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  • General principles of emergency care

    Historically, the organization of "Emergency Medical Services" arose because of the increase in the number of accidents related to the intensive growth of cities and industry. In 1881, Vienna established the first station of this service. In Russia, an ambulance first appeared on the basis of a charity hospital in 1844.

    Emergency medical care is provided for diseases and conditions that are life-threatening, and is provided by the ambulance station around the clock. The causes of the above conditions can be life-threatening sudden illnesses, attempted murder and suicide, poisoning, natural disasters, etc. The tasks of this service also include the transportation of parturient women to the maternity hospital and patients, except for infectious diseases, at the request of doctors. The list of activities that are carried out by the ambulance staff at the scene of the incident or during transportation to a specialized medical institution includes ensuring the safety of the patient and conducting prevention of complications. In the case of injuries or acute illnesses, patients are referred for treatment to specialized hospitals, which are combined with an ambulance service. This ensures continuity at all stages of emergency care.

    The functions of emergency personnel are not systematic treatment and monitoring of patients and injured persons, examination of alcohol intoxication, issuance of certificates and sheets of disability.

    This service operates in settlements with a population of more than 50 thousand. The ambulance station can both be an independent medical and preventive institution and enter the structure of the city hospital for emergency medical care. Urgent medical care is also provided by the emergency and planned department of consultative medical care, which is part of the regional hospital. Such a system of emergency medical care is organized in remote areas of the country. The development of the activity plan of this service should be made taking into account the age composition and morbidity of the population, the density, geographical location of the district, etc. One of the structural units of the emergency medical care station is the substation, which is calculated for 15-minute transport accessibility. The local health authority regulates the territory served by one station. Employees of the emergency service are united in teams for work in one shift. There are teams specializing in one profile( cardiological, traumatological, psychiatric, etc.).Urgent activities are carried out on the way to a hospital or on the scene. The ambulance employees perform artificial respiration and closed heart massage, stop bleeding, and transfuse blood. They also produce a number of diagnostic procedures: they determine the prothrombin index, the duration of bleeding, remove the ECG, etc. In this connection, the transportation of the ambulance service has the necessary medical-reanimation and diagnostic equipment.

    The activities of the ambulance station are complex and multifaceted. The ambulance cars are obliged to safely travel to all challenges. The doctor or paramedic should be provided with the first medical aid and the prompt and qualified delivery of the sick or injured to a specialized medical institution is ensured. According to the profile, the brigade must have all the necessary medicines. Reduction in the number of complications and deaths but the way to the hospital is provided by expanding the scope and improving the provision of medical care.

    Currently, there is a dual system for organizing emergency medical care, taking into account prehospital and hospital stages. In large cities, associations of emergency medical services are being established, which include a hospital for emergency medical care and an emergency consultative department. The given structure is engaged in questions of the organization of emergency and advisory medical aid to the population, using sanitary aviation and ground transportation. On the basis of ambulance services under the control of the polyclinic, home care units are organized. This makes it possible to improve the organization of the activities of ambulance services and increase the responsibility of polyclinic institutions for providing medical care to the population attached to them.

    The responsibilities of this department include: providing appropriate medical care to patients with acute illnesses, providing, at the request of a call, an ambulance team. Most patients after the first aid are further examined in order to avoid complications.

    The qualitative level of performing medical care for patients at home contributes to a more rational work of the hospital. In the work of polyclinics, various forms of care are used: emergency rooms, nursing and elderly care units, active patronage departments, short-term or day hospitals with subsequent care of the patient at home, etc. When addressing patients, reasons, goals, and the nature of appealsprimary or repeated), forms of diseases( chronic or acute), seasonality of calls, etc. In general, the therapeutic profile predominates.

    Very important for the treatment of patients at home is the laboratory and diagnostic and treatment and support services. Assessing the effectiveness of providing emergency medical care to the population is necessary given the timeliness of the call, the percentage of discrepancies in the diagnosis established by the ambulance and in the hospital. One of the main indicators of the work is its quality, which is indicated by the number of repeated calls and the ratio of the number of hospitalized and the total number delivered to a specialized institution.

