambulance Transport was again organized.

On July 18, 1919, the board of the medical and sanitary department of the Moscow Council of Workers' Deputies, chaired by Nikolai Aleksandrovich Semashko, considered the proposal of the former provincial medical inspector, and now a post office doctor, Vladimir Petrovich Pomortsov (by the way, the author of the first Russian ambulance - a city ambulance model of 1912), decided to organize an Emergency Medical Service Station in Moscow. Doctor Pomortsov became the first head of the station.

Three rooms were allocated for the station in the left wing of the Sheremetyevo Hospital (now the Sklifosovsky Research Institute of Emergency Care).

The first departure took place on October 15, 1919. In those years, the garage was located on Miusskaya Square, and when a call came in, the car first picked up the doctor from Sukharevskaya Square, and then moved to the patient.

At that time, ambulances only served accidents in factories, streets and public places. The team was equipped with two boxes: therapeutic (medicines were stored in it) and surgical (a set of surgical instruments and dressings).

In 1920, V.P. Pomortseov was forced to leave work in the ambulance due to illness. The ambulance station began to operate as a department of the hospital. But the available capacity was clearly not enough to serve the city.

On January 1, 1923, the Station was headed by Alexander Sergeevich Puchkov, who had previously proven himself to be an outstanding organizer as the head of the Gorevakopunkt (Tsentropunkt), which was involved in the fight against the enormous epidemic of typhus in Moscow. The central point coordinated the deployment of hospital beds and organized the transportation of typhus patients to repurposed hospitals and barracks.

First of all, the Station was merged with the Tsentropunkt into the Moscow Ambulance Station. A second car was transferred from Tsentropunkt

For the purposeful use of teams and transport, and to isolate truly life-threatening conditions from the flow of calls to the Station, the position of senior doctor on duty was introduced, to which professionals who knew how to quickly navigate the situation were appointed. The position is still retained.

Two brigades, of course, were clearly not enough to serve Moscow (2,129 calls were serviced in 1922, 3,659 in 1923), but the third brigade was organized only in 1926, the fourth in 1927. In 1929, with four brigades, 14,762 calls were served. The fifth brigade began working in 1930.

As already mentioned, in the first years of its existence, ambulance service in Moscow served only accidents. Those who were sick at home (regardless of severity) were not served. An emergency aid station for those suddenly ill at home was organized at the Moscow Ambulance Service in 1926. Doctors visited patients on motorcycles with sidecars, then in cars. Subsequently, emergency care was separated into a separate service and transferred under the authority of district health departments.

Since 1927, the first specialized team has been working at the Moscow ambulance - a psychiatric one, which went to the “violent” patients. In 1936, this service was transferred to a specialized mental hospital under the direction of a city psychiatrist.

By 1941, the Leningrad ambulance station consisted of 9 substations in various areas and had a fleet of 200 vehicles. The service area of ​​each substation averaged 3.3 km. Operational management was carried out by the staff of the central city station.

Emergency medical service in Russia

The responsibilities of the ambulance also include notifying local law enforcement agencies about so-called criminal injuries (for example, knife and gunshot wounds) and local governments and emergency response services about all emergency situations (fires, floods, automobile and man-made disasters, etc.).

Structure

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.

Central city ambulance station

The ambulance station can operate in 2 modes - everyday and emergency mode. In an emergency situation, operational management of the station's work passes to the territorial center for disaster medicine (TCMC).

Operations department

The largest and most important of all departments of large ambulance stations is the 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.

The senior duty doctor or senior shift doctor manages the duty personnel of the operational department and 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.

The senior dispatcher supervises the work of the dispatcher, manages dispatchers according to directions, selects cards, grouping them by area of ​​receipt and by urgency of execution, then he hands them to subordinate dispatchers to transfer calls to district substations, which are structural divisions of the central city ambulance station, and also monitors location of visiting teams.

The dispatcher in the directions communicates with the on-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.

The hospitalization dispatcher distributes patients to inpatient medical institutions and 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 record cards are handed over to the senior dispatcher; if any doubt arises regarding a particular call, the conversation is switched to 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 heads of health centers to inpatient medical institutions, and 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

At the Moscow ambulance station there is another name for this department - "first branch".

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 from both outpatient and inpatient doctors medical institutions, and directly from the population, representatives of law enforcement agencies and emergency 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.

Department of medical evacuation and transportation of patients

The “transportation” teams are subordinate to this department. In Moscow they have numbers from 70 to 73. Another name for this department is "second branch".

