Extended First Aid: Perspectives and Challenges of Regulatory and Legal Framework

In order to improve quantitative and qualitative characteristics of first aid, an urgent need arose to increase its authorised volume for certain categories of first aid providers in accidents, disasters, natural calamities, epidemics, terrorist acts and armed conflicts and under other special conditions. In accordance with Order No. 3155-r of the Government of the Russian Federation of 28 November 2020, legislative mechanisms should be developed by December 2021 to expand the scope of first aid. Introduction of changes and additions into Art. 31 of Federal Law No. 323-FZ of 21 November 2011 “On Fundamentals of Public Health Protection in the Russian Federation” will make it possible to update current legislation by amending a number of acts and by adopting new documents. The authors suggest the development of draft amendments to the federal law “On Medical Drugs Circulation”, to draft normative legal acts of the Government of the Russian Federation and of federal executive bodies which will be necessary for implementation of norms of the federal law “On Amendments to Art. 31 of the federal law “On Fundamentals of Public Health Protection in the Russian Federation”.

Experience of Applying Telemedicine Technologies in the Work of Voronezh Regional Clinical Center for Disaster Medicine

The purpose of the study is to determine the role of telecommunication technologies in increasing the efficiency of Voronezh Regional Clinical Center for Disaster Medicine. Materials and methods of research. The data contained in analytical reports and other documentation of the Center for 2018-2020 in terms of identifying patterns of their change with the introduction of telecommunications technologies were analyzed. Results of the study and their analysis. Introduction of telemedicine technologies in the work of the Center resulted in increase of volume of rendering of medical care by its specialists. The neurosurgeons were the most demanded specialists, who performed telemedical consultations, which is mostly related to the necessity of performing consultations for the doctors of trauma centers of the II and III levels, engaged in treatment of victims of car accidents. Voronezh Regional Clinical Center for Disaster Medicine plans to further expand the use of telecommunication technologies not only in treating victims of road accidents, but also victims of other man-made and natural emergencies.

Organization of Medical Support for the Military Service Call-Up of Citizens during New Coronavirus Infection COVID-19 Pandemic

The aim of the study was to evaluate the organization of screening of conscripts for COVID-19 infection in one of the subjects of the Russian Federation — Orenburg region. Materials and methods of the study. The study of organization of examination of conscripts for COVID-19 infection included study of the experience of the Center of Military Medical Examination of the Military Commissariat of Orenburg Region in carrying out military conscription under conditions of the COVID-19 pandemic; methodological recommendations approved by the Head of the Main Military Medical Department of the Defense Ministry of Russia as well as the analysis of the activities carried out at different stages of medical sorting. Results of the study and their analysis. The results of the study of the organization of COVID-19 screening of conscripts in Orenburg Region showed that sufficient and effective barrier medical screening was organized at all stages. Conscripts in good health condition were sent to the Armed Forces for military service under conscription. No claims were received from military units about poor quality selection of conscripts. In 2020, during the COVID-19 pandemic, recruitment commissions of Orenburg Region coped successfully with the task of drafting citizens for military service.

Analysis of Organizational Models of Disaster Medicine Service of the Ministry of Health of the Russian Federation at Regional Level

The results of study and analysis of organizational and functional changes in the Disaster Medicine Service of the Ministry of Health of Russia at the regional level, organizational models of the Disaster Medicine Service functioning in the subjects of the Russian Federation are presented. The study was conducted at the All-Russian Center for Disaster Medicine “Zashchita” (since 2015) and at the Federal Center for Disaster Medicine of the National Medical and Surgical Center named after N.I. Pirogov of the Ministry of Health of Russia. The purpose of the study is to analyze organizational models of the Disaster Medicine Service functioning at the regional level. Materials and research methods. The following methods were used in the study: expert evaluation, statistical, analytical, field observation, etc. The method of expert evaluation was applied through questionnaire survey of experts – Russian experts in the field of disaster medicine and emergency medical care. The questionnaires were filled in twice – questionnaire №1 – in 2015 and questionnaire №2 – in 2019-2020; a total of 529 people took part. Questionnaires № 1 and № 2 included questions and provisions relating to organizational models of the Disaster Medicine Service functioning at the regional level and to organizational and functional changes in the Disaster Medicine Service of the subjects. Results of the study and their analysis. The results of the research helped to formulate a number of principle statements on further improvement of the Disaster Medicine Service, including development of organizational structure, implementation of its organizational models at the regional level.

Simulation Modeling and Practice of Inpatient Emergency Department in COVID-19 Pandemic

The article presents the experience of using simulation modeling to optimize inpatient emergency department as an admission unit of a hospital — Center for treatment of patients with new coronavirus infection COVID-19. It was noted that the inpatient emergency department effectively performed the functions of the inpatient department of the Center for treatment of patients with new COVID-19 coronavirus infection for a total of more than 7 months. A correct calculation of staffing and a competent use of the department “zones” ensured efficient and rapid reception of patients during both “waves” of the pandemic. The model also proved positive role of such departments with a large number of patients in a multimillion metropolis needed to be hospitalized on a daily basis.

