Ambulance point. What is emergency care. Emergency medical help arrives if you have

), who found himself helpless in the face of disaster. He could not provide effective and proper assistance to people randomly lying on the snow. The very next day, Dr. J. Mundi set about creating the Vienna Voluntary Rescue Society. Count Hans Gilczek (ur. Johann Nepomuk Graf Wilczek ) donated 100,000 guilders to the newly founded 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 very first year of its existence, the Vienna Ambulance Station provided assistance to 2067 victims. The team consisted of doctors and students of the medical faculty.

Soon, like Vienna, a station in Berlin was created by Professor Friedrich Esmarch. The activities of these stations were so useful and necessary that for short period in a number of cities in 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 attributed to 1898. Until that time, the victims, who were usually picked up by policemen, firefighters, and sometimes cabbies, were taken to the emergency rooms at police houses. Necessary in such cases medical checkup was absent from the scene. Often severely injured people spent hours without proper care in police houses. Life itself demanded the creation of ambulances.

The ambulance station in Odessa, which began its work 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.

Interestingly, from the very first days of the work of the Moscow Ambulance, a type of brigade was formed that has survived with minor changes to the present day - doctor, paramedic and orderly. Each Station had one carriage. Each carriage was equipped with a stowage with medicines, tools and dressings. Only officials had the right to call an ambulance: a policeman, a janitor, a night watchman.

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

In St. Petersburg, each of the 5 ambulance stations was equipped with two double-horse carriages, 4 pairs of manual stretchers and everything necessary for first aid. At each station, 2 orderlies were on duty (there were no doctors on duty), whose task was to transport the 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 first aid business 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 ambulance.

In 1912, a group of doctors of 50 people agreed to travel free of charge on a call from the Station to provide first aid.

Since 1908, the Society of Emergency Medicine has been established by volunteer enthusiasts on private donations. For several years, the Society unsuccessfully tried to re-subordinate the police ambulance stations, considering their work to be insufficiently effective. By 1912, in Moscow, the Ambulance Society bought the first ambulance equipped according to the project of Dr. Vladimir Petrovich Pomortsov with private funds raised, and the Dolgorukovskaya ambulance station was created.

Doctors worked at the station - members of the Society and students of the medical faculty. 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 car was based is unknown.

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

In St. Petersburg, 3 Adler ambulances (Adler Typ K or KL 10/25 PS) were purchased in 1913, and an ambulance station was opened on 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 archives of the company, in particular the sales sheets, which recorded all the cars sold with the addresses of the customers, burned down in 1945 during the American bombing.

During the year, the Station made 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 the days February Revolution In 1917, an ambulance detachment was created, from which Ambulance and ambulance transport was again organized.

On July 18, 1919, the collegium 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 the post office doctor Vladimir Petrovich Pomortsov (by the way, the author of the first Russian ambulance car - a city ambulance model 1912), decided to organize an ambulance station in Moscow. Dr. Pomortsov became the first head of the station.

Under the premises for the station, three rooms were allocated in the left wing of the Sheremetyevskaya hospital (now the Sklifosovsky Research Institute for Emergency Medicine).

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

Ambulances then served only accidents in factories and factories, streets and public places. The brigade was equipped with two boxes: therapeutic (medicines were stored in it) and surgical (a set of surgical instruments and dressing material).

In 1920, V.P. Pomortsev was forced to leave his work in an ambulance due to illness. The ambulance station began to operate as a hospital department. But the available capacities were clearly not enough to serve the city.

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

First of all, the Station was merged with the Tsentropunkt to form the Moscow Ambulance Station. The second car was handed over from the Center

For the expedient use of crews and transport, the isolation of really life-threatening conditions from the flow of applications to the Station, the position of senior doctor on duty was introduced, to which professionals were appointed who were able to quickly navigate the situation. The position is still held.

Two brigades, of course, were clearly not enough to serve Moscow (in 1922, 2129 calls were serviced, in 1923 - 3659), but the third brigade could be organized only in 1926, the fourth - in 1927. In 1929, 14,762 calls were serviced with four brigades. The fifth brigade began to work in 1930.

As already mentioned, in the early years of its existence, an ambulance in Moscow served only accidents. Those who fell ill at home (regardless of severity) were not served. An emergency room for suddenly ill people at home was organized at the Moscow Ambulance Service in 1926. Doctors went to the patients on motorcycles with sidecars, then in cars. Subsequently, emergency care was separated into a separate service and transferred to the district health departments.

Since 1927, the first specialized team has been working at the Moscow ambulance - a psychiatric team that went to "violent" patients. In 1936, this service was transferred to a specialized psychiatric hospital under the leadership of the city psychiatrist.