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 Psychiatry

Psychiatric teams are subordinate to this department. Has its own separate referral and hospitalization dispatchers. The duty shift is managed by the senior doctor on duty of the psychiatry department.

TUPG Department

Department of transportation of deceased and deceased citizens. The official name of the corpse transportation service. Has its own control room.

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

Inquiry Office 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 via a special hotline or during a personal visit by 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.

Regional ambulance substations

Regional (city) emergency medical care substations are usually located in a good-quality building. In the late 1970s - early 1980s, standard designs for ambulance stations and substations were developed, which provided premises for doctors, paramedical personnel, drivers, pharmacies, household needs, locker rooms, showers, etc.

The location for substations is selected taking into account the number and density of the population in the exit area, transport accessibility of the remote ends of the exit area, the presence of potentially “dangerous” objects where an emergency situation may occur and other factors. The boundaries between the exit areas of neighboring substations are established taking into account all of the above factors, in order to ensure a uniform call load for all neighboring substations. The boundaries are quite arbitrary. In practice, teams very often go to the areas of neighboring substations, “to help” their neighbors.

The staff of large regional substations includes substation manager, senior substation doctor, senior shift doctors, senior paramedic, dispatcher. defector(senior pharmacy assistant), sister-hostess, nurses And field staff: doctors, paramedics, paramedics-obstetricians.

Substation manager carries out general management, hiring and dismissal of employees (his consent or disagreement to resolve personnel issues is mandatory), controls and directs the work of all substation personnel. Responsible for all aspects of his substation's operations. He reports on his activities to the chief physician of the Ambulance Station or the Regional Director (in Moscow). In Moscow, several neighboring substations are united into “regional associations”. The head of one of the substations in the region simultaneously holds the position of Regional Director (with rights like the deputy chief physician). Regional Director resolves current issues, signs documents on behalf of the chief physician, and controls the work of managers in his region. For example, in order to be hired or fired, you do not need to go with an application personally to the chief physician (although it is addressed to the chief physician) - the signature of the substation manager, the signature of the regional director and the human resources department. The chief physician regularly holds meetings with regional directors (there are 54 substations in the city, 9 regions).

Senior substation doctor Responsible for overseeing clinical work. Reads team call cards, examines complex clinical cases, examines complaints about the quality of medical care, makes a decision to refer the case for analysis to the CEC (clinical expert commission) with the possible subsequent imposition of a penalty on the employee, is responsible for improving the qualifications of employees and conducting work with them training sessions, etc. At large substations, the volume of work is so large that a separate position of a senior doctor is required. Usually replaces the manager when he is on vacation or on sick leave.

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. There is no senior doctor shift in Moscow. His functions are performed by the senior doctor of the substation, the senior doctor of the operational department and the substation dispatcher (each within his competence). In Moscow, in the absence of the manager and senior doctor of the substation, the senior at the substation is the dispatcher, reporting to the senior doctor on duty of the operational department.

Senior paramedic formally is the leader and mentor of secondary medical and service personnel substation, but his actual responsibilities far exceed these tasks. His responsibilities include:

• drawing up a duty schedule for a month and a vacation schedule for employees (including for doctors);
• daily staffing of mobile teams (except for specialized teams, which report only to the head of the substation and the dispatcher of the “special control panel” of the operational department);
• training employees in the correct operation of expensive equipment;
• ensuring the replacement of worn-out equipment with new ones (together with the defector);
• participation in organizing the supply of medicines, linen, furniture (together with the defector and the housewife);
• organizing cleaning and sanitization of premises (together with the sister-hostess);
• control of the timing of sterilization of reusable medical instruments and equipment, dressings, control of the expiration dates of drugs in the packs of the teams;
• keeping records of working hours of substation personnel, sick leave, etc.;
• registration of a very large volume of various documentation.

Along with production tasks, the responsibilities of the senior paramedic include being " right hand"the head of all aspects of the daily activities of the substation, participation in organizing the life and leisure of medical personnel, ensuring timely improvement of their qualifications. In addition, the senior paramedic participates in the organization of paramedic conferences.

In terms of the level of “real power” (including in relation to doctors), the senior paramedic is the second person at the substation, after the manager. Who will the employee work with as part of the team, will he go on vacation in winter or summer, will he work full-time or one and a half times, what will the work schedule be, etc. - all these decisions are made individually by the senior paramedic, who is usually in charge of these decisions doesn't interfere. The senior paramedic has exceptional influence on the creation of a favorable working environment and on the “moral climate” in the substation team.