    The ambulance service is an extremely important step in the structure of medical care for the population. Workers of this organization must have high qualification, on the lives of thousands of patients depend on their activities. It is established that the Ambulance every year produces more than 100 million trips. The staff of this service is distinguished by the speed of reaction, hardness and ability to quickly concentrate in any conditions. An ambulance doctor must have a certain level of medical thinking in order to establish a diagnosis in a matter of minutes and provide appropriate assistance. Specialists of this service should have a clear knowledge of differential diagnosis, be able to navigate the symptoms of the disease and complaints of the patient. Doctors of ambulance should correctly evaluate the symptoms and syndromes, the clinical picture of the disease, which is extremely important in diagnosis. They should be well-oriented and have in-depth knowledge of many medical disciplines. It is a direct civil and human duty of every medical professional to provide first aid, the avoidance of which entails disciplinary or criminal liability.

    In our country there is a network of medical institutions providing emergency medical care. This includes specialized ambulance hospitals, research institutes, clinics of medical universities and universities.

    There have been recent trends in improving the quality of emergency care. This is achieved by continuous improvement of the ambulance structure: using new modern equipment, increasing the network of medical institutions, increasing the number of medical workers, etc. It is necessary to emphasize the importance of activities aimed at alerting and educating the population about the rules for providing first aid. Therefore, the simplest and at the same time vitally important activities are taught since the school age. The first medical aid is a system of urgent measures aimed at the injured or suddenly ill person at the scene of the accident or on the way to the medical institution.

    There are several types of first aid. The first medical unskilled help is provided by a non-medical worker, usually without any medications and medical equipment. The first medical qualified( pre-medical) help is provided by a medical specialist( nurse, paramedic, etc.), who received special training. The first medical aid is provided by a doctor with the help of the necessary apparatuses, instruments and medicines.

    Accident is the defeat or disruption of the functions of human organs in the event of sudden adverse environmental effects. The danger of accidents is the difficulty in reporting the incident to the ambulance station. In this case, a great responsibility for the victim rests on the surrounding people who are supposed to render the first medical unqualified care before the arrival of the medical team.

    Specialists with medical education should be highly competent. Therefore, one of the most important sections of training students of various medical specialties is the course "First aid".For a competent and clear approach to emergency care, the health worker is required to know the main symptoms of the disease, the signs of various injuries and their danger to the life of the injured or sick.

    First aid should include three groups of activities. The first implies a rapid cessation of the impact of the damaging agent( electric current, high or low temperature, heavy objects) and the immediate transportation of the victim from an unfavorable situation( extraction from a pond, a room burning and smoldering with poisonous gases, etc.).The second group of measures includes the direct provision of medical assistance to the victim according to the nature and type of injury, accident or sudden illness( resuscitation, stopping bleeding, applying a bandage to the wound, anesthesia, etc.).This type of assistance is provided by medical personnel. The third group includes the immediate delivery of the patient to a specialized institution.

    Activities related to the first group relate to mutual and self-help and are first aid in general. The first aid should be carried out as soon as possible, so that the damaging effect is minimal. In order to prevent complications, it is important immediately and most importantly - to correctly transport the victim to a hospital. In accordance with the nature of the disease or injury, the patient is delivered at various fixed positions of the body. Thus, for example, when unconsciously vomiting, the victim is transported in a position on his side;with injuries of the pelvic bones - on the back with the legs raised and bent at the knees. To deliver the patient to the hospital, they use an ambulance and an airplane, and in their absence, any available means of transportation. In some cases, the victim is transferred to the hands with the help of improvised stretchers, tarpaulins, etc. Depending on the conditions, the time of transportation of the victim varies from several minutes to several hours. Each health worker must perfectly master the rules of transferring the patient, shifting from one stretcher to another, and also to know the causes that lead to complications during transportation( shaking, immobilization, hypothermia, etc.).The first medical aid, rendered correctly and in the shortest possible time, will save the life of the victim, ensure the success of further treatment and prevent a number of serious complications.

    In any medical institution( hospital, pharmacy, polyclinic, laboratory) for emergency care, there must be a first aid kit containing essential medicines( antiseptics, analgesics, antipyretic, antibacterial, etc.) and the simplest medical supplies( thermometer, hemostatic tourniquet, sterile bandage, cotton wool, etc.).The ambulance station has many machines with a full set of medicines and medical equipment to carry out the set goals. Ambulances are equipped with an artificial respiration apparatus, a set of medicines needed in case of emergency, dressings, medical instruments( tweezers, syringes, etc.), a set of tires and a stretcher, etc.