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

Ambulance service in Russia

Ambulance duties also include alerting local law enforcement about so-called criminal injuries (for example, knife and gunshot wounds) and local governments and emergency response services about all emergencies (fires, floods, automobile and man-made disasters etc).

Structure

Head of the ambulance station 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 major stations have in their composition various departments and structural divisions.

Central city ambulance station

The ambulance station can operate in 2 modes - everyday and in emergency mode. In emergency mode, the operational management of the station is transferred to the territorial center for disaster medicine (TTsMK).

Operations department

The largest and most important of all the divisions of large ambulance stations is the operations department. It is on his organization and diligence that all the operational work of the station depends. The department is negotiating with persons calling ambulance, accepts a call or refuses it, transfers orders for execution to field teams, controls the location of teams and ambulance vehicles. Head of department senior doctor on duty or senior shift doctor. In addition to it, the division includes: senior dispatcher, direction dispatcher, hospitalization dispatcher and medical evacuators.

The senior doctor on duty or the senior doctor of the shift manages the duty personnel of the operational department and the station, that is, all the 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 field doctors, doctors of outpatient and inpatient medical institutions, as well as with representatives of the investigation and law enforcement agencies and emergency response services (firefighters, rescuers, etc.). All issues related to the provision of emergency medical care are decided by the senior doctor on duty.

The senior dispatcher manages the work of the dispatcher, manages the dispatchers by direction, selects cards, grouping them by areas of receipt and by urgency, then he hands them to subordinate dispatchers to transfer calls to regional substations, which are structural divisions of the central city ambulance station, and also monitors location of field teams.

The dispatcher in the directions communicates with the duty personnel of the central station and regional and specialized substations, transfers the call addresses to them, controls the location of the ambulance vehicles, the working hours of the field personnel, keeps records of the execution of calls, making appropriate entries in the call records.

The hospitalization manager distributes patients to inpatient medical institutions, keeps records of vacant places in hospitals.

Medical evacuators or ambulance dispatchers receive and record calls from the public, officials, law enforcement agencies, emergency response services, etc., filled out call records are transferred to the senior dispatcher, in case of any doubt about a particular call, the conversation is switched to senior shift physician. 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 the sick and injured at the request (referral) of doctors from hospitals, polyclinics, trauma centers and heads of health centers to inpatient medical institutions, distributes patients to hospitals.

This structural unit is headed by a doctor on duty, it includes a registry and a dispatch service that manages the work of paramedics who transport the sick and injured.

Department of hospitalization of women in labor and gynecological patients

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

This division carries out both the organization of the provision, the 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 public, representatives of law enforcement agencies and emergency response services. Information about “emergency” women in childbirth flows here from the operational department.

The outfits are performed by obstetrics (the composition includes a paramedic-obstetrician (or, simply, an obstetrician (midwife)) and a driver) or obstetric-gynecological (the composition 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 (obstetric-gynecological) substations.

This department is also responsible for the delivery of consultants to gynecological departments, departments of obstetrics and maternity hospitals for emergency surgical and resuscitation interventions.

The department is headed by a senior physician. The department also includes registrars and dispatchers.

Department medical evacuation and transportation of patients

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

Infectious department

This department is engaged in the provision of emergency medical care for various acute infections and the transportation of infectious patients. He is in charge of the distribution of beds in infectious diseases hospitals. It has its own transport and mobile teams.

Department of Psychiatry

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

Department of TUPG

Department of Transportation of the Dead and Lost Citizens. Official name corpse transportation services. Has its own control room.

Department of Medical Statistics

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

Communication department

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

Inquiry Office

Inquiry Office or, otherwise, information desk, information desk is intended for issuing reference information about patients and victims who received emergency medical care and / or who were hospitalized by ambulance teams. Such certificates are issued by a special hotline or during a personal visit of citizens and/or officials.

Other divisions

An integral part of both the central city ambulance station, and regional and specialized substations are: economic and technical departments, accounting, personnel department and pharmacy.

Immediate emergency medical care for the sick and injured is provided by mobile teams (See below Types of teams and their purpose) of both the central city station and regional and specialized substations.

District ambulance substations

District (in the city) emergency substations, as a rule, are located in a solid building. In the late 1970s and early 1980s, standard designs of ambulance stations and substations were developed, which provide premises for doctors, nurses, drivers, a pharmacy, household needs, locker rooms, showers, etc.

The location of the substations is chosen taking into account the number and density of the population in the area of ​​departure, the transport accessibility of the remote ends of the area of ​​departure, the presence of potentially "dangerous" facilities where emergencies (emergency situations) may occur, and other factors. The boundaries between the departure areas of neighboring substations are established taking into account all the above factors, in order to ensure a uniform call load for all neighboring substations. The boundaries are rather arbitrary. In practice, crews very often go to the areas of neighboring substations, "to help" their neighbors.