Senior paramedic for emergency services(pharmacy) - the official name of the position, "folk" names - "pharmacist", "defector". "Defectar" is a name usually used everywhere except in official documents. Defectar takes care of the timely supply of traveling teams with medicines and instruments. Every day, before the start of the shift, the defector checks the contents of the storage boxes and replenishes them with missing medications. His responsibilities also include sterilizing reusable instruments. Prepares documentation related to expenses medicines and consumables. Regularly goes to the warehouse to “get a pharmacy.” Usually replaces the senior paramedic when he is on vacation or sick leave.

To store the stock of medicines, dressings, instruments and equipment specified by the standards, a spacious, well-ventilated room is allocated for the pharmacy. The room must have an iron door, bars on the windows, and an alarm system - the requirements of the Federal Drug Control Service ( federal service drug control) to the premises for storing records medicines.

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.

Paramedic for PPV(for receiving and transmitting calls) - the official title of the position. He is also a substation dispatcher - he receives calls from the operational department of the central city station, or, at small stations, directly from the population by telephone "03", and then, in order of priority, transfers orders to field teams. There are at least two medical assistants on duty shift. (minimum - two, maximum - three). In Moscow, the reception and transmission of calls are fully computerized - ANDSU (computer control system) and the Brigada automated workplace complex (navigators and communication devices for brigades) are in operation. The dispatcher's participation in the process is minimal. The call transfer time from the moment of calling “03” to the moment the team receives the card takes about two minutes. When transferring a call using the traditional “paper” method, this time can range from 4 to 12 minutes.

Before the start of the shift, the substation dispatcher reports to his dispatcher of the operational department (he is also the regional dispatcher, in Moscow, see above) about the vehicle numbers and the composition of the field teams. The dispatcher records the incoming call on a call card form approved by the Ministry of Health (in Moscow, the card is automatically printed on a printer, the dispatcher only indicates which team to assign the task to), enters brief information into the operational information log and invites the team to leave via intercom. Control over the timely departure of teams is also entrusted to the dispatcher. After the team returns from the field trip, the dispatcher receives a completed call card from the team and enters data on the results of the field trip into the operational log and into the ANDSU computer (in Moscow).

In addition to all of the above, the dispatcher is in charge of a safe with reserve storage in case of emergency (stacks with accounting drugs), a reserve cabinet with medicines and consumables, which he issues to the teams as needed. The control room premises are subject to the same requirements as the pharmacy premises (iron door, bars on the windows, alarm system, panic buttons, etc.)

There are often cases when people seek medical help directly at an ambulance substation - “by gravity” (this is the official term). In such cases, the dispatcher is obliged to invite a doctor or paramedic from one of the teams located at the substation to provide assistance, and if all teams are on call, he is obliged to provide the necessary assistance himself, and then transfer the patient to one of the teams returning to the substation. The substation must have a separate room to provide assistance to patients who come in by gravity. The requirements for the premises are the same as for a treatment room in a hospital or clinic. Modern substations usually have such a room.

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. Or one of the line paramedics may be assigned to the control room for daily duty.

Sister-hostess is in charge of issuing and receiving uniforms for employees, other standard equipment for the substation and teams not related to medicines and medical equipment, monitors the sanitary condition of the substation, and supervises the work of the nurses.

Small individual stations and substations may have simpler organizational structure. In any case, there is a substation manager (or the chief physician of a separate station) and a senior paramedic. Otherwise, the structure of the administration may be different. The manager of the substation is appointed to the position by the chief physician; the manager appoints the remaining employees of the substation administration himself, from among the substation employees.

Types of EMS brigades and their purpose

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

• medical - doctor, paramedic (or two paramedics) and driver;
• paramedics - paramedic (2 paramedics) and driver;
• obstetrics - obstetrician (midwife) and driver.

Some 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.

Brigades are also divided into linear and specialized.

Line brigades

Line brigades There are doctors and paramedics. Ideally (by order), a medical team should consist of a doctor, 2 paramedics (or a paramedic and a nurse), an orderly and a driver, and a paramedic team should consist of 2 paramedics or a paramedic and a nurse, an orderly and a driver.