    First aid is available to every citizen of our country. This is determined not only by the expanded network of institutions of this medical service, but also by a single telephone number for calling( 03).Urgent care in rural areas is provided by doctors and paramedics of rural medical institutions. There are first aid institutes involved in the scientific development of emergency care. The ambulance stations work together with ambulance hospitals, which provides a single tactic of emergency care both at the prehospital stage and in the hospital. Also, the qualification of brigades and emergency doctors is increasing. One of the functions of the ambulance hospital is active participation in various conferences and meetings, which discuss the problems of providing emergency assistance to the population. Each hospital of emergency medical care is assigned a certain territory, the population of which is served by this hospital. This medical institution assesses and controls the work of the emergency hospital service. The task of emergency hospitals also includes the provision of sanitary education for the population. The medical staff of this medical institution every 5 years passes the refresher courses in the field of emergency care. Toxicological, traumatological, burn centers are based on the activities of the emergency hospital. The units of this hospital are the ambulance station, the administrative-economic departments, the treatment departments( hospitals).The ambulance will deliver the victims to the hospital, who will receive and distribute them to the departments according to the nature of the disease or injury. A thorough examination and a full complex of treatment for patients and victims are conducted here. The operation of emergency medical hospitals is based on the basic provisions of the work of any city hospital.

    The ambulance includes the following departments: surgical, therapeutic, neurological, pediatric, gynecological, etc. One of the main structural units of such hospitals is the resuscitation department, which provides assistance to patients with severe respiratory and circulatory disorders. It has been established that there are 14 beds for 10 thousand adults. So calculate the number of beds in the intensive care center. An important place in the structure of emergency medical hospitals is occupied by an express diagnostic laboratory. Further treatment of patients admitted from the intensive care unit or operating room is performed in intensive care units. The number of beds in these wards should be 15% of the total number of beds of therapeutic, surgical, trauma and other departments. The reception desk should be ready round-the-clock for the admission of patients. The complexity of the activities of his employees is the need to diagnose and immediately provide appropriate care to patients. Therefore, a whole set of diagnostic rooms( X-ray, functional diagnostics, etc.) and laboratories( biochemical, serological, hematological, etc.) is the first part of the receiving dormancy. It was found that more than 30% of patients who entered the emergency room need urgent rapid blood and urine analysis;10% X-ray examination is required;5% remove the electrocardiogram. In cases of ingress of foreign bodies into the respiratory tract, or lesions of the esophagus, thoracic and abdominal organs, or bleeding from the gastrointestinal tract, great importance is given to endoscopic examination.

    The patient is on duty receiving patients and patients. He also appoints a number of diagnostic procedures and takes a direct part in the examination of patients with an unclear diagnosis. Due to acute disease, especially with the combined damage of various organs, certain difficulties arise in establishing the correct primary diagnosis. Therefore, medical workers in the admissions department are forced to use special research methods. In the waiting room, chambers are organized, in which patients with an unclear diagnosis stay for a certain time. They are provided with activities to maintain the functions of vital organs and systems.

    Specialists( surgeons, therapists, gynecologists, etc.) who make up the on-duty brigade carry out a survey and provide emergency medical assistance to sick and injured people.

    The basis of the construction of specialized departments of the ambulance hospital is the block principle. Each surgical department has an operation unit with intensive care and intensive care units. The ambulance hospital is being built according to the standard design of this settlement. It is established that, based on 500 residents, hospitals are built for 60 beds, more than 90 beds are required for a larger population.

    Emergency hospital care is also provided by the central district hospital. Such a system works in settlements with a population of less than 200. When assessing the activities of emergency hospitals, it is necessary to use the basic quantitative indicators: the number of sick and injured people who were taken and who applied for help in the emergency room;ratio of the number of hospitalized and all people who entered the admissions office. The main causes and diseases that lead to emergency conditions are recorded. The cases of denial of hospitalization are analyzed, the frequency of which is also differentiated for reasons.

    The main accounting and reporting document of the Admission Office is the form number 74, where the measures taken in the reception room are recorded. Analyze the activities of the hospital emergency medical care is necessary in view of the three main stages of emergency care in these institutions.

    The first stage involves the arrival of a patient or a victim in the reception room, and then to a specialized department.

    The second stage is the diagnosis in this department.

    The third stage involves the treatment of a patient in a hospital.