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

Substation Manager carries out general management, hiring and dismissal of employees (his consent or disagreement for resolving personnel issues is mandatory), controls and directs the work of all substation personnel. Responsible for all aspects of its substation operations. He reports on his activities to the chief physician of the Ambulance Station or the Director of the Region (in Moscow). In Moscow, several neighboring substations are combined into "regional associations". The head of one of the substations in the region simultaneously holds the position of the Director of the region (with the rights of the deputy chief physician). Regional director solves current issues, signs documents on behalf of the chief physician, controls the work of managers in his region. For example, for hiring or dismissal, you do not need to go with a statement personally to the head doctor (although it is in the name of the head doctor) - the signature of the head of the substation, the signature of the director of the region and the personnel department. The chief doctor regularly holds meetings with the directors of the regions (substations in the city - 54, regions - 9).

Senior doctor of the substation responsible for controlling clinical work. Reads brigade call cards, parses complex clinical cases, examines complaints about the quality of medical care, makes a decision to submit a case for analysis to the CEC (clinical expert commission) with a possible subsequent imposition of a penalty on the employee, is responsible for improving the skills of employees and conducting training sessions with them, etc. In 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.

Substation Shift Senior Physician carries out operational management of the substation, replaces the head in the absence of the latter, controls the correctness of the diagnosis, the quality and volume of emergency medical care provided, organizes and conducts scientific and practical medical and medical assistant conferences, promotes the introduction of the achievements of medical science into practice. There is no shift for a senior doctor in Moscow. His functions are performed by the senior doctor of the substation, the senior doctor of the operational department and the dispatcher of the substation (each within their competence). In Moscow, in the absence of the head and senior doctor of the substation, the senior at the substation - the dispatcher, reports to the senior doctor on duty of the operational department.

Senior paramedic Formally, he is the head and mentor of the substation's paramedical and maintenance personnel, but his real duties far exceed these tasks. His responsibilities include:

• drawing up a schedule of duty for a month and a schedule of vacations 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 console" of the operational department);
• training employees in the proper operation of expensive equipment;
• ensuring the replacement of worn-out equipment with new ones (together with the defector);
• participation in the organization of the supply of medicines, linen, furniture (together with the defector and the hostess);
• organization of cleaning and sanitation of premises (together with the hostess sister);
• control of the terms of sterilization of reusable medical instruments and equipment, dressings, control of the expiration dates of drugs in packing at the teams;
• keeping records of the working hours of the substation personnel, sick leave, etc.;
• preparation of a very large volume of various documents.

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

According to the level of "real power" (including in relation to doctors), the senior paramedic is the second person at the substation, after the head. With whom the employee will work as part of the brigade, go on vacation in winter or summer, will work at a rate or "one and a half" rates, what will be the work schedule, etc. - all these decisions are made solely by the senior paramedic, the head of these decisions is usually does not interfere. The chief paramedic has an exceptional influence on creating a favorable working environment and on the “moral climate” in the substation team.

Senior paramedic for AHO(pharmacy) - the official name of the position, "popular" names - "pharmacist", "defector". "Defectar" is a name commonly used in all but official documents. The defector takes care of the timely supply of mobile teams with medicines and tools. Every day, before the start of the shift, the defector checks the contents of the packing boxes, replenishes them with the missing medicines. His duties also include the sterilization of reusable instruments. Prepares documentation related to the consumption of medicines and consumables. Regularly travels to the warehouse "to get a pharmacy." Usually replaces the senior paramedic when he is on vacation or on sick leave.

For the storage of a stock of medicines, dressings, tools and equipment determined by the standards, a spacious, well-ventilated room is allocated for the pharmacy. The room must have an iron door, bars on the windows, alarm systems - the requirements of the Federal Drug Control Service (Federal Drug Control Service) for rooms for storing registered medicines.

In the absence of the position of a defector or if his place is vacant for any reason, his duties are assigned to the senior paramedic of the substation.

PPV Paramedic(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 by phone "03" from the population, and then, in order of priority, transfers orders to mobile teams. There are at least two PPV paramedics on duty shift. (minimum - two, maximum - three). In Moscow, the reception and transmission of calls are fully computerized - ANDSU (computer control system) and the AWP "Brigada" complex (navigators and communication devices for brigades) work. The participation of the dispatcher in the process is minimal. The call transfer time from the moment of calling on "03" to the moment the team receives the card takes about two minutes. When transferring a call in the traditional "paper" way, this time can be from 4 to 12 minutes.