Line brigades They respond to all calls and make up the bulk of ambulance teams. Reasons for calling are divided into “medical” and “paramedic”, but this division is quite arbitrary, affecting only the order of distribution of calls (for example, the reason for calling “arrhythmia” is a reason for the medical team. There are doctors - doctors will go, there are no free doctors - paramedics will go. The reason “fell and broke his arm” is a reason for paramedics, there are no available paramedics - doctors will go.) Medical reasons are mainly related to neurological and cardiological diseases, diabetes mellitus, as well as all calls to children. Paramedic reasons - “stomach ache”, minor injury, transportation of patients from the clinic to the hospital, etc. For the patient, there is no real difference in the quality of care between the medical and paramedic line teams. There is a difference only for team members in some legal subtleties (formally, a doctor has much more rights, but there are not enough doctors for all teams). In Moscow, line brigades have numbers from 11 to 59.

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

Specialized brigades

Reanimobile based on GAZ-32214 "Gazelle"

Specialized brigades intended for initial travel to special complex cases, their own specialized calls, as well as for calling “on themselves” by line crews if they are faced with a difficult case and cannot cope with the situation. In some cases, calling “for yourself” is mandatory: paramedics who have an uncomplicated myocardial infarction are required to call doctors “for themselves.” Doctors have the right to treat and transport an uncomplicated myocardial infarction, and for a complicated myocardial infarction or arrhythmia or pulmonary edema, they are required to call the BITs or a cardiology team. This is in Moscow. At some small ambulance stations, all teams on duty shifts may be paramedics, and one, for example, may be a doctor. There are no specialized teams. Then this linear medical team will serve as a specialized team (if a call comes with the reason for “road accident” or “fall from a height”, they will go first). Specialized teams directly at the scene and in the ambulance carry out extended infusion therapy (intravenous drip administration of drugs), systemic thrombolysis for myocardial infarction or ischemic stroke, bleeding control, tracheotomy, artificial ventilation, chest compressions, transport immobilization and other emergency measures (at a higher level than conventional line teams), and also perform the necessary diagnostic studies (ECG registration, monitoring the patient’s condition (ECG, pulse oximetry, arterial pressure etc.), determination of prothrombin index, duration of bleeding, emergency echoencephalography, etc.).

The equipment of the linear and specialized ambulance teams is practically the same in terms of personnel and quantity, but the specialized teams differ in quality and capabilities (for example, the linear team must have a defibrillator, the resuscitation team must have a defibrillator with a screen and monitor function, the cardiology team must be a defibrillator with the ability to supply biphasic and single-phase pulses, with the function of a monitor and pacemaker (pacemaker), etc. And “on paper” in the equipment sheet there will simply be the word “defibrillator.” The same applies to all other equipment). But the main difference from a line team is the presence of a specialist doctor with the appropriate level of training, work experience and the ability to use more complex equipment. A paramedic on a specialized team also with extensive work experience and after appropriate advanced training courses. “Young specialists” do not work on special teams (occasionally - only on internship as a “second” paramedic).

Specialized teams are only medical. In Moscow, each type of specialized brigade has its own specific number (numbers 1 to 10, 60 to 69, and 80 to 89 are reserved). And in the conversation of medical workers, and in official documents More often the designation is the brigade number (see below). An example of a brigade designation from official document: brigade 8/2 - substation 38 responded to the call (crew 8, number 2 from substation 38, there are two “eighth” brigades at the substation, there is also brigade 8/1). An example from a conversation: the “eight” brought a patient to the emergency department.

In Moscow, all specialized teams report not to the direction dispatcher or the dispatcher at the substation, but to a separate dispatch console in the operations department - the “special console”.

Specialized teams are divided into:

