Providing specialized medical care. Organization of specialized medical care for the population. Centers for specialized medical care, types, tasks, structure

Specialized medical care

With the entry into force of the Federal Law "On the General Principles of Organization of Legislative (Representative) and Executive Bodies of State Power of the Subjects of the Russian Federation" of October 6, 1999 N 184-FZ (as amended by the Federal Law of July 4, 2003 N 95-FZ), which established that the powers of the state authorities of the constituent entity of the Russian Federation on subjects of joint jurisdiction include the organization of the provision of specialized medical care in dermatovenerological, tuberculosis, narcological, oncological dispensaries and other specialized medical institutions, several issues have acquired particular relevance in the professional community:

what is specialized assistance;

what medical organizations are specialized;

whether only specialized medical organizations provide specialized medical care or, in other words, whether specialists from outpatient clinics and multidisciplinary hospitals at various levels provide specialized medical care;

who owns the specialized medical organizations and, therefore, who bears the expenditure obligations for financing medical care rendered in them?;

Article 40 of the Fundamentals of Legislation on the Protection of Citizens' Health (as amended by N 122-FZ of August 22, 2004) establishes that "specialized medical care is provided to citizens with diseases that require special methods of diagnosis, treatment and the use of complex medical technologies.

Specialized medical care is provided by specialist doctors in medical institutions that have received a license for medical activities.

Types and standards of specialized medical care provided in health care institutions are established by the federal executive body that carries out regulatory legal regulation in the health sector.

Financial provision of activities for the provision of specialized medical care in dermatological, venereological, anti-tuberculosis, narcological, oncological dispensaries and other specialized medical organizations (with the exception of federal specialized medical organizations, the list of which is approved by the Government of the Russian Federation) in accordance with these Fundamentals, is an expenditure obligation of the subject of the Russian Federation Federation.

Financial provision of measures for the provision of specialized medical care provided by federal specialized medical organizations, the list of which is approved by the Government of the Russian Federation, in accordance with these Fundamentals, is an expenditure obligation of the Russian Federation.

The law determined that, unlike primary health care, specialized medical care is provided in accordance with the standards that, along with the types of medical care, are established by the federal executive body responsible for legal regulation in the field of health care.

Federal Law N 122-FZ eliminated the contradictions in the Fundamentals regarding the delegation of powers to establish standards for specialized medical care by the constituent entities of the Russian Federation, equalizing the rights of the republic within the Russian Federation, the region, the territory, the cities of Moscow and St. Petersburg, excluding the very possibility of such delegation.

However, the provision of specialized medical care in accordance with the standards is limited to state and municipal health care institutions. The legislator did not oblige private medical organizations and persons engaged in private medical activities to provide medical care in accordance with the standards of medical care.

This contradicts the provisions of the Constitution of the Russian Federation (Article 71) on the assignment of standardization to the competence of the Russian Federation, the establishment of equal rights for organizations of various organizational and legal forms and forms of ownership, equal rights of citizens to receive medical care.

Contradictory provisions of the articles of the Law regarding licensing have also been preserved. The legislator retained the norm establishing that institutions providing specialized medical care are licensed. At the same time, there are no instructions on licensing institutions whose medical activities are related to primary health care. The legislation on licensing establishes the norm on licensing medical activities without dividing it into types. In this regard, it is necessary to make appropriate amendments to the sectoral legislation.

Thus, this article of the law also does not answer the questions, but only confirms their validity.

The medical community expected to find answers to these questions in Orders of the Ministry of Health and Social Development of Russia dated October 7, 2005 N 627, which approved a new nomenclature of healthcare institutions and dated October 13, 2005 N 633 "On the organization of medical care."

At the same time, these Orders further complicated the understanding and implementation of the legislation on the division of powers.