    It is established that early hospitalization of the victim or patient will ensure successful treatment and recovery. To assess the work of the emergency hospital also resorted to differentiation of the terms of hospitalization and the timing of delivery of hospitalized. The time interval from the moment of treatment of the victim or patient for help before transportation to the hospital is the time of delivery of hospitalized patients. Analyze the activities of emergency hospitals, also taking into account the length of stay of the patient or the injured person in the hospital bed in general and separately on the cots of different departments;average employment of the hospital bed capacity. It is necessary to evaluate the above-mentioned parameters by comparing them with the data of the average values ​​for the rayon, oblast, and country. An important condition for such an analysis is the long-term monitoring and control of all quantitative and qualitative indicators of the activities of emergency medical hospitals.

    Assistance provided by the ambulance stations is available and free of charge for everyone. One of the main branches of the ambulance station is the operational department. Timely work of visiting brigades is largely determined by the clarity and literacy of the operational branch. This unit accepts calls from sick or injured and organizes the departure of emergency medical teams. Reception of calls is carried out by the evacuator by phone 03. Then this information is received by the dispatcher, whose functions include the grouping of orders taking into account the urgency of the call and the area from which the information came. The dispatcher must also inform the brigades leaving for the call, the address at the place of demand and the approximate diagnosis of the injured or sick person. Having called to the service of the "First Aid", it is necessary to give a brief and at the same time basic information about the sick or injured( name, address, age, cause of the call).The management and control of the operations department is carried out by the senior doctor on duty. He also has the right to make decisions about a justified refusal to call. The arrival time of visiting brigades to the place of demand is strictly regulated and differentiated according to the reason of the call. It is established that the brigade leaves for signals about childbirth, heart pain, abdominal pain no later than 5 minutes later. Control over the location of each emergency car, informing the driver of the best route to the place of call is provided by the dispatcher of the operative department of the ambulance station.

    The next branch of the ambulance station is the hospitalization department. This department deals with the accounting of the number of beds and provision of emergency hospitalization in accordance with the availability of vacancies, the specialization of a medical and preventive institution. The task of this department is also the fulfillment of applications of doctors from polyclinic institutions and hospitals for the transportation of patients to specialized medical institutions. The structure of the ambulance stations includes the obstetric and gynecological department. He deals with the transportation of women in labor and women with acute gynecological diseases. The midwives are included in the brigades leaving for such patients. This department ensures the reception of applications both from specialists of medical institutions and from the public.

    The ambulance station consists of an infectious disease department that transports patients and distributes places in infectious clinics. This department has its own vehicle and staff of the visiting team.

    The structural unit of the ambulance station is the information desk, which contains complete information about the sick and injured, delivered by ambulances to medical institutions. This department can give the population information on the phone or at personal appearance.

    The immediate brigade of the substations located in different parts of the city provides immediate medical assistance to the sick and injured. The time from the moment the signal for assistance to the arrival of the brigade depends on the location of the substation( not later than 15 minutes).The substation includes two groups of visiting brigades. The first group includes ambulance brigades. The second group includes brigades intended for the transportation of patients and injured in treatment and prophylactic institutions. It is established that the total time spent by an emergency team for one call is approximately 40 minutes.

    The activity and development of the ambulance structure is based on a territorial principle, implying the presence of a central emergency ambulance station and the adjacent substation complex located in different parts of the city. When organizing the location of the substation, it is necessary to take into account the number and mass of population in the area, the intensity of traffic. In rural areas, first aid is provided by the central district hospital. The activities of the staff of this service can be carried out at a considerable distance from the hospital. Therefore, in the central district hospital there is a round-the-clock duty of doctors and paramedics on duty, ambulance ambulances are always ready for departure.

    All ambulance stations in accordance with the number of annual calls are divided into 6 categories. Out-of-category station makes over 100 thousand calls a year;the first category - 75-100 thousand visits;the second - 75-50;the third - 50-25;the fourth - 25-10;the fifth - 10-5.The third and fifth categories of stations operate on the basis of in-patient departments. The quality of emergency medical care directly depends on the speed of ambulances and the technical equipment of visiting teams.

    The ambulance car has a white color and an inscription on the bodywork "Emergency Medical Assistance".It is also equipped with light indicators and a special signal - a siren. The ambulance cars are also equipped with modern communication systems, which makes it possible to establish audio and video communication with the doctor of a specialized hospital for counseling. In this case, the medical institution, where the patient is transported, receives full information about his health. This allows you to prepare for the conduct of diagnostic procedures, surgical interventions, etc. Sanitary machines in the performance of an operational assignment have an advantage on the roads of the city. In this case, the drivers of ambulances are allowed to exceed the set speed and intersection of the intersections regardless of traffic light signals. But they must comply with all the rules that ensure traffic safety.