• An intensive care team (IIT) is an analogue of a resuscitation team, it responds to all cases of increased complexity if there are no other more “narrow” specialists at a given substation. The vehicle and equipment are completely identical to the resuscitation team. The difference from the intensive care unit is that it consists of an ordinary emergency physician, usually with many years (15-20 years or more) of work experience and who has completed numerous advanced training courses and passed the exam for permission to work on "BITs". But not a doctor - a narrow specialist anesthesiologist-resuscitator, with an appropriate specialist certificate. The most versatile and versatile special team. In Moscow - 8th brigade, "eight", "BITs";
• cardiological - intended to provide emergency cardiac care and transportation of patients with acute cardiopathology (complicated acute myocardial infarction (uncomplicated AMI is dealt with by linear medical teams), coronary heart disease in the form of manifestations of unstable or progressive angina, acute left ventricular failure (pulmonary edema), disorders heart rate and conductivity, etc.) to the nearest inpatient medical facility. In Moscow - the 67th "cardiology" team and the 6th "cardiology advisory team with intensive care status", "six";
• resuscitation - designed to provide emergency medical care in borderline and terminal conditions, as well as to transport such patients (victims) to the nearest hospital. However, a stable or stabilized doctor of the resuscitation team, the latter can take him as far as he likes, has the right to do so. Involved in long-distance transportation of patients, transportation of extremely critically ill patients from hospital to hospital, and has the best opportunities for this. When going to the scene of an incident or to an apartment, there is practically no difference between the “eight” (BITs) and the “nine” (resuscitation team). The difference from BITs is that they consist of a specialist anesthesiologist-resuscitator. In Moscow - 9th brigade, "nine";
• pediatric - designed to provide emergency medical care to children and transport such patients (victims) to the nearest children's medical institution (in pediatric (children's) teams, the doctor must have the appropriate education, and the equipment implies a greater variety of medical equipment of “children’s” sizes). In Moscow - the 5th brigade, "five". The 62nd brigade, children's intensive care unit, advisory unit, are located at substations 34, 38, 20. The 62nd brigade from the 34th substation is based at Children's City Clinical Hospital No. 13 named after. N. F. Filatova; There is also a 62nd brigade at the 1st substation, but it is based at the Research Institute of Emergency Children's Surgery and Traumatology (Research Institute of Pediatric Surgery and Traumatology). It is staffed by an anesthesiologist-resuscitator from the Scientific Research Institute of National Chemistry and Traumatology and Traumatology.
• psychiatric - intended to provide emergency psychiatric care and transport patients with mental disorders (for example, acute psychosis) to the nearest psychiatric hospital. They have the right to use force and forced hospitalization, if necessary. In Moscow - the 65th brigade (visits to patients already registered as psychiatric patients and to transport such patients) and the 63rd brigade (consultative psychiatric brigade, goes to newly diagnosed patients and to public places);
• drug treatment - designed to provide emergency medical care to drug treatment patients, including delirium delirium and prolonged binge drinking. There are no such teams in Moscow; its functions are distributed between the psychiatric and toxicology teams (depending on the situation on the call, alcoholic delirium is a reason for the departure of the 63rd (consultative psychiatric) team);
• 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, epilepsy attacks. In Moscow - the 2nd brigade, the "two" - neurological, the 7th brigade - neurosurgical, advisory, usually goes to hospitals where there are no neurosurgeons to provide prompt neurosurgical care on site and transport patients to a specialized medical institution, to apartments and does not leave the street;

Newborn resuscitation vehicle

• traumatological - designed to provide emergency medical care to victims of various types of injuries to the limbs and other parts of the body, victims of falls from heights, natural disasters, man-made accidents and road transport accidents. In Moscow - the 3rd brigade (trauma) and the 66th brigade (the "CITO-GAI" brigade is a traumatological, advisory with resuscitation status, the only one in the city, based at the central substation);
• neonatal - intended primarily to provide emergency assistance and transportation of newborn children to neonatal centers or maternity hospitals (the qualifications of the doctor in such a team are special - this is not just a pediatrician or resuscitator, but a neonatologist-resuscitator; in some hospitals, the team staff is not made up of ambulance station doctors, but specialists from specialized hospital departments) . In Moscow - the 89th brigade, "transportation of newborns", a car with an incubator;
• obstetrics - designed to provide emergency care to pregnant women and women giving birth or giving birth outside of medical institutions, as well as to transport women in labor to the nearest maternity hospital. In Moscow - 86th brigade, “midwife”, paramedic team;
• gynecological, or obstetric-gynecological - are 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. In Moscow - the 10th brigade, "ten", obstetric and gynecological medical unit;
• 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. There are no such brigades in Moscow;
• surgical - intended to provide emergency medical care to patients with acute and exacerbation of chronic surgical pathology. In St. Petersburg there are RCB brigades (resuscitation-surgical) or another name - “assault brigades” (“assaults”), an analogue of the Moscow “eight” or “nine”. There are no such brigades in Moscow;
• toxicological - intended to provide emergency medical care to patients with acute non-food, that is, chemical, pharmacological poisoning. In Moscow - the 4th brigade, toxicology with intensive care status, "four". "Food" poisoning, that is, intestinal infections Linear medical teams are involved.
• infectious- are intended to provide advisory assistance to line teams in cases of difficult diagnosis of rare infectious diseases, organization of assistance and anti-epidemic measures in case of detection of particularly dangerous infections- OI (plague, cholera, smallpox, yellow fever, hemorrhagic fevers). They are used to transport patients with dangerous infectious diseases. Based at the infectious disease hospital, an infectious disease specialist from the corresponding hospital. They go out rarely, on “special” occasions. They also carry out advisory work in those medical institutions in Moscow where there is no infectious diseases department.