So, new order about the unified nomenclature of state and municipal health care institutions is not much different from the old one. In the Order of 03.06.2003 N 229 (hereinafter - the Nomenclature 2003) all types of children's medical institutions are named in a separate line, and in the Order of 02.10.2005 N 627 (hereinafter - the Nomenclature 2005) they are indicated "including", which is not changes things. Excluded from the list of institutions, as an independent type of institution, the Russian Children's Clinical Hospital of the Ministry of Health of Russia and included in the republican hospitals, including children's. The 2005 Nomenclature excludes central district hospitals (former hospitals of "vodniks"), as well as all types of hospitals on railway transport, since they do not belong to either the state or municipal health care system.

At the same time, the Ministry of Health and Social Development of Russia is a federal body of state power that implements state policy and carries out regulatory legal regulation in the field of healthcare. Based on the vested powers, he must determine the nomenclature of healthcare organizations for all departments, levels of government, as well as healthcare systems, including private ones.

In addition, the 2005 Nomenclature clarified the name of a medical institution providing nursing care - a nursing home (hospital), excluding the type of hospitals "1.2. Clinics", which is completely legitimate.

Section "1.1.2. Specialized hospitals" has not changed.

From this design of the Order, it follows that the regional, republican, regional hospitals included in section 1.1.1. are not specialized and cannot be financed from the budget of a constituent entity of the Russian Federation. Also, the Order does not include leprosariums as specialized institutions, which is not correct in fact, as well as hospitals. At the same time, Order No. 633 states that hospitals provide specialized medical care.

From the edition of N 95-FZ and the Order of the Ministry of Health and Social Development of Russia, it follows that the constituent entities of the Russian Federation can only finance dispensaries and specialized hospitals named in section 1.1.2. Nomenclature 2005 and centers of specialized types of medical care, named in the section "Centers, including scientific and practical" (section 1.4).

In the logic of the Order, diabetological, drug rehabilitation centers, also named in section 1.4 of the 2005 Nomenclature, are not specialized healthcare organizations, while drug treatment and endocrinology dispensaries are classified by law, and therefore by the Order, as healthcare organizations providing specialized medical care.

A number of special type healthcare institutions are excluded from the "centers" section: the National Medical and Surgical Center of the Ministry of Health of Russia, the regional center for the prevention and control of AIDS and infectious diseases, a clinical center, an outpatient dialysis center as an independent institution.

The word “organizations” has been removed from the names of the centers for specialized types of medical care, rehabilitation centers have become one of the types of healthcare institutions, and not an exclusive healthcare institution of the Administration of the President of the Russian Federation, the centers of the district medical and medical centers of the Ministry of Health of Russia have become district medical centers.

Ambulance stations and emergency care, the Russian Rehabilitation Center "Childhood" of the Ministry of Health of Russia was excluded from the section "Institutions for the protection of motherhood and childhood", a new type of health care institution "Center for the Reproductive Health of Adolescents" was introduced. Children's homes are united, specialized ones are listed as well. At the same time, paragraph 8 of the Note contains a list of specialized orphanages, from which it may follow that they are specialized healthcare institutions and should be attributed to the expenditure authorities of the constituent entities of the Russian Federation. In pursuance of this paragraph, these orphanages were transferred to the jurisdiction of the constituent entities of the Russian Federation.

Let's try to find in the Order of the Ministry of Health and Social Development of Russia dated October 13, 2005 N 633 "On the organization of medical care" the answer to the question of what refers to specialized medical care and what to primary health care?

The order divides medical care into primary health care, medical care for women during pregnancy, during and after childbirth, emergency medical care, specialized medical care, emergency specialized care (sanitary and aviation) and high-tech (expensive) medical care.

Special attention It draws attention to the fact that the Order classifies 31 types of medical care as primary health care, ranging from therapy to cardiovascular surgery, which are referred to as specialized types of medical care in the "Specialized Medical Care" section.