Before the start of the shift, the substation dispatcher reports to his dispatcher of the direction of the operational department (he is also the dispatcher of the region, in Moscow, see above) about the car numbers and the composition of the mobile teams. The dispatcher writes the incoming call to approved by the Ministry of Health, a call card form (in Moscow - the card is automatically printed on a printer, the dispatcher only indicates which team to assign an outfit to), enters brief information into the operational information log and invites the team to leave via intercom. Control over the timely departure of the teams is also entrusted to the dispatcher. After the brigade returns from the exit, the dispatcher receives a completed call card from the brigade and enters the data on the result of the departure 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 backup packs in case of emergencies (packages with accounting drugs), a backup cabinet with medicines and consumables, which he issues to teams as needed. The same requirements apply to the control room as to the pharmacy (iron door, bars on the windows, alarm, "panic buttons", etc.)

It is not uncommon for people to seek medical help directly at the ambulance substation - "by gravity" (this is the official term). In such cases, the dispatcher is obliged to invite a doctor or paramedic of one of the teams located at the substation to provide assistance, and if all the teams are on call, he is obliged to provide needed help, after transferring the patient to one of the teams that returned to the substation. There should be a separate room at the substation to provide assistance to patients who applied "by gravity". The requirements for the premises are the same as for the treatment room in a hospital or clinic. Modern substations usually have such a room.

At the end of the duty, the dispatcher draws up a statistical report on the work of mobile teams for the past day.

In the absence of a staff unit of the substation dispatcher or if this place is vacant for any reason, his functions are performed by the responsible paramedic of the next brigade. Or one of the line paramedics can be assigned to the daily duty in the control room.

Mistress Sister is in charge of issuing and receiving uniforms for employees, other service items of equipment of the substation and teams that are not related to medicines and medical equipment, monitors the sanitary condition of the substation, manages the work of nurses.

Small individual stations and substations may have a simpler organizational structure. The head of the substation (or the Chief Physician of a separate station) and the senior paramedic are in any case. Otherwise, the structure of administration may be different. The chief physician appoints the head of the substation, and the head of the substation appoints the rest of the employees of the substation administration himself, from among the employees of the substation.

Types of SMP teams and their purpose

In Russia, there are several types of SMP teams:

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

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

Brigades are also divided into linear and specialized.

Line brigades

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

Line brigades go to all occasions to call, make up the bulk of the ambulance crews. The reasons for calling are divided into “medical” and “paramedical”, but this division is rather arbitrary, it only affects the order in which calls are distributed (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 - The reason "I fell, broke my arm" is a reason for paramedics, there are no free paramedics - doctors will go.) Medical reasons are mainly related to neurological and cardiological diseases, diabetes, and also - all calls to children. Paramedic reasons - "stomach hurts", minor trauma, 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 11th to 59th.

For the earliest possible provision of specialized medical care directly at the scene and during transportation, specialized teams are organized intensive care, traumatological, cardiological, psychiatric, toxicological, pediatric, etc.

Specialized teams

Reanimobile based on GAZ-32214 "Gazelle"

Specialized teams are intended for the initial departure for particularly difficult cases, their profile calls, as well as for calling "on themselves" by line crews if they encounter a difficult case and cannot cope with the situation. In some cases, a call "to yourself" is mandatory: paramedics who have an uncomplicated myocardial infarction are required to call doctors "to themselves". Doctors have the right to treat and transport an uncomplicated myocardial infarction, and for those complicated by arrhythmias or pulmonary edema, they are required to call the ICUs or the cardiological team "on themselves". This is in Moscow. At some small ambulance stations, all teams on duty can be paramedics, and one, for example, can be medical. There are no specialized teams. Then this linear medical team will play the role of a specialized one (when a call comes in with the reason "accident" or "fall from a height" - it 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 in case of myocardial infarction or ischemic stroke, bleeding arrest, tracheotomy, artificial lung ventilation, chest compressions, transport immobilization and other urgent measures (for more high level than conventional line teams), and also perform the necessary diagnostic tests ( ECG registration, monitoring the patient's condition (ECG, pulse oximetry, blood pressure, etc.), determination of the prothrombin index, bleeding duration, emergency echoencephalography, etc.).

The equipment of the line and specialized ambulance teams practically does not differ in terms of payroll and quantity, but the specialized teams differ in quality and capabilities (for example, the line team should have a defibrillator, the resuscitation team should have a defibrillator with a screen and monitor function, the cardiology team should be a defibrillator with the ability to deliver biphasic and single-phase impulses, with the function of a monitor and a pacemaker (pacemaker), etc. And "on paper" in the equipment list will simply be the word "defibrillator". The same applies to all other equipment). But the main difference from the linear team is the presence of a specialist doctor with the appropriate level of training, work experience and the ability to use more sophisticated equipment. A paramedic on a specialized team also with a long work experience and after appropriate refresher courses. "Young specialists" do not work on special teams (occasionally - only on internships 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 and 60 to 69, 80 to 89 are reserved). And in conversation medical workers, and in official documents the designation of the brigade number is more common (see below). An example of the designation of a brigade from an official document: brigade 8/2 - 38 substation went to the call (8 brigade, number 2 from substation 38, at the substation - two "eighth" brigades, there is also a brigade 8/1). An example from a conversation: the "eight" brought the patient to the emergency department.