    The concept of "ambulance" is a collective one and includes three main structures.

    The first - the material and technical base, which includes equipment, premises, transport, etc. The second is the organization of emergency assistance to the population. The third implies ways to provide emergency assistance. Emergency medical care is carried out under emergency conditions, when changes occur in the human body leading to illness or life threatening. There are different types of these states that manifest themselves differently. In one case, there is a real threat to life, which without a corresponding medical action leads to a fatal outcome. In another case, an urgent situation does not threaten the life of the patient or the victim, but progression can lead to the onset of a critical moment. It is established that in the locality with a population of 10 thousand people, the ambulance station receives and executes an average of 250 to 350 calls per day. About 85% of all calls are sudden illnesses, 10% - accidents, 5% - other reasons.

    The main groups of diseases that caused the call are diseases of the cardiovascular, respiratory, digestive systems, as well as certain symptoms.

    The main places from where the single number 03 is dialed are the apartment and the street. It is established that the greatest number of calls falls on the winter period, mainly at night time( from 17 to 23 hours).Stations and departments of emergency medical care medical personnel are sent to carry out two types of tasks. One of them is the provision of medical assistance and, if necessary, transportation to hospitals of the affected and sick. This is the case with accidents( serious injuries, injuries, fractures, electric shock, frostbites, asphyxiation, poisoning, etc.).Medical staff of visiting teams carry out the above measures in cases of life-threatening acute diseases. The main symptoms are sudden loss of consciousness, stopping the activity of the heart and respiratory systems, severe bleeding, cerebral blood flow disorders, seizures, etc. The delivery of the corresponding complex of urgent measures is due to the parturient mothers whose birth occurred at home or in public places.

    The second task of the visiting teams includes transportation of patients and victims to specialized medical facilities. These activities are persons with acute appendicitis, perforated gastric ulcer, intestinal obstruction, uterine bleeding and other conditions that require emergency care. The mothers and puerperas during normal delivery, as well as premature newborns together with mothers, are also urgently transported to a specialized medical institution."First Aid" carries the transportation of patients who need for their health in an ambulance. This type of assistance is carried out in a planned manner, on the day the application is received from the patient. Transportation of an infectious patient is carried out by the service of sanitary-epidemiological stations. Rendering emergency assistance to both patients and those affected with thromboembolic pathology is carried out by a specialized visiting brigade at the request of only an emergency doctor. Experts of the team can be sent to the place of demand on the calls of district doctors, which is decided by the health authorities. For prevention, treatment of shock and terminal conditions, a specialized team is also organized. She makes calls to the sick and injured in the atonal state, as well as with severe injuries, severe bleeding, various kinds of asphyxia, etc. Psychoneurological patients are also assisted by a specialized team, of whom the main psychoneurologist is a doctor. The visiting brigade sent to a patient with acute mental illness, in addition to a doctor, includes an average medical worker and two orderlies.

    The tasks of the ambulance team are in the early diagnosis, emergency care in the shortest possible time and, if necessary, in immediate hospitalization. On the way to the hospital, the medical staff of the brigade carry out urgent measures. These include anesthesia, stopping bleeding, tracheotomy, artificial respiration using medical equipment, closed heart massage. Employees of specialized visiting teams perform a number of diagnostic measures: they remove the electrocardiogram, determine the prothrombin index, the duration of bleeding, etc.

    At present, the services of the paid "First Aid" are in great demand among the population. The activity of this organization is in addition to the work of the municipal medical service. The main advantages of paid first aid are the high speed of the call and the creation of the most comfortable conditions of delivery to the medical institution at the request of the patient or his relatives. Commercial teams transport the patient to different areas of our country, transport the patient to diagnostic procedures, waiting for him, and taken back, meet at the airport or at the railway station. The services of this service are not subject to the program of compulsory health insurance and, accordingly, do not require the patient to have an insurance policy.