The Order also contains a list of institutions providing primary health care. These include - outpatient clinics (at the same time, they are excluded as an independent type of institutions from the Nomenclature 2005), general medical centers ( family practice), district hospitals, district hospitals, central district hospitals, nursing homes, hospices, polyclinics, including children's, city polyclinics, including children's, centers, medical units, city hospitals, orphanages, antenatal clinics, maternity, emergency hospitals, perinatal centers.

In order to understand the concept of primary health care, one should refer to the norms of the law of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens.

Thus, article 38 of the Fundamentals defines: “Primary health care is the main, accessible and free type of medical care for every citizen and includes: treatment of the most common diseases, as well as injuries, poisonings and other emergency conditions; medical prevention of major diseases; sanitary hygienic education, carrying out other activities related to the provision of health care to citizens at the place of residence.

Primary health care is provided by the institutions of the municipal health system. Public and private healthcare institutions may also participate in the provision of primary health care on the basis of contracts with insurance medical organizations.

The volume and procedure for the provision of primary health care is established by legislation in the field of protecting the health of citizens.

Financial provision of activities for the provision of primary health care in outpatient, inpatient and hospital facilities, medical care for women during pregnancy, during and after childbirth in accordance with these Fundamentals, is an expense obligation of the municipality.

The provision of primary health care may also be financed from the funds of compulsory medical insurance and other sources in accordance with the legislation of the Russian Federation.

In Article 13 of the Fundamentals of the "Municipal Health System", the legislator once again fixes the sources of financing of primary health care.

Financial support for the activities of organizations of the municipal health care system is an expenditure obligation of the municipality.

The provision of medical care in organizations of the municipal health care system may also be financed from the funds of compulsory medical insurance and other sources in accordance with the legislation of the Russian Federation.

It follows from these norms that the main source of funding for the activities of organizations of the municipal health system that provide primary health care, emergency medical care, as well as medical care for women during pregnancy, childbirth and after childbirth, should be the budget of the municipality, and compulsory medical insurance is not an obligatory source of financing and can, "as well" as other sources, be used by decision of local governments. Such consolidation of funding sources is absolutely contrary to the basic principles of compulsory health insurance and the legislation governing it. It is primary health care that should be financed from the funds of compulsory medical insurance, since it is the main, affordable, free type of medical care. The main source of its funding is compulsory health insurance, based on the joint financial responsibility of the healthy in favor of the sick, the young in favor of the old, the rich in favor of the poor.

In addition, the legislator, for the sake of delimiting financial powers between levels of government, excluded from the concept of health care, such its most important components as the implementation of sanitary and hygienic and anti-epidemic measures. It is difficult to agree with such changes. The exclusion of sanitary and hygienic and anti-epidemic measures from primary health care may lead to the fact that medical institutions will not carry out such important measures as vaccination, measures to isolate infectious patients and establish quarantine, sanitary and hygienic treatment within the framework of this form of organization of medical care. in the foci of infections, etc. There will be no proper coordination of actions in carrying out these measures between municipal medical institutions and institutions and bodies of the sanitary and epidemiological service, which fall within the competence of the federal center. This will lead to a deterioration in the implementation of preventive measures.

In the edition of the Fundamentals of 1993, primary health care included measures to protect the family, motherhood, fatherhood and childhood, which are excluded by Federal Law N 122-FZ. The complete exclusion of these measures is unjustified. Primary health care should include measures to protect the health of the family, motherhood, fatherhood and childhood. And this should be enshrined in law.

It should be noted that when amending this law in the summer of 2004, it was necessary to replace the concept of "medical care", the legal and organizational meaning of which is poorly understood, with the constitutional concept - medical care.

In addition, it should be noted that the definition of specialized medical care refers to diagnostic and treatment technologies, while primary health care refers only to prevention and treatment technologies.

Previously, the Basics fixed the establishment of the volume of primary health care by local administrations in accordance with the territorial program of compulsory medical insurance.