In Moscow, all specialized teams report not to the dispatcher of the direction and not to the dispatcher at the substation, but to a separate dispatcher console in the operational department - the "special console".

Specialized teams are divided into:

• Intensive care team (ICB) - an analogue of the resuscitation team, leaves for all cases of increased complexity, if there are no other more "narrow" specialists at this substation. The car and equipment are completely identical to the resuscitation team. The difference from the intensive care unit is that it consists of an ordinary ambulance doctor, as a rule, with many years (15-20 years or more) of work experience and who has passed numerous advanced training courses, passed the exam for admission to work at "BITs". But not a doctor - a narrow specialist anesthesiologist-resuscitator, with an appropriate specialist certificate. The most versatile and versatile special team. In Moscow - the 8th brigade, "eight", "BITS";
• cardiological - designed to provide emergency cardiac care and transportation of patients with acute cardiopathology (complicated acute myocardial infarction (uncomplicated AMI is handled by linear medical teams), coronary heart disease in the form of manifestations of unstable or progressive angina pectoris, acute left ventricular failure (pulmonary edema), cardiac arrhythmias and conductivity, etc.) to the nearest hospital. In Moscow - the 67th brigade "cardiological" and the 6th brigade "cardiological advisory with the status of resuscitation", "six";
• resuscitation - designed to provide emergency medical care in borderline and terminal conditions, as well as to transport such patients (injured) to the nearest hospital. However, a stable or stabilized by the doctor of the resuscitation team, the latter can carry as far as it likes, has the right to do so. It is involved in long-distance transportation of patients, transportation of extremely critical patients from hospital to hospital, has for this best opportunities. When leaving for the scene or apartment, there is practically no difference between the "eight" (BITs) and the "nine" (resuscitation team). The difference from the BITs is in the composition of the specialist anesthesiologist-resuscitator. In Moscow - the 9th brigade, "nine";
• pediatric - designed to provide emergency medical care to children and transport such patients (injured) 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 medical equipment children's sizes). In Moscow - the 5th brigade, "five". The 62nd brigade, children's resuscitation, advisory, are located at 34, 38, 20 substations. 62 brigade from 34 substations is based at Children's City Clinical Hospital No. 13 named after. N. F. Filatova; There are also 62 teams at the 1st substation, but it is based at the Research Institute of Emergency Children's Surgery and Traumatology (NII NDKhiT). An anesthesiologist-resuscitator from the NII NDHiT works on it.
• psychiatric - designed 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 involuntary hospitalization, if necessary. In Moscow - the 65th brigade (goes to patients already on psychiatric records and for the transportation of such patients) and the 63rd brigade (consultative psychiatric, goes to newly diagnosed patients and to public places);
• narcological - designed to provide emergency medical care to narcological patients, including alcoholic delirium and a state of prolonged binge. There are no such teams in Moscow, its functions are distributed between the psychiatric and toxicological teams (depending on the situation on call, alcoholic delirium- the reason for the departure of the 63rd (consultative psychiatric) brigade);
• neurological - designed to provide emergency medical care to patients with acute or exacerbation of chronic neurological and / or neurosurgical pathology; for example: tumors of the brain and spinal cord, neuritis, neuralgia, strokes and other circulatory disorders of the brain, encephalitis, epileptic seizures. In Moscow - the 2nd brigade, the "two" - neurological, the 7th brigade - neurosurgical, advisory, usually goes to hospitals where there are no neurosurgeons to provide surgical neuro surgical care on the spot and transporting patients to a specialized medical institution, to apartments and the street does not leave;

Car "Resuscitation of newborns"