    At present, the ambulance service has developed a memo for relatives or simply accompanying a patient to a hospital. Calling to the ambulance service, it is necessary to give full and detailed information about the condition of the victim or patient, so that the dispatcher organizes the departure of the corresponding brigade. It is necessary to collect and prepare the basic documents and things of the patient, do not interfere with the traveling brigade to transport the sick or injured in the ambulance. In the car, you must lay or seat the patient in accordance with his condition. On the way to a medical institution, it is forbidden to feed or water a victim or a sick person.

    In the ambulance car, accompanying relatives hold onto the handrails. An ambulance doctor has the right to refuse relatives to accompany a sick or injured person who is in serious condition.

    In order to keep secret the case of emergency assistance, the public often uses the services of commercial teams. Emergency help in this situation can include removal from drinking-bout, activities when breaking up among drug addicts, etc. The car is equipped with darkened medical glasses, the ceiling, walls and doors of the cabin are thermo- and noise-insulated;the seams of the flooring are waterproofed. The equipment of the ambulance includes cabinets with medical preparations and instruments;a table, a washbasin with an electric pump;an armchair for a medical worker;the control system of work of an electric equipment;complex of lighting devices. There is also a ventilation and heating system, there are supports on which oxygen cylinders are attached, etc. The equipment for the ambulance ambulance includes a stretcher, a shield for transporting patients and injured with spine and pelvis injuries, an artificial respiration apparatus, a portableportable anesthesia machine, oxygen inhaler, tonometer, an emergency doctor's bag, a cover with a set of transport tires, a generic package, sanitary property and care itemsspecial suitcase, with accompanying documents folder.

    The activity of the Emergency Medical Service in our country is carried out in accordance with clause 5.2.12 of Resolution No. 321 of the Government of the Russian Federation of June 30, 2004 "Further improvement and effective organization of emergency medical care for the population".The costs of emergency assistance are borne by the municipal entity existing in the given territory. The exception is the work of specialized( sanitary-aviation) emergency teams. The structure of the ambulance station includes cabinets equipped with alarm systems, where medicines are stored. Here, rooms are organized in which the station employees spend their free time and eat. On the territory of the ambulance station, there are sites where sanitary vehicles stop, and if necessary, a site for helicopters is being built.

    At present, the operational department of the ambulance station is fully computerized, there are devices that record conversations and automatically determine telephone numbers. There should be a single database of patients and victims who have appealed to the emergency service.

    The ambulance car should be regularly disinfected. In addition, immediate disinfection with the use of disinfectants is subject to transport, which carried the transport of an infectious patient.

    The planned number of visiting brigades is calculated according to the number of residents in the area and the estimated load per team of the brigade per day. The main indications for emergency care and the possibility of medical specialists to work on shifts are also taken into account. There are two types of visiting teams: paramedic and medical. The medical team includes one doctor, two paramedics( or a paramedic and an anesthesiologist), a paramedic and a driver. The paramedic brigade consists of two paramedics, a paramedic and a driver. The specialized exit brigade includes one doctor on the appropriate profile, two nurses or a medical assistant, a paramedic and a driver. The obstetric visiting team includes one midwife, a paramedic and a driver. The above brigades provide assistance in accordance with the standards of emergency medical care. The sanitary exit brigade includes one paramedic, a paramedic and a driver. For the work of each team a schedule is drawn up.

    Medical personnel of the visiting brigade, not called by the dispatcher of the operational department, should be in the premises of the substation or the ambulance station. The equipment of the ambulance must comply with the order of the Ministry of Health of the Russian Federation No. 100 of March 26, 1999( Appendix No. 13).One of the functions of the visiting brigade is an early departure and arrival to the place of the request in accordance with the temporary standards of emergency work in the area. Employees of the visiting team should, as soon as possible, establish a diagnosis of the patient or the victim and implement a set of relevant emergency measures. The ambulance service's task is to immediately deliver the patient to a medical institution. Having carried out the delivery of the sick or injured, the staff of the visiting brigade is handed over to the on-duty doctor of the hospital the relevant documentation.

    The ambulance service can carry out its activities in emergency situations, in which massive diseases, poisoning, people's traumas take place. In this case, the exit brigades provide the sorting of patients and victims and establish the sequence of emergency care. The ambulance service should also conduct appropriate sanitary and anti-epidemic and hygienic measures in the area. All the sick and injured, delivered by the ambulance brigade of the Emergency Medical Service to the hospital, are noted in the "Call Map" document, indicating the time of their arrival. Specialists of the visiting brigade, who discovered the corpse of the deceased or the deceased, report this to the district internal affairs body. In this case, a corresponding note is also made in the "Call Map" document. To transport a corpse, the use of an ambulance is prohibited: this function is provided by special transport. If death occurred in an ambulance, employees of the visiting brigade can deliver the corpse to the forensic facility only with the consent of the dispatcher of the ambulance station.