The order of provision was instructed to establish the governing bodies of the municipal health care system on the basis of the regulations of the federal and regional executive authorities in the field of health care. Federal Law No. 122-FZ excluded these norms, the establishment of the volume and procedure for the provision of primary health care in the law is defined in a fairly general form - "in accordance with the law."

The procedure for organizing the provision of primary health care is determined by the Order of the Ministry of Health and Social Development of Russia dated July 29, 2005 N 487. The specified procedure regulates issues related to the organization of the provision of this type of medical care. Institutions providing primary health care must carry out their activities in accordance with the established procedure. According to the Order, primary health care includes, among other things, medical care for women during pregnancy, during and after childbirth. Primary health care is provided by institutions of the municipal health care system mainly at the place of residence, namely outpatient clinics, which are specifically listed in the Order: an outpatient clinic, a center for general medical (family) practice, a district (including central), a city polyclinic, a children's city ​​polyclinic, female consultation.

The order duplicates the norm of the law on the participation in the provision of primary health care of public and private health care institutions on the basis of contracts with insurance medical organizations.

It should be noted that the Order (paragraphs 8 and 9) defines in detail the structure of outpatient and inpatient care, and in relation to inpatient care it is specified that it is provided to the population of municipalities in hospitals and inpatient polyclinics without specifying their types defined by the Nomenclature-2005 .

Thus, only the Order of the Ministry of Health and Social Development of Russia dated October 13, 2005 N 633 defines a list of institutions providing primary health care in hospitals - district, district and central district hospitals ah, nursing homes and hospices, centers, medical units, city hospitals, orphanages, maternity hospitals, emergency hospitals, perinatal centers. However, there is no reference to the previous Order.

The order (clause 7) clarifies that the obligation of institutions to provide primary health care is performed by medical workers of these institutions: district therapists, district pediatricians, general practitioners (family) obstetrician-gynecologists, other medical specialists, as well as specialists with secondary medical and higher education, in accordance with the established procedure.

From this definition It follows that medical specialists provide primary health care in accordance with their specialty and position. Specialists of the same specialties also provide specialized medical care in 31 specialties. That is, in 31 specialties, medical care can be specialized and primary health care, and only in 16 specialties is medical care specialized. So, for example, cardiovascular surgery provided by an emergency hospital of an urban district refers to primary health care, and cardiovascular surgery organized in healthcare institutions of the constituent entities of the Russian Federation - a hospital, center, regional regional, republican, district hospital , is a specialized cardiovascular surgery.

Hematological, dermatovenerological, diabetological, coloproctological, neonatological, oncological for adults and children, specialized medical care for infectious diseases, psychiatric, psychiatric-narcological, dental, urological-andrological, phthisiatric, medical genetic medical care (total 16) are specialized.

The question arises about the difference between these two types of medical care provided within the same specialty. Is it possible to distinguish between diseases, standards of medical care, technologies used, the level of training of specialists, and other criteria. Theoretically, you can justify anything. It's practically impossible. The distinction established by this Order is artificial and does not at all solve the issues of delimiting powers in the healthcare sector and fixing sources of funding by levels of government.

At the same time, it should be noted that this Order completely deprives the population of municipalities of affordable TB medical care, since it can only be provided in a specialized dispensary and a specialized hospital. The population of rural areas will have to go to these specialized institutions. The logic of the Order does not allow to have a phthisiatrician and a phthisiatric department on the staff of the central district hospital. This management decision was immediately realized in the stagnation of tuberculosis incidence rates and an increase in mortality rates.

A similar situation develops with the availability of other types of medical care.

Separate attention should be paid to accessibility dental care, which is referred by the Order only to specialized medical care provided in health care institutions of the constituent entity of the Russian Federation: regional, regional, republican hospital, dispensary, specialized hospital, hospital (from which it follows that it is a specialized medical institution, however, in the Nomenclature 2005 it does not apply to those), in a center without specifying a specialized or other types, and most importantly in a polyclinic (without specifying its profile), which does not belong to specialized healthcare institutions.