• traumatological - designed to provide emergency medical care to victims of various kinds injuries to limbs and other parts of the body affected by a fall from a height, natural disasters, man-made accidents and auto-transport accidents. In Moscow - the 3rd brigade (traumatological) and the 66th brigade (the "CITO-GAI" brigade - traumatological, advisory with the status of resuscitation, the only one in the city, based at the central substation);
• neonatal - designed primarily to provide emergency care and transport newborns to neonatal centers or maternity hospitals (the qualifications of a doctor in such a brigade are special - this is not just a pediatrician or resuscitator, but a neonatologist-resuscitator; in some hospitals, the brigade staff are not doctors of ambulance stations , and specialists from specialized departments of hospitals). In Moscow - the 89th brigade, "transportation of newborns", a car with an incubator;
• obstetrical - designed to provide emergency care to pregnant women and women giving birth or who have given birth outside of medical facilities, as well as to transport women in labor to the nearest maternity hospital. In Moscow - the 86th brigade, "midwife", paramedic brigade;
• gynecological, or obstetric-gynecological - are intended both to provide emergency care to pregnant women and women giving birth or who have given birth outside medical facilities, 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;
• urological - designed to provide emergency medical care to urological patients, as well as male patients with acute and exacerbation of chronic diseases and various injuries their reproductive organs. There are no such brigades in Moscow;
• surgical - designed to provide emergency medical care to patients with acute and exacerbation of chronic surgical pathology. In St. Petersburg - RCB (resuscitation and surgical) brigades or another name - "assault brigades" ("assaults"), an analogue of the Moscow "eight" or "nine". There are no such brigades in Moscow;
• toxicological - designed to provide emergency medical care to patients with acute non-food, that is, chemical, pharmacological poisoning. In Moscow - the 4th brigade, toxicological with the status of resuscitation, "four". "Food" poisoning, that is, intestinal infections engaged in linear medical teams.
• infectious- designed 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- OOI (plague, cholera, smallpox, yellow fever, hemorrhagic fevers). Engaged to transport patients with dangerous infectious diseases. Based at infectious diseases hospital, an infectious disease specialist from the corresponding hospital. Leave rarely, in "special" cases. They are also engaged in advisory work in those healthcare facilities in the city of Moscow where there is no infectious diseases department.

The term "consultative team" means that the team can be called not only to the apartment or the street, but also to a medical institution where there is no necessary specialist doctor. It can provide assistance to the patient within the framework of the hospital, 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 cardio intensive care unit. The 6th brigade will be called there.)

The term "with the status of an intensive care unit" 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 conditions labor". For example, the "ninth" brigade has such benefits, the "eighth" brigade has no benefits. Although the work they perform is no different.

In Moscow, if a specialized team works in linear mode (there is no specialist doctor, only a paramedic or a paramedic with an ordinary line doctor work) - the brigade number will start with the number 4: the 8th brigade will be the 48th, the 9th will be the 49th 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, Kyiv, 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 referred to as "dead bodies") 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 of Transportation of the Dead and Lost Citizens". In Moscow, these brigades are located at a separate - 23rd substation, the "transportation" brigades and other brigades that do not have medical functions are based at the same substation.

Emergency Hospital

The emergency hospital (BSMP) is a complex medical and preventive institution designed to provide in-patient and on-site prehospital stage round-the-clock emergency medical care for the population in case of acute diseases, injuries, accidents and poisonings. The main difference from a regular hospital is round-the-clock availability a wide range specialists and relevant specialized departments, which allows to provide assistance to patients with complex and combined pathology. The main tasks of the BSMP in the service area are to provide emergency medical care to patients with life-threatening conditions that require resuscitation and intensive care; implementation of organizational, methodological and advisory assistance to medical institutions on the organization of emergency medical care; constant readiness to work in emergency conditions (mass influx of victims); ensuring continuity and interconnection with all medical and preventive institutions of the city in the provision of emergency medical care to patients at the pre-hospital and hospital stages; analysis of the quality of emergency medical care and evaluation of the effectiveness of the hospital and its structural divisions; analysis of the needs of the population in 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 subdivisions of the BSMP are a hospital with specialized clinical and treatment-diagnostic departments and offices; ambulance station (Ambulance); organizational and methodological department with an office of medical statistics. On the basis of the BSMP, city (regional, regional, republican) centers of emergency specialized medical care can operate. It organizes a consultative and diagnostic remote center for electrocardiography for timely diagnosis acute heart disease.

In such large cities as Moscow and St. Petersburg, research institutes for emergency and emergency medical care have been created and are operating (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 the 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, the stations operate as a department 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 some cases, when settlements are very remote from the district center, ambulances on duty, together with teams, can be located on the territory of district hospitals and receive orders by radio, telephone or electronic means of communication, which is not yet available everywhere. Such an organization of the mileage of cars within a radius of 40-60 km brings assistance much closer to the population.

Technical equipment of stations

The operational departments of large stations are equipped with special communication panels that have access to the city automatic telephone exchange. When dialing the number "03" from a landline or mobile phone, the lamp on the remote control lights up and a continuous beep starts to sound. These signals cause the medical tow truck to switch the toggle switch (or telephone key) corresponding to the glowing 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 of the ambulance dispatcher with the caller is recorded.