The term “consultative team” means that the team can be called not only to an apartment or on the street, but also to a medical institution where the required medical specialist is not available. Can provide assistance to a patient within a hospital setting, and after stabilizing his condition, transport the patient to a specialized medical institution. (For example, a patient with a complicated myocardial infarction was delivered by gravity, by passers-by from the street to the nearest hospital; it turned out to be a hospital where there is no cardiology department and no cardiac intensive care unit. The 6th brigade will be called there.)

The term “with intensive care status” means that employees working on this team are accrued preferential length of service - one and a half years of experience per year of work and are paid a salary bonus for “harmful and dangerous working conditions.” For example, the “ninth” brigade has similar benefits, but the “eighth” brigade does not. Although the work they do is no different.

In Moscow, if a specialized team works in line mode (there is no specialist doctor, only paramedics or paramedics work with a regular line doctor) - the team number will begin with the number 4: the 8th team will be the 48th, the 9th will be 49- th, 67th will be 47th, etc. This does not apply to psychiatric teams - they are always 65th or 63rd.

In some large cities of Russia and the post-Soviet space (in particular in Moscow, Kiev, etc.), the ambulance service is also responsible for transporting the remains of the dead or deceased in public places to the nearest morgue. For this purpose, at ambulance substations there are specialized teams (popularly called “corpse trucks”) and specialized vehicles with refrigeration units, which include a paramedic and a driver. The official name of the corpse transportation service is the TUPG department. "Department for transportation of deceased and deceased citizens." In Moscow, these teams are located at a separate substation 23, and the “transportation” teams and other teams that do not have medical functions are based at the same substation.

Emergency Hospital

Emergency Hospital (EMS) is a comprehensive treatment and preventive institution designed to provide inpatient and prehospital stage 24-hour emergency medical care for the population acute diseases, injuries, accidents and poisonings. The main difference from a regular hospital is 24-hour availability wide range specialists and relevant specialized departments, which makes it possible to provide assistance to patients with complex and combined pathologies. The main tasks of the emergency hospital in the service area are to provide emergency medical care to patients with life-threatening conditions requiring resuscitation and intensive care; providing organizational, methodological and advisory assistance to medical institutions on the organization of emergency medical care; constant readiness to work in emergency conditions (mass casualties); ensuring continuity and relationship with all medical and preventive institutions of the city in providing emergency medical care to patients at the 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.

Such hospitals are organized in large cities with a population of at least 300 thousand inhabitants, their capacity is at least 500 beds. The main structural units of the emergency hospital are a hospital with specialized clinical, treatment and diagnostic departments and offices; emergency medical service station (Emergency Medical Care); organizational and methodological department with a medical statistics office. City (regional, regional, republican) emergency specialized medical care centers can operate on the basis of emergency medical care. It organizes a consultative and diagnostic remote electrocardiography center for timely diagnosis acute heart diseases.

In such large cities as Moscow and St. Petersburg, research institutes of emergency and emergency medical care have been created and operate (named after N.V. Sklifosovsky - in Moscow, named after I. I. Dzhanelidze - in St. Petersburg, etc.), which, in addition to the functions of inpatient emergency medical institutions, are engaged in research activities and scientific development of issues related to the provision of emergency medical care.

Rural Ambulance Service

"Ambulance" based on UAZ 452

In different rural areas, the work of the ambulance service is structured differently, depending on local conditions. For the most part, stations operate as branches of the central district hospital. Several ambulances based on UAZ or VAZ-2131 are on duty around the clock. As a rule, mobile teams consist mainly of a paramedic and a driver.

In a number of cases, when populated areas are very remote from the district center, ambulances on duty together with teams can be located on the territory of local hospitals and receive orders by radio, telephone or via electronic means communications, which is not yet available everywhere. Such organization of vehicle runs within a radius of 40-60 km brings assistance significantly closer to the population.

Technical equipment of stations

The operational departments of large stations are equipped with special communication consoles that have access to the city telephone exchange. When dialing number “03” from a landline or mobile phone The light on the remote control lights up and a continuous beep starts to sound. These signals cause the medevac to flip the switch (or telephone key) corresponding to the light bulb. And at the moment when the toggle switch is switched, the remote control automatically turns on the audio track, on which the entire conversation between the ambulance dispatcher and the caller is recorded.