The result of such an artificial division of medical care may be the destruction of relevant medical care services, a decrease in the availability and deterioration of its quality, a decrease in morbidity rates and an increase in mortality rates. Most importantly, this does not comply with the legislation on the division of powers.

The order also clarifies that citizens are entitled to free medical care in the state and municipal health care system in accordance with the legislation of the Russian Federation, the legislation of the constituent entities of the Russian Federation and the regulatory legal acts of local governments.

A guaranteed amount of free medical care is provided to citizens in accordance with the Program of State Guarantees for the Provision of Free Medical Care to Citizens of the Russian Federation. It follows from these norms that primary health care is included in the program of state guarantees.

At the same time, the legislator allowed that public and private healthcare organizations can provide primary health care under contracts with insurance medical organizations, without specifying what type of insurance they will carry out - compulsory or voluntary medical insurance. Thus, in this definition there is no clarity in the delimitation of powers for the implementation of financing.

This duality in defining the types of medical care leads to different understandings in determining measures for the restructuring of medical care. There is one more question. What is included in primary health care?

According to N 131-FZ and the Fundamentals, as amended. N 122-FZ is the entire volume of medical care provided by medical organizations of municipalities - a municipal district and an urban district, which provide both outpatient and inpatient medical care. At the same time, among many specialists in the field of domestic healthcare organization, the opinion is firmly entrenched that primary health care is exclusively outpatient medical care provided at the place of residence by district doctors. The last interpretation is connected with drawing parallels with foreign analogues in determining this type of medical care. Indeed, health systems foreign countries, with a developed system of general medical (family) practice, the general practitioner provides a fairly wide range of medical services and refers the patient for an outpatient consultation with a hospital specialist or for hospitalization. Quite rarely, hospital specialists consult patients with a general (family) practitioner or in group practice.

I believe it is advisable to fix the concept of primary health care in the federal law, taking into account the recommendations of the Alma-Ata conference, the legislation on the delimitation of powers and the historical features of the domestic healthcare system in the following edition:

"Primary health care is guaranteed for every citizen, an accessible and free type of medical care provided to a citizen by medical organizations of a municipal district or city district, as well as to certain categories of citizens in medical organizations of the constituent entities of the Russian Federation or the Russian Federation, licensed to provide medical care .Primary health care includes:

primary medical care provided using simple medical technologies at the outpatient stage by doctors with a medical specialty as a district doctor, general practitioner (family doctor) in medical organizations of municipalities;

specialized medical care of the first and second levels, provided by doctors, specialists of outpatient and hospital healthcare organizations of municipalities;

primary medical care and first-level specialized medical care provided to certain categories of citizens in accordance with the law in outpatient organizations of a constituent entity of the Russian Federation and the Russian Federation.

Primary health care is provided in accordance with the standards of medical care and includes prevention, diagnosis, treatment and rehabilitation of the most common diseases (conditions), as well as injuries, poisoning, sanitary and hygienic education; carrying out measures to protect the health of the family, motherhood, fatherhood and childhood, other measures related to the provision of medical and sanitary assistance to citizens, including sanitary and hygienic and anti-epidemic measures.

SPECIALIZED MEDICAL CARE- the type of medical care provided by medical specialists in medical institutions or departments specially designed for this purpose using special medical and diagnostic equipment, tools and equipment.

Differentiation medical science in the course of its development and the specialization of medical affairs deepening on this basis entail changes in the organization of medical care, in the functions to lay down. - prof. institutions, their typification and structure. The quality of prevention, diagnosis and treatment depends on the degree of specialization, forms and methods of organizing specialized types of medical care. various diseases.

Story

In Russia S.'s development of m of the item proceeded very slowly, especially concerning the organization of specialized departments in to lay down. - the prof. institutions, despite the desire of leading doctors to provide the population with medical care in various specialties.