    In our country there are medical and preventive institutions, one of the main functions of which is to provide urgent sanitary and aviation assistance. This function is assigned by the executive authority of the subject of the Russian Federation in health care. To implement this function, a dispatcher is created in this medical institution, which provides round-the-clock duty. It accepts and registers calls from the subjects of the country, maintains a constant contact with the department, the manager of sanitary aviation, as well as with medical specialists who have left for the assignment. The composition of the specialized visiting teams includes the most experienced, qualified medical personnel. Employees of medical universities and research institutions work here. Hospital administrators agree, and the relevant health authorities approve the list of doctors working in the ambulance service.

    For several decades, the form of the "Ambulance" service has been constantly changing. It is currently planned to establish a coordination and dispatching service for emergency assistance to the population in many regions of the country. Management of this service should be centralized and automated at all stages. The tasks of the coordination and dispatching services include: improving the quality of emergency care, reducing the arrival time of visiting teams, ensuring the stage of patient care. The management of this medical organization is carried out by the head of the coordination and dispatching service. This contributes to the centralized management of medical services: ambulance, emergency services, a specialized brigade, including aviation. The activity of the control and dispatching service is constantly being improved. The emergency services are actively working in this direction. Together with the doctors of the ambulance, they quickly provide immediate assistance to patients, clarify the diagnosis and decide on the question of hospitalization, using modern means of communication. The effectiveness of this activity depends on the quality of equipping the ambulance machines with communication equipment.

    On March 26, 1999, an important document was adopted - the order of the Ministry of Health of Russia "On the improvement of the organization of emergency medical care for the population of the Russian Federation", regulating the activities of medical workers of this service. There is an Advisory Board of the Ministry of Health of Russia for emergency medical care, consisting of the best specialists and scientists in Russia. The creation of the Council facilitated the development of the entire service of the Emergency Medical Service and the improvement of the quality of professional activities.

    On March 14, 2002, the Ministry of Health of Russia issued Order No. 265 "On the organizational and methodological department of the ambulance station", which helped to unite and centralize all the activities of the First Aid services. However, in Russia, more specifically - in Moscow and St. Petersburg - there are independent stations and departments of the "First Aid".

    This work is regulated by a system of contracts. Further development of the control and dispatching system is carried out in close cooperation with other law enforcement agencies: the State Traffic Safety Inspectorate, the Internal Affairs Directorate, the National Security Service, firefighters and the Ministry of Emergency Situations, which will facilitate more prompt actions in emergency situations.

    In order to improve this system, it is necessary to unite the district ambulance stations to regional and regional levels. For this, it is necessary to conduct a professional analysis of the existing system of rendering emergency medical care in the region, to create special programs for the development of the service in the following sections: strengthening the material and technical base of this system of services;a qualitative change in the training of emergency medical personnel;possession of the basics of emergency assistance by all rescue services,

    by all road users, both drivers and pedestrians;when providing emergency care, intensive use of intensive care teams, doctors of a narrow profile;improve the control system when using automation and electronics;lead emergency care to the patient in accordance with the rules and regulations. In addition, it is important to develop quality standards for the work performed;clearly execute the job descriptions of the employees of this service, help them improve their skills.

    The Russian ambulance system enjoys well-deserved authority both abroad. Every year, the number of people appeals to emergency medical services, especially in large cities.

    Today in this service there is a certain shortage of personnel, especially in the diagnostic departments, so necessary for literate

    first aid. A particularly acute situation develops in rural areas. The system of first aid service is in dire need of improvement and development."The program of state guarantees for providing citizens of the Russian Federation with free medical assistance" provides for the timely provision of first aid to the population, but there are significant difficulties. The population is not always on time and qualified to get free first aid. The growth of natural anomalies, technogenic catastrophes entails significant human casualties, and this implies a qualitative organization of emergency medical care, which is far from perfect today. Low and the level of legal and social, financial and material services in these situations. In addition, the medical service of the emergency care system is in dire need of modern diagnostic devices, in high-quality medical equipment. From this depends the most important thing for a person - life.