Use of Innovative Technologies in the Treatment of Patients with Severe Concomitant Injury with Liver Damage: Clinical Observation

Liver injury is one of the most common abdominal injuries in patients with severe trauma. A total of 2988 patients with concomitant injuries were treated at the city clinical hospital named after S.S. Yudin during the period from 2010 to 2020, of which 371 (12.4%) were found to have closed abdominal trauma. Damage to the liver was revealed in 124 (33.4%) patients with closed abdominal trauma. The number of discharged patients was 78 (62,9%), lethal outcome — 46 patients (37,1%). The severity of injury according to ISS was (38,1±11,3) points. The development of innovative multimodal approaches, such as endovascular trauma and bleeding management (EVTM), as well as damage control tactics have significantly increased the likelihood of nonoperative treatment for individual patients. A clinical observation is presented that allows to evaluate the effectiveness of innovative technologies in the treatment of patients with severe concomitant trauma with liver damage.

Peculiarities of Respiratory Support in Patients with Severe Pathology during Air Ambulance Evacuation

The aim of the study is to identify and to analyze the features of respiratory support in patients with severe acute respiratory failure when performing air ambulance evacuation by light class helicopters by specialists of aeromedical teams. Materials and methods. We used materials containing data on the frequency and peculiarities of ventilator usage and tracheal intubation during emergency medical care for patients with acute respiratory failure over the last 5 years (2016-2020). During this period emergency medical care was provided to 53579 patients, 298 of whom were in extremely severe and serious condition requiring ventilator usage and tracheal intubation. The following methods were used in the study: historical, statistical, analytical. Results of the study and their analysis. Trauma prevailed among nosological forms in patients with acute respiratory failure. Artificial lung ventilation with tracheal intubation should be started before the patient is transported to the helicopter cabin. During air ambulance evacuation of patients with acute respiratory failure by helicopter of light class, doctors should take differentiated approach to the choice of type and mode of respiratory support and of method of airway patency assurance.

Emergency Medical Care for Patients in Coma in Ryazan in 2016-2020

The study objectives were to investigate the prevalence and to determine the most frequent causes of coma in patients in Ryazan; to determine the frequency of fatal outcomes at the stage of medical evacuation and the frequency of hospitalizations; to identify the features of emergency medical care in the prehospital period. Materials and methods. We analyzed statistical data on the number of witnesses who applied for emergency medical aid in cases of disturbance of consciousness in patients who were subsequently diagnosed as comatose patients; we revealed main causes and types of comatose states, number of fatal outcomes and frequency of hospitalizations in Ryazan. Materials of the study – cards of calls of ambulance crews in Ryazan in 2016-2020. Results of the study and their analysis. Analysis of statistical data for Ryazan in 2016-2020 showed a steady increase in the number of ambulance calls to patients in coma. In Ryazan, as in Russia as a whole, cerebral coma prevailed, with diabetic coma in second place and toxic coma – in third. In 2016-2020, the proportion of coma-related deaths was 2.7% in the prehospital period and had no upward trend. In 84% of cases patients were hospitalized in medical treatment organisations, patients with hypoglycemic coma sometimes refused hospitalization, there was no tendency in increase of the number of refusals. In the prehospital period, ambulance care for patients with coma was provided in accordance with the algorithms, average time to reach the call was 12.4 min, which corresponds to the respective norms for emergency calls for Ryazan.

On the Issue of Special Exercises in the Counterterrorism System Involving Specialists of Health Care Management Bodies, Medical Formations and Organizations

The objectives of the study are to analyze the experience of exercises conducted in the counter-terrorism system by specialists of the regional Disaster Medicine Service, to identify key organizational issues of preparation and implementation of exercises; to develop proposals for their improvement in the subject of elimination of medical and sanitary consequences of terrorist acts committed with the use of conventional means of destruction. Materials and research methods. Sources of information and materials studied: normative and methodological documents regulating the procedures of organizing and conducting military training in the field of healthcare; materials of trainings performed by specialists from regional EMC on the subject of organizing the liquidation of medical and sanitary consequences of terrorist acts; data from expert evaluation maps on the subject of the study; scientific papers and publications on technologies of training and exercises involving specialists from healthcare management bodies, medical units and organizations. The following scientific methods were used in the research: content analysis method, expert assessment method, statistical method, logical and informational modeling, and analytical method. Results of research and their analysis. The results of the study of basic organizational issues of preparing and conducting special exercises (command-staff exercise, staff training, tactical and special exercises) conducted in the regions with the participation of specialists of public health authorities, medical formations and organizations within the framework of counter-terrorism are presented. Sound proposals were made to improve the technology of preparing and conducting special exercises and communicating their results to medical specialists. The results of the study showed that almost all the experts (98.0%) were in full agreement with the need, in order to maintain and increase the preparedness of health care authorities, medical organizations, including emergency medical care and the Disaster Medicine Service, to conduct regional trainings on the subject of medical support of the population during terrorist acts. And only 2.0% of the experts had difficulty in formulating a specific conclusion on this issue.

Mental Health Support Measures for Medical Professionals in the Context of COVID-19 Pandemic: Global and Domestic Experience

A new coronavirus infection COVID-19 has been declared a pandemic by the World Health Organization (WHO). Medical professionals, who play the leading role in the fight against the spread of the dangerous virus, work under conditions of high and prolonged stress. There is an urgent need for psychologists to intervene and to develop support measures for medical professionals to maintain and to preserve their mental health. In connection with the need to determine the state of mental health of medical professionals and to assess international and domestic experience in the implementation of measures to support it, the analysis of scientific publications for 2020, devoted to the issue of mental health of medical workers in the pandemic COVID-19 was conducted. The conclusion is made that the organization of psychological help and psychological support as well as positive world experience of the realized measures of support will allow to keep mental health of medical professionals during the pandemic.