The appearance of stationary S. m. p. in Russia dates back to the second half of the 18th century, when the construction of large civil business, where, along with general profile, a number of specialized departments were also presented. Then specialized clinics began to be created, the first of which were organized: psychiatric in 1808 (Moscow), ophthalmic in 1826 (Moscow), children's in 1834 (Moscow), etc. At the beginning of the 19th century. in outpatient clinics, in addition to “private” general practitioners, medical care began to be provided by specialists in eye diseases, obstetrics, and dental diseases. At the same time, in 1913, only 16% of outpatient clinics provided specialized types of outpatient care, while general practitioners worked in the rest. A number of specialized outpatient institutions in Russia were created with charitable funds, for example, in 1904 the first outpatient clinic for tuberculosis patients was opened in Moscow, and by the beginning of the First World War there were 67 anti-tuberculosis outpatient clinics in the country, which existed mainly on charitable funds . The Pirogov congresses played a big role in S.'s development of m of the item in Russia (see), already on the first of to-rykh in 1885 meetings on 8 various sections passed.

Fundamental changes in the organization of S. m. p. occurred after the establishment Soviet power. The formation of a number of specialized types of medical care was due not only to the development of science and practice, but also to serious social problems - high rates incidence and mortality of the population as a result of severe economic, dignity. and other consequences of the tsarist regime, the first world and civil wars. For example, from the very beginning of existence of the Soviet power for fight against infectious, venereal diseases, tuberculosis, etc. on a national scale the corresponding services, types of establishments (specialized-tsy, dispensaries) were created and the corresponding doctors-specialists were trained.

Before the Great Patriotic War many questions of the organization of S. of m of the item were solved. In particular, in 1938 the task of providing the population with the specialized help at home was set. The organization of specialized stationary departments in city-tsakh was widely developed and by 1941 only 2,7% of their number remained unspecialized.

During the Great Patriotic War, S. m. p. received its further development in the organization of honey. service of the Red Army. The hospital network was organized not only according to the general type (therapeutic, surgical, infectious, etc.), but also according to the principle of differentiated specialized treatment: for those wounded in the head (including the maxillofacial profile), in the chest, abdomen, pelvic bodies, etc. In 1942, an order was issued by the People's Commissar of Health of the USSR, the Crimea determined the ways of restoring a specialized hospital network.

The IV Plenum of the Hospital Council of the People's Commissariat of Health of the USSR and the People's Commissar of Health of the RSFSR in 1943 pointed out the urgent need to correct shortcomings in the training of medical personnel in certain specialties, and then an order was issued by the People's Commissar of Health of the USSR on the organization of special departments and wards for the treatment of patients with peptic ulcer, diabetes mellitus, etc. For the purpose of improvement of management and improvement of quality S. of the m of the item the Institute of chief specialists of the ministries, regional, regional and nek-ry city departments of health care was created (see. Chief specialist).

The process of specialization of medical care has developed especially intensively since the 1950s, when surgical and then therapeutic types of care began to be widely differentiated. The development of S. m. item was expressed not only in the appearance of its new types, but also in the development of new organizational forms of its provision. Specialized centers for various profiles began to be created. The creation of a network of regional (regional, republican) BCs with advisory polyclinics, as well as central district BCs, where specialized departments were organized in at least 5 profiles, contributed to the provision of the rural population with out-of-hospital and inpatient S. m. p.: therapy, surgery , obstetrics and gynecology, pediatrics, infectious diseases. The network of district and regional specialized dispensaries has grown. The organization of on-site planned and consultative assistance by teams of medical specialists contributed to the expansion of the volume of out-of-hospital specialized care for the rural population.