The remote controls have both “passive” channels, that is, working only “for input” (this is where all calls to the phone number “03” go), and active channels that work “for input and output”, as well as channels that directly connect the dispatcher with law enforcement agencies (police) and emergency response services, local health authorities, emergency and emergency hospitals and other inpatient institutions of the city and/or region.

The call data is recorded on a special form and entered into a database, which necessarily records the date and time of the call. The completed form is handed over to the senior dispatcher.

Shortwave radios are installed in emergency vehicles to communicate with the control room. Using a radio station, the dispatcher can call any ambulance and send a team to the desired address. Using it, the team contacts the control room in order to determine the availability of free space in the nearest hospital for a hospitalized patient, as well as in case of any emergency situations.

When leaving the garage, the paramedic or driver checks the functionality of radio stations and navigation equipment and establishes communication with the control room.

In the operational department and at substations, maps of city streets and light displays are installed, showing the presence of free and occupied cars, as well as their location.

Neonatal (for newborns)

The main difference in equipping the machine for assisting newborns is the presence of a special box for a newborn patient - an incubator (incubator). This is a complex device, similar to a box with plastic transparent opening walls, in which a given temperature and humidity are maintained, and with the help of which the doctor can observe the vital functions of the child (that is, monitor), and also, if necessary, connect a ventilator, oxygen and other devices that ensure the survival of a newborn or premature baby.

Typically, neonatology machines are “tied” to specialized centers for caring for newborns. In Moscow there are such machines at City Clinical Hospital No. 7 and City Clinical Hospital No. 13, in St. Petersburg - at a specialized advisory center.

Obstetrics and gynecology

Not so long ago [ When?] conventional linear machines were also used. In recent years [ When?] to equip such teams, vehicles appeared equipped with both a stretcher (for the mother) and a special incubator/incubator (for the newborn).

Shipping

To transport a patient from hospital to hospital (for example, to conduct some special examination), the so-called. "transportation". As a rule, these are the most “dead” and oldest linear machines. Sometimes Volgas are used for this purpose. In Moscow, sometimes there are minibuses based on the Gazelle, similar to a regular minibus, but with medical symbols and without special signals. Used, for example, for transporting patients with chronic renal failure (chronic renal failure) for hemodialysis - from home to hospital and back home. In Moscow, transportation teams are numbered from 70 to 73.

Hearse (corpse carriage)

A specialized van designed to transport corpses to morgues. Designed to transport 4 corpses on special stretchers. Externally, the car can be distinguished by the absence of windows on the body and the presence of additional ventilation outlets and “fungi” on the roof. Usually, there are also no special signals (“beacons”). There are also cars with a van located separately from the body.

In smaller cities, such teams are assigned to city morgues and are on their balance sheet.

Air transport

Also, helicopters and airplanes are used as emergency vehicles, especially in areas with low population density (for example, the Emergency Medical Retrieval Service operates in the west of Scotland), or, conversely, in cities to avoid traffic jams.

However, in Russia, practically, with rare exceptions, all air ambulances are concentrated in the aviation of the Ministry of Emergency Situations, doctors from the Disaster Medicine Service.

Other modes of transport

In the historical aspect and in the modern world, there are known cases of using other types of transport in the emergency medical service, sometimes even the most unexpected ones.

For example, in large cities during the Great Patriotic War, when most of the road transport, including city trucks and buses, was mobilized to the front, and the tram became the main transport for both passengers and freight, as “ambulances”, as well as for other medical transportation, it was the tram that was used.

Sanitary trains that ran along the same

All calls in large cities arrive at a single dispatch center of the central city ambulance station, and from there they are distributed to regional substations. Ambulance dispatchers are typically people who have medical education not lower than a paramedic. The direction of the emergency dispatch service is carried out by the senior shift dispatcher. All operational management of the ambulance station is concentrated on it.

In addition to the above, the duties of the emergency medical station dispatcher include reporting information about the medical institution to which the patient was hospitalized (without indicating the diagnosis or reason for the call).