On the consoles, there are both “passive”, that is, working only “for input” (this is where all calls to the phone number “03” fall), and active channels that work “for input and output”, as well as channels that directly connect the dispatcher with law enforcement (police) and emergency response services, local health authorities, hospitals for emergency and emergency medical care and others stationary institutions city ​​and/or region.

Call data is recorded on a special form and entered into the database, which must record the date and time of the call. The completed form is transferred to the senior dispatcher.

Shortwave radio stations are installed in ambulances to communicate with the control room. With the help of a radio station, the dispatcher can call any ambulance and send the team to the right address. The team also uses it to contact the control room in order to determine the availability of a free place in the nearest hospital for a hospitalized patient, as well as in case of any emergency.

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

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

Neonatal (for newborns)

The main difference in the equipment of the car 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 a doctor can observe vital signs. important functions child (that is, to monitor), as well as, if necessary, connect a ventilator, oxygen and other devices that ensure the survival of a newborn or premature baby.

Usually neonatological machines are "tied" to specialized centers for nursing 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 still used. AT last years [when?] on the equipment of such brigades appeared cars 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 carry out some kind of special survey) are usually used so-called. "transportation". As a rule, these are the most “killed” and old linear machines. Sometimes Volga is used for this purpose. In Moscow, sometimes there are minibuses based on the Gazelle, similar to a regular fixed-route taxi, but with medical symbols and without special signals. They are used, for example, to transport patients with CRF (chronic renal failure) for hemodialysis - from home to hospital and back home. In Moscow, transportation teams have numbers from 70 to 73.

Hearse (corpse car)

A specialized van designed to transport corpses to morgues. Designed to transport 4 corpses on a special stretcher. Externally, the car can be distinguished by the absence of windows on the body and the presence of additional ventilation outlets, "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 brigades are assigned to city morgues and are on their balance sheet.

Air transport

Also, as Vehicle ambulances are used by helicopters and planes, especially in areas with low population density (for example, in the west of Scotland there is an Emergency Medical Retrieval Service), 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 cases of using other types of transport in the ambulance service, sometimes even the most unexpected ones.

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

They write to us: “Please explain, is there a difference between emergency medical care and ambulance? Maybe it's the same thing, it's just that people call it differently. If not, which service will come to the patient faster and where should I call in this or that case?

Ambulance and ambulance are two different medical services. They have different tasks and terms of arrival to the patient. Consider in order who and in what cases to call.

AMBULANCE

This is an emergency service that is designed to provide urgent medical care to the patient and bring him to the hospital as soon as possible. She does not issue any references or prescriptions. You should seek help in the following cases:

Loss of consciousness, impaired respiratory and circulatory systems
strong pain syndrome
sudden dysfunction of an organ
injury
different kind burns
heavy bleeding

As you can see from this list, an ambulance should be called when a life-threatening situation arises. However, there are exceptions in the following cases:

A mental disorder in which the patient's actions become dangerous to others
childbirth and threatened miscarriage
duty during emergency response

WHERE TO CALL

To call an ambulance, dial:
03 - from a regular landline phone
103 - from a mobile phone (but you can also use a landline)
112 - from mobile, even when there is no money on the account

WHAT TO REPORT

Despite the critical situation and emotions, the following should be clearly communicated to the ambulance dispatcher:

What happened to the victim and what he complains about
tell who called the ambulance
name the address where to go
leave your phone number for contact

WHEN COMES

In Moscow, the standard for the arrival of an ambulance is no more than 20 minutes. A patient with a stroke or myocardial infarction, despite traffic jams, should be delivered to a medical facility in 80 minutes.

EMERGENCY

Arrives on call around the clock in cases where there is a threat to health. Doctors from the ambulance team prescribe necessary treatment, write out prescriptions and issue documents for issuing sick leave.

IN WHAT CASES IS IT POSSIBLE TO CALL AMBULANCE

migraine, fever, fever blood pressure
pain in the chest when moving, inhaling and coughing
pain under the cast and phantom pain
pain syndrome in sciatica and neuralgia, in cancer patients and after injuries
abdominal pain in patients with gastritis and ulcers
pain in the ear, throat, tooth, muscles, against the background of fever.

WHERE TO CALL

For Muscovites and guests of the capital complete list Emergency telephone numbers by districts are available at mos03.ru/patients/neotl_v.php

WHEN COMES

An ambulance, unlike an ambulance, will have to wait at least 2 hours

NOTE:

1. So, ambulance or ambulance? If you are in doubt where to call, you can consult by phone 103 or 03. The dispatcher will decide whether to send an ambulance or transfer your call to an ambulance.
2. Both emergency and emergency medical care in Moscow is free and is provided to everyone, regardless of availability insurance policy and places of residence.
3. You can make your comments on the operation of these services through the mos03.ru website in the appropriate section.