The course for further specialization of medical care was determined by the Program of the CPSU and was developed in the relevant decisions of the Central Committee of the CPSU and the Soviet government, orders M3 of the USSR. The resolution of the Central Committee of the CPSU and the Council of Ministers of the USSR "On measures to further improve medical care and health protection of the population of the USSR" (1960) and the order of the Minister of Health of the USSR issued in the light of this resolution reflected the development of specialized outpatient care. The order of the Minister of Health of the USSR "On the state and measures to further improve the inpatient care of the population of the USSR" (1963) outlined the main directions for the development of inpatient medical care, the main of which were the enlargement of existing BCs and the construction of new, more powerful hospital complexes necessary In order to expand and improve C. m. p. The Decree of the Central Committee of the CPSU and the Council of Ministers of the USSR “On measures to further improve health care and the development of medical science in the country” (1968) planned to “continue the construction of large specialized and multidisciplinary hospitals, clinics, dispensaries in order to in order to improve the quality of specialized medical care and provide the population with all its types more fully. Issued in the light of this decree, the order of the Minister of Health of the USSR obliged the health authorities to organize in 1971-1975. inter-republican, republican, inter-regional, regional, regional departments (centers) for cardiac surgery, cardiology, vascular surgery, neurosurgery, nephrology, pulmonology, for the treatment of patients with myocardial infarction, with burns, mainly as part of multidisciplinary BC. It was pointed out the need to develop in cities and regions that do not have independent specialized dispensaries, a network of appropriate dispensary departments (offices) in polyclinics. Treatment and diagnostic centers of the hospital-polyclinic type began to be created according to certain types S. m. p., educational-scientific-practical centers. Significant influence on the development of specialized types of medical care was exerted by the orders of the Minister of Health of the USSR "On staff standards for medical and pedagogical personnel of urban polyclinics, medical and feldsher health centers" (1968) and "On the nomenclature medical specialties and the nomenclature of medical positions in health care institutions” (1970). In order to improve S. m. item for the rural population, the M3 of the USSR approved the “Regulations on the Interdistrict Specialized Department” (1975). The ordering of the development of the network of institutions providing specialized care was facilitated by the orders of the Minister of Health of the USSR "On approval of the nomenclature of health care institutions" (1978) and "On measures to improve the organization of the work of outpatient clinics" (1981). The reflection of the processes of specialization and integration in practical health care is the improvement of the organizational forms of specialized types of medical care, the creation of specialized rooms, departments, consultative and diagnostic centers, rehabilitation departments and institutions, the further development of phasing in the eye for Him medical care, etc.

In the course of performing these tasks, it was taken into account that the degree of specialization of medical care is determined not only by the differentiation of science and practice, but also by the real needs of the population in connection with the number of contingents of patients with different profiles, the nature and structure of the pathology, the volume and forms of medical care needed by patients, as well as economic and urban planning opportunities, prospects for the resettlement of residents, etc.

Simultaneously with the differentiation of medical science and practice, the integration process also developed, which was greatly facilitated by the construction of large multidisciplinary BCs, the improvement of the activities of doctors of various specialties, as well as the complexity and coordination of scientific research, the development of approaches to a comprehensive examination of certain contingents of patients, etc. .Construction of large diversified and specialized business centers, ambulance centers, dispensaries, etc. allows you to create specialized departments in their composition and form centers of a hospital-polyclinic type, equipped with the most advanced equipment and provided with highly qualified specialists. The organization of specialized centers ensures the most rational use of the bed fund, personnel of specialists, honey. technology, contributes to the improvement of medical skills. personnel and the quality of medical care they provide to patients. In modern city-tsah the population receives medical care in all major specialties. A lot of work has been done on the further development and enlargement of regional (territorial, republican) hospitals that provide the population with specialized medical care. The growth in the provision of the population of the USSR with specialized hospital beds - see table. 6 to Art. Hospital, vol. 3.

The dynamism of the differentiation process of S. m. p. is reflected in the improvement of standard indicators. So, in 1954, the standards for the needs of the population in inpatient medical care were planned for 12 bed profiles, and in 1982, the M3 Board of the USSR approved standards for 35 specialties, including differentiation of the therapeutic profile of