Development prospects

On March 5, 2010, at the board of the Ministry of Health and Social Development, the head of the department discussed the type and system of medical care for conditions that threaten human life and health. Providing emergency services, including specialized medical care at the scene of the incident, en route, at home; delivery for medical reasons of patients... ... Big Encyclopedic Dictionary

I Emergency medical care is a system for organizing round-the-clock emergency medical care for life-threatening conditions and diseases at the scene of an incident and en route to treatment. preventive institutions. In our country, the provision... ... Medical encyclopedia

Type and system of medical care for life-threatening and health-threatening conditions. Providing emergency, including specialized, medical care at the scene of an incident, along the route, at home; delivery for medical reasons... ... encyclopedic Dictionary

Emergency- 1. Ambulance, including specialized emergency medical care, is provided to citizens in case of illnesses, accidents, injuries, poisoning and other conditions requiring urgent medical intervention. Ambulance, including ambulance... ... Official terminology

Emergency- Emergency medical care is emergency medical care for life-threatening conditions and diseases. It turns out that emergency medical care stations or hospital departments in cities and rural areas are available around the clock. In large... ... First aid - popular encyclopedia

The type and system of medical care for conditions that threaten human health and life: accidents (injuries, poisonings) and sudden acute diseases. As a medical service system, S. m.p. has the task of providing emergency... ... Great Soviet Encyclopedia

Emergency- (English first medical aid) in the Russian Federation, medical assistance provided to citizens in conditions requiring urgent medical intervention (in case of accidents, injuries, poisoning, and other conditions and diseases). S.m.p. must be carried out... Large legal dictionary

Ambulance bike in London. Bicycles are used as official transport by various emergency services such as police, emergency medical services and fire departments. This is due to... Wikipedia

Health care- see Medical intervention; Primary health care; Emergency; Specialized medical care... Encyclopedia of Law, Bagnenko F.S.. The national guide to emergency medical care contains up-to-date information based both on the practical experience of the authors and on publications including the results of scientific…

Emergency (ambulance) medical care team - 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 the institution healthcare. 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 work place of the team 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 operator of the emergency medical assistance system to the population is received by 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. Having received an electronic card from the call reception dispatcher, the dispatcher passes it on to the head of the EMS team. An electronic card is information support at all stages of emergency medical care, from the scope of emergency care to 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 unhindered access to the patient, and the necessary conditions to provide 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, drug, toxic intoxication, or mental disorder and poses a threat to the health or life of 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, for the provision of dental care, removal of 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 medical products that meet 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 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 healthcare facilities by order of the dispatcher of the Center's operational dispatch service;

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 of local health authorities 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 the bed capacity, interaction with other inpatient medical institutions not included in the system Department of Health, on the use of hospital beds for 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.

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

What qualities should an emergency physician have?

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

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

Responsibilities of an emergency physician

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

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

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

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

The responsibilities of an emergency physician include:

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

Found an error in the text? Select it and press Ctrl + Enter.

Comments on the material (30):

1 2

I quote Nadezhda:

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

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

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

I quote Elena:

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

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

I quote Galina:

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

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

I quote SERGEY:

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

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

1 2

Do you know that:

The liver is the heaviest organ in our body. Its average weight is 1.5 kg.

Millions of bacteria are born, live and die in our intestines. They can only be seen under high magnification, but if they were put together, they would fit in a regular coffee cup.

According to research, women who drink several glasses of beer or wine per week have increased risk get breast cancer.

Smiling just twice a day can lower your blood pressure and reduce the risk of heart attacks and strokes.

Tooth decay is the most common infectious disease in the world, which even the flu cannot compete with.

If your liver stopped working, death would occur within 24 hours.

According to many scientists, vitamin complexes are practically useless for humans.

The most heat The body was recorded in Willie Jones (USA), who was admitted to the hospital with a temperature of 46.5°C.

There are very curious medical syndromes, for example, compulsive swallowing of objects. One patient suffering from this mania had 2,500 foreign objects in her stomach.

When we sneeze, our body stops working completely. Even the heart stops.

In an effort to get the patient out, doctors often go too far. For example, a certain Charles Jensen in the period from 1954 to 1994. survived more than 900 operations to remove tumors.

Many drugs were initially marketed as medicines. Heroin, for example, was originally brought to market as a cure for children's coughs. And cocaine was recommended by doctors as an anesthesia and as a means of increasing endurance.

In 5% of patients, the antidepressant Clomipramine causes orgasm.

You are more likely to break your neck if you fall off a donkey than if you fall off a horse. Just don't try to refute this statement.

The first vibrator was invented in the 19th century. It was powered by a steam engine and was intended to treat female hysteria.

A healthy back is a gift from fate that needs to be treasured very carefully. But how many of us think about prevention when nothing bothers us! We not only...