Every day at least 12,000 people call 03 in the capital. Ambulances deliver 2,500 patients to hospitals daily. Of these, approximately 35% complained of diseases of the circulatory system, 10% - associated with injuries and poisoning.

In the town. Consists of 58 substations united in 10 regional associations (according to Moscow districts).

It has more than 10 thousand employees, makes about 11-15 thousand ambulance trips per day (more than 5 million per year).

At the beginning of 2013, 1119 crews worked at the station. In 2011, according to Igor Elkis, about 900 ambulances (owned by the State Unitary Enterprise Avtokombinat Mosavtosantrans) and 900 brigades worked at the station.

Story

The first ambulance stations (at the Sushchevsky and Sretensky police stations) appeared in Moscow on April 28, 1898, in 1899 three more stations were opened (at the Lefortovsky, Tagansky and Yakimansky sections). The sixth station (Prechistensky fire station) opened in 1900, and the seventh (Presnensky fire station) opened in 1902. Each station had one horse-drawn ambulance, which could only be called by officials, and calls were accepted only to the streets, but not to apartments.

In 1919, the Collegium of the Medical and Sanitary Department of the Moscow Council of Workers' Deputies organized a centralized city ambulance station at the Sheremetev Hospital, which was headed by the doctor Leonid Grigorievich Ovosapov (until 1920), then G. M. Gershtein (chief physician of the Sheremetev Hospital), and in 1923 - 1952 - Alexander Sergeevich Puchkov. At first, the Ambulance Service had a single department at the Sheremetyevo Hospital (now). In 1930, the 1st substation (First Gradskaya Hospital) was opened, in 1933 - the 2nd (Botkinskaya Hospital) and the 3rd substation (First Taganskaya Hospital). In 1936, the 4th substation was opened near the Kyiv railway station on Bryanskaya street. In 1939, the 5th substation (Rostokinskaya hospital) was opened, and in 1940, the 6th (Blagushinskaya hospital).

The ambulance station received independence in the summer of 1940, when it was separated from the composition. She was directly subordinate to the Moscow City Health Department.

The current state of the SSiNMP them. A. S. Puchkova

At present, the Station of emergency and emergency medical care (SSiNMP) named after. A.S. Puchkov, is an independent medical organization and is directly subordinate to the Department of Health of the city of Moscow. The SS&NMP provides emergency medical care at the prehospital stage in accordance with the Federal Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" in case of diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention.

About 10 thousand employees work in the SSiNMP in Moscow.

The basis of the organization of the work of the Station is the principle of centralized reception and sorting of calls and management of EMS teams. The station network has 58 substations and 70 posts deployed on the territory of Moscow. 20 posts are located on major highways, including 10 on the Moscow Ring Road, and 50 posts are organized at medical institutions. The station performs up to 12 thousand trips daily. Ambulance transport of the Station is fully equipped with satellite GLONASS/GPS-navigation facilities.

Since 2013, the order of the Ministry of Health of the Russian Federation No. 388n "On approval of the Procedure for the provision of emergency, including emergency specialized, medical care", divided emergency medical care for children and adults into two forms:

• emergency care - in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient's life;
• emergency care - in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs threat to the life of the patient.

Also, on the basis of the SSiNMP, there is a Medical Advisory Panel that allows you to consult by phone about urgent situations without calling a doctor.

Leaders

Regional associations and substations

The S&NMP includes 58 substations and 70 posts, grouped into 10 regional associations.

Call statistics

Number of calls and visits to the SS&NMP in Moscow:

see also

Notes

1. - reference Information on the SSIMP website. A.S. Puchkova
2. Station of ambulance and emergency medical care. A.S. Puchkova Archival copy dated August 31, 2013 at the Wayback Machine - reference information on the website of the Moscow City Health Department
3. dit.mos.ru/upload/iblock/d68/03.ppt
4. “The ambulance is the broom that sweeps up all health problems” - Igor Semenovich Elkis // Kommersant Nauka magazine, No. 4 (4), 07/25/2011
5. N.Plavunov reported on the work of the ambulance and emergency service in 2012 // Website of the Moscow government, 01.02.2013
6. History of ambulance in Russia // RIA Novosti, 03/19/2013
7. Belokrinitsky, V.I., History of the ambulance service in Russia // Section ISSUES OF THE ORGANIZATION OF THE WORK OF THE EMS, magazine Ambulance doctor 2010/12 - P. 4-11
8. The history of the creation and development of the Station of emergency and emergency medical care in Moscow Archival copy of August 15, 2013 on the Wayback Machine // SSiNMP website