Feldsher

An important part of the activity of medical assistants is the provision of medical care for patients at home. The order of treatment of patients at home is determined by the doctors of the district hospital or the central district hospital( CRH) and only in some cases by the paramedic himself. Patients left at home should be monitored continuously until they recover. This especially applies to children. Patients from remote settlements from FAP should be hospitalized;while leaving the patient at home, the paramedic will notify the doctor of the rural medical unit and monitor the patient.

In the outpatient care of patients with tuberculosis, the paramedic, as the direct executor of medical appointments, conducts immunochemical prophylaxis, medical examination, anti-epidemic measures in the outbreaks of tuberculosis infection, hygiene education, etc.

A paramedic working for the FAP should have the simplest reanimation methods at the prehospital stage, especiallywith sudden cardiac arrest or breathing, the causes of which can be severe trauma, blood loss, acute myocardial infarction, poisoningNiya, drowning, electrocution. On feldshers and midwives, working independently, is also entrusted with the provision of emergency medical care for acute illnesses and accidents. In case of emergency call, the paramedic must carry a suitcase, completed with medical instruments and medicines according to the list of stowage.

A big role belongs to paramedics in the medical examination of the rural population. Its main goal is to implement a set of measures aimed at the formation, preservation and strengthening of public health, preventing the development of diseases, reducing morbidity, increasing active creative longevity.

For the purpose of universal medical examination, the entire population living in the polyclinic, outpatient clinic and FAP service area is personally monitored in accordance with the "Instruction on the Procedure for Accounting for the Annual Clinical Screening of the Whole Population".In rural areas, the lists of residents are made up of the average medical workers of the FAP.

For the individual registration of each resident, the average medical workers fill in the "Medical examination book"( study form No. 131 / у - 86) and number it in accordance with the number of the medical card of the outpatient( registration form No. 025 / y).After clarifying the composition of the population, all the "Clinical check-up cards" are transferred to the card file.

A paramedic or midwife makes sure that patients who need seasonal( autumn, spring) anti-relapse treatment receive it in a hospital or outpatient in a timely manner. An appropriate organization for examining temporary incapacity for work at the FAP is important for reducing the incidence.

In accordance with the "Provision on the head of the feldsher-midwife point", the head of the FPP paramedic may have the right to issue sick leave lists, certificates and other medical documents in the order established by the Ministry of Health of the Russian Federation.

The basis for granting the nature of the issuance of sickness cards to the paramedic is the petition of the district chief doctor, in which:

• the distance from the hospital( outpatient clinic) to which he is assigned;

• number of serviced settlements of the sovkhoz and the number of employees in them;

• state of the routes of communication;

• the length of service of a paramedic and the level of his qualification;

• knowledge and observance by the feldsher of the basics of temporary disability examinations and the "Instruction on the procedure for the issue of sick leave sheets".The medical assistant keeps records of the issued sick leaves in the "Book of registration of the sheets of incapacity for work"( form No. 036 / y) with the mandatory completion of all of its counts.

Treatment and preventive care for women and children. At each FLP, a paramedic( midwife) maintains a personal record card of women starting from the age of 18, where passport data, past illnesses, information on all pregnancies( years, than each pregnancy, complications) end. Examination of each pregnant woman at the first treatment of a paramedic( midwife) begins with a general examination, measures length and body weight, arterial pressure on common arms, within the limits of her competence determines the condition of the heart, lungs and other organs, examines urine for protein. While monitoring the pregnant women, the paramedic( midwife) of the FAP is obliged to show each of them to the doctor;in cases where the woman shows the slightest deviations from the normal development of pregnancy, she should be immediately directed to the doctor.

One of the important sections of FAP's medical assistants' activities is the provision of primary antiepidemic measures in the emergence of foci of infectious diseases, the timeliness and quality of which determine the effectiveness of preventing the spread of infection beyond the outbreak. In this regard, the organization of the activity of the FLP staff, aimed at the detection of infectious diseases among the population, is of great importance.

When determining the diagnosis of an infectious disease( or suspected of it), the average medical personnel of the FAP should:

• conduct primary antiepidemic measures in the outbreak;

• isolate the patient at home and organize routine disinfection before hospitalization of the patient;

• identify all persons who have come into contact with the patient, take them on record and set up medical supervision for them;

• carry out( together with a doctor) quarantine measures for persons who have been in contact with sick persons, who attend preschool institutions, schools or work in epidemically important facilities;

• report at the place of work, study, to preschool institutions, at the place of residence about the person who fell ill and who contacted him;

• as directed by a pediatrician or epidemiologist to perform gamma-globulin prophylaxis in contact with a patient with viral hepatitis A.

An infectious patient is hospitalized during the first day of the disease on a special vehicle. In his absence, the patient can be transported on any transport with subsequent disinfection. In the future, the medical officer of the FAP follows the instructions of the epidemiologist( epidemiologist assistant) and implements:

• collecting material from persons who have been in contact with patients for a laboratory study to detect bacterial carriers;

• Inoculations for epidemiological indications and chemoprophylaxis;

• Dynamic monitoring of persons who have been in contact with patients during the incubation period of the infectious disease.

Feldshers and midwives of the FAP play an important role in conducting health-improving activities, hygienic education of the rural population and promoting healthy lifestyles. To properly assess the level of well-being of the facility, paramedics are taught the simplest laboratory analyzes, express methods and supply them with marching express laboratories. With the help of such a laboratory, it is possible to determine residual amounts of chlorine in disinfecting solutions, on objects and surfaces( iodine starch method), residual amounts of detergents on tableware( phenolphthalein test).

Feldsher FAP often has to take part in the analysis of occupational injuries and the development of measures to reduce it, so he should be well acquainted with the main causes of injury: technical, organizational and sanitary-hygienic. More than half of all victims are referred to the FAP, therefore, the average medical staff needs constant improvement of knowledge, in particular, in the provision of first aid for injuries. In addition to providing first aid to the victim, the FAP paramedics perform registration and recording of injuries;identify, study and analyze their causes, depending on various factors;together with doctors develop specific measures to eliminate the identified causes;monitor compliance with safety regulations;train agricultural workers in the methods of first aid.

When working as part of a medical team, the medical assistant fully submits to the doctor during the call. Its task is to fulfill all appointments clearly and quickly. Responsibility for the decisions made lies with the doctor. The paramedic should possess the technique of subcutaneous, intramuscular and intravenous injections and ECG recording, be able to quickly establish a system for drip fluid administration, measure blood pressure, count the pulse and the number of respiratory movements, insert an airway, conduct cardiopulmonary resuscitation, etc. He must also be able to impose a tireand bandage, stop bleeding, know the rules of transportation of patients.

In the case of independent work, the paramedic of the First Aid is fully responsible for everything, so he must fully know the methods of diagnosis at the prehospital stage. He needs knowledge on emergency therapy, surgery, traumatology, gynecology, pediatrics. He must know the basics of toxicology, be able to independently take delivery, assess the neurological and mental state of the patient, not only to register, but also to estimate the ECG tentatively.

Appendix No. 10 to the order of the Ministry of Health of the Russian Federation No. 100 of 26.03.99

"Regulations on the paramedic of the ambulance ambulance"

I. General provisions

1.1.For the post of paramedic brigade "Emergency Medical Care" appointed specialist with secondary medical education in the specialty of "Medical Business", having a diploma and a corresponding certificate.

1.2.In the performance of duties in the provision of emergency medical care as part of the paramedic brigade, the paramedic is the responsible performer of the whole work, and as part of the medical team acts under the guidance of a doctor.

1.3.The paramedic of the ambulance brigade of the Emergency Medical Service is guided by the legislation of the Russian Federation, the normative and methodological documents of the Ministry of Health of the Russian Federation, the Statute of the Emergency Medical Service Station, orders and orders of the station administration( substation, department), this Regulation.

1.4.The paramedic of the ambulance brigade of the Emergency Medical Service is appointed and dismissed in accordance with the procedure established by law.

II.Obligations of

The paramedic of the ambulance brigade of the Emergency Medical Aid is obliged to:

2.1.Ensure the immediate departure of the brigade after receiving the call and its arrival at the scene of the incident within the established time limit in the given territory.

2.2.Provide emergency medical care to patients and injured at the scene and during transportation to hospitals.

2.3.To introduce medications to patients and victims for medical reasons, stop bleeding, carry out resuscitation measures in accordance with the approved industry standards, rules and standards for paramedic emergency medical personnel.

2.4.To be able to use the available medical equipment, own the technique of imposing transport tires, bandages and methods of conducting basic cardiopulmonary resuscitation.

2.5.Own the technique of removing electrocardiograms.

2.6.Know the dislocation of treatment and prevention facilities and service areas of the station.

2.7.Ensure the patient is carried on a stretcher, if necessary, take part in it( in the conditions of the work of the team, the patient is carried on a stretcher as a kind of medical aid).When transporting a patient, stay next to him, carrying out the necessary medical care.

2.8.If it is necessary to transport the patient unconscious or in a state of intoxication, inspect for documents, valuables, money, indicating in the "Call Card", hand them over to the inpatient department of the hospital with a mark in the direction of the attendant list.

2.9.When providing medical assistance in emergency situations, in cases of injuries of a violent nature, act in accordance with the procedure established by law( report to the internal affairs bodies).

2.10.Provide infectious safety( observe the rules of sanitary and hygienic and anti-epidemic regime).If a patient has a quarantine infection, provide him with the necessary medical care, observing the precautionary measures, and inform the senior physician of the shift about the patient's clinical, epidemiological and passport data.

2.11.Ensure proper storage, registration and write-off of medicines.

2.12.When the watch is over, check the state of the medical equipment, transport tires, replenish the medicines consumed during the operation, oxygen, nitrous oxide.

2.13.Inform the administration of the ambulance station about all emergencies that occurred during the call.

2.14.At the request of the internal affairs officers to stop for emergency medical care, regardless of the location of the patient( victim).

2.15.Maintain approved accounting and reporting documentation.

2.16.In accordance with the established procedure, to improve their professional level, improve their practical skills.

III.Rights

The paramedic of the ambulance brigade of the Emergency Medical Service has the right:

3.1.Call in case of need to help the medical team of the Emergency Medical Service.

3.2.Make suggestions on improving the organization and provision of emergency medical care, improving the working conditions of medical personnel.

3.3.To improve their qualification in the specialty at least once every five years. To pass in the established order attestation and re-attestation.

3.4.To participate in the work of medical conferences, meetings, seminars, conducted by the administration of the institution.

IV.Responsibility of

The paramedic of the ambulance brigade of the Emergency Medical Service is liable in accordance with the procedure established by law:

4.1.For the ongoing professional activities in accordance with the approved industry standards, rules and standards for paramedical personnel of the Emergency Medical Service.

4.2.For unlawful acts or omissions resulting in damage to the patient's health or death.

In accordance with the order of the Ministry of Health of the Russian Federation No. 100, exit brigades are divided into paramedic and medical. The paramedic brigade includes two paramedics, a paramedic and a driver. The medical team includes a doctor, two paramedics( either a paramedic and an anesthetist's nurse), a paramedic and a driver.

The tactics of the behavior of the paramedic of the "First Aid" during the call. Personnel of the "First Aid", including paramedics, works in very difficult conditions. During the call, the paramedic can face any, the most unexpected pathology. He needs to have a broad outlook, to have knowledge from a wide range of medical fields, to be able to quickly navigate in a difficult situation, keep cool, and in a short time make the right decision. For this purpose, only one special preparation is not enough, certain moral qualities, good health and life experience are also required.

One of the main difficulties is that at the moment of going to the call, it is never absolutely certain what lies ahead. A "heart attack" can turn into anything - from hysterics to poisoning with pills, and when leaving for a hand injury on the spot, it may be a patient with a gunshot wound, massive blood loss and shock. Therefore, the paramedic must be constantly ready for any situations. But one should not maintain oneself in a state of nervous tension for a long time - one must be able to quickly orientate and mobilize, having arrived to the place.

Already approaching the place of the call, you need to start watching and drawing conclusions. Meet you or not;what the meeting looks like - worried, tearful, anxious or indifferent-unhurried;Whether they are in a state of intoxication, do not they look strange for these circumstances. There are no general laws, but as a rule, when something really serious happens, the ambulance is met on the street. Unusual behavior can lead to the idea of ​​the insincerity of those who caused it. In case of departure on obviously criminal case( fights, riots, etc.) it is necessary to demand police escort.

The meeting should be skipped ahead, let him show the way. On the way, you should start questioning to clarify what happened.

Arriving to the patient, you need to quickly assess the situation. The collection of anamnesis in conditions of first aid has its own peculiarities. It should be carried out purposefully. It is not necessary at the outset to admit lengthy stories about the history of life, marriage and a variety of chronic ailments. It is necessary to find out what happened right now, everything else - then and if necessary. Often, chronic patients abusing the "First Aid" without sufficient grounds, this is stalling. At the same time, a person who is really seriously ill can become confused, frightened, unable to immediately find the right words. This should be helped. One should not only go about the patient, but also suppress it, adjust his complaints to his( perhaps incorrect) idea of ​​the nature of the disease. It is necessary to ask, with what the patient connects his own condition, but his answer is critical.

After finding out the picture of the incident, it is necessary to find out whether this condition first appeared or had already happened, what helped then what diagnosis was made, what other diseases the patient is suffering, whether there are any medical documents( outpatient card, hospital discharge, survey results).

Simultaneously with the collection of anamnesis, one must begin the examination( count the pulse, measure BP, palpate the stomach, etc.).

If a small child is sleeping, it is better to carefully palpate the stomach first, and then wake him and conduct a further examination. Inspecting yawning in restless children should be the last thing, since this unpleasant procedure can make contact with the child difficult for a long time.

In the case of injuries, the injury site should first be inspected, simultaneously evaluating the patient's general condition, and then proceeding to a survey of organs and systems.

For the collection of anamnesis and examination in the conditions of an ambulance, 5-10 minutes are given. But sometimes there are not even them! After this, we must draw conclusions, put a preliminary diagnosis and decide on the provision of assistance.

At the bedside patient should behave in a friendly, correct, but efficient and firm manner. You can not tolerate familiarity or condescending attitude on the part of relatives or a patient, especially rudeness. All actions must be clear, confident, it is necessary to inspire the patient with all their kind of calm.

Before you do injections or give pills, you need to find out if the patient has allergies to these medications.

It is especially difficult in the moral sense to face challenges to the street or other public place about car accidents, falls from a height or sudden serious illnesses, when an excited crowd gathers around, usually negatively or even aggressively towards the employees of the First Aid. People in such a situation do not adequately assess what is happening. At the scene of the incident, there may be other employees of the ambulance. Their advice should be heeded, take help. During transportation to the hospital, you should not take more than one escort into the car. If you have to hospitalize a drunk or aggressive patient, you should put it or put it in such a way that it can not reach the feldsher unexpectedly and quickly. If the ambulance was stopped on the way to a call to help another patient and he really needs it, you should inform the dispatcher that the first call is transferred to another team.

After the medical help has already been given, it is necessary to explain to the patient what has happened to him, how to behave in such a case next time, to give general recommendations for the treatment and prevention of this disease. If necessary, transfer the active call to the local doctor( when the patient is not hospitalized for any reason, but requires dynamic observation) or the medical team( when the patient in serious condition requires specialized help or the picture of the disease is not completely clear and you are not sure of the diagnosis).

The principle of the medical assistant( and the doctor) of the "First Aid" is hyperdiagnostics. The severity of the patient's condition is better to be overestimated than underestimated.

In organizing its health education, the medical assistant along with the traditional methods of educating the population on health issues( such as interviews, group discussions, lectures, thematic evenings, question and answer evenings, round-table discussions, oral journals, health schools, publicationsin the press, in the conference) widely uses also methods of visual agitation: wall newspapers;sanlets;exhibitions and health corners;book exhibitions.

The sanitary bulletin is an illustrated sanitary and educational newspaper devoted to only one topic. The topics should be relevant and selected in the light of the challenges facing modern healthcare, as well as the seasonality and epidemiological situation in the region. The title is shown in large print. The name should be interesting, intriguing, it is advisable not to mention the word "illness" and "prevention".

The San-Bulletin consists of two parts - text and illustrated. The text is placed on a standard sheet of the paper in the form of columns, 13-15 cm in width, printed on a typewriter or a computer. It is allowed to write the text with a calligraphic handwriting paste of black or purple. It is necessary to single out an advanced article or an introduction, the rest of the text should be divided into subsections( headings) with subtitles in which they state the essence of the questions and give practical advice. Noteworthy is the submission of material in the form of questions and answers. The text should be written in a lucid language for the broad masses without medical terminology, with the obligatory use of local material, examples of proper hygienic behavior in relation to one's health, cases from medical practice. Artwork: drawings, photographs, applications should illustrate the material, but do not duplicate it. A drawing can be one or more, but one of them - the main one - should carry the main semantic load and attract attention. Text and decoration should not be cumbersome. The sanitary bulletin ends with a slogan or appeal.

It is necessary to ensure the release of the sanitary bulletin at least 1-2 times per quarter.

Health Corner. The organization of the corner must be preceded by a certain preparatory work: agreement with the leadership of this institution;the definition of the list of works and necessary building materials( stands, slats, buttons, glue, cloth, etc.);a choice of a place - such, where constantly or often there is a mass of people;a selection of relevant illustrated material( posters, photo and literature exhibitions, transparencies, photographs, memos, leaflets, clippings from newspapers and magazines, drawings).

The leading topic of health is the different aspects of a healthy lifestyle. In the event of the emergence of an infection or its threat in a given locality, appropriate prevention material should be placed in the corner. This can be a sanitary bulletin, a leaflet prepared by the local sanitary and epidemiological supervision agency, a brief memo, a clip from a medical newspaper, etc. The health corner should have a question and answer board. Answers to questions should always be timely, prompt and useful.

Oral logs. In the oral journals, in addition to medical workers, traffic police officers, juvenile inspectors, and lawyers should participate. In their reports, they are addressing not only medical issues, but also affecting legal, social and moral problems. Therefore, in oral journals you can consider several topics at once.

Disputes and conferences. Dispute is a method of polemical discussion of an actual, moral or educational problem, a method of collective search, discussion and resolution of issues of concern to the population. Dispute is possible when well prepared, when it involves not only specialists, but also( for example, in school) students, teachers. Clashes, the struggle of opinions are related to differences in the views of people, life experience, in inquiries, tastes, knowledge, in the ability to approach the analysis of phenomena. The purpose of the dispute is to support the progressive opinion and convince everyone of the rightness.

A form of propaganda close to a dispute is a conference with a pre-designed program and fixed speeches by both professionals and the public.

Oral forms of sanitary and educational propaganda are also classified as theme nights, round-table discussions, question and answer evenings. A big role in the promotion of a healthy lifestyle can be played by theatrical and entertainment events, mass sports events. The content of the work in carrying out various forms and methods of hygienic education of the population and promoting healthy lifestyles at the FAP should be aimed at covering the basics of personal and public hygiene, hygiene of the village, village, home, improvement and gardening, maintenance of personal plots;on struggle against pollution of environment;prevention of diseases caused by exposure to adverse weather conditions( high humidity, high and low temperatures, etc.);on the introduction of physical culture in the everyday life of every person. The range of these activities includes also labor and professional orientation: the creation of healthy household and production conditions, the formation of a healthy lifestyle. Great attention should be paid to the prevention of infectious diseases, improving water supply and water use. One of the important tasks is the promotion of occupational health measures in agricultural work, the prevention of agricultural traumatism and poisoning with pesticides, the clarification of hygienic requirements for the delivery, purification and storage of water in the field. An important place should be occupied by anti-alcohol propaganda, explanation of the harm of smoking. Smoking is one of the most common types of addiction. The work of a paramedic on anti-alcohol propaganda should be based on a certain system, including legal, medical-biological and moral aspects.

Depending on the gender and age, you can select topics for better listening.

1. For men: the effect of alcohol on all organs and systems of the body;alcohol and trauma;alcohol and venereal diseases;alcohol and mortality;alcohol and work capacity;alcohol and family;alcohol and heredity;economic damage to the state from people who abuse alcohol.

2. For women: the effect of alcohol on the woman's body;the effect of alcohol on pregnancy;alcohol and children;The role of women in strengthening the family and overcoming the drunkenness of men.

3. For adolescents: anatomical and physiological characteristics of the adolescent organism;the effect of alcohol on the teenager's body;the effect of alcohol on the ability of the adolescent;the effect of alcohol on offspring;alcohol and violation of law and order;how to maintain mental health.

A large section of preventive work on the education of a healthy lifestyle should be highlighted in pediatrics. Hygienic training and education begins with early childhood, with antenatal protection of future offspring.

It is advisable to educate a healthy lifestyle and prevent various diseases with pregnant women on antenatal patronages and group sessions in the form of individual interviews( for example, in the "School of Pregnant Women").Conversations about the hygiene of a pregnant woman and the features of the newborn period should preferably be conducted not only among women themselves, but also among members of their families, especially husbands in the School of Young Fathers.

The need for extensive preventive measures in relation to the child population and youth, including primarily educational and sanitary measures, is also increasing due to the fact that at this age the basic behavioral attitudes, attitudes, habits, habits, etc., are formed,e. everything that later determines the way of life of a person. During this period, you can prevent the emergence of bad habits, emotional intemperance, the installation of passive rest and inadequate nutrition, which can later become a risk factor for many diseases. It is relatively easy for children to develop a habit of motor activity, physical education and sports, diverse and moderate nutrition, and a rational regime.

Sanitary-enlightenment work at the FAP should be carried out in accordance with a prearranged plan. Drafting of the plan of sanitary-educational work is carried out for the whole current year and for a month. In the annual plan, the main tasks are to protect health and promote healthy lifestyles, and for each month make up a specific plan with the names of topics and methods for their coverage. At the end of the month and at the end of the reporting year, the medical worker is required to report for the done sanitary and educational work.

Hygienic education of the population and promotion of healthy lifestyles should promote early access to medical care, improve maternity rates, reduce child mortality, morbidity with temporary disability and injury, timely hospitalization of patients, attracting the population for preventive examinations, improving the level of sanitary culture of the population,conditions of their work and life, the activation of people's creative initiative in matters of preserving and strengtheninghealth, increased efficiency and creative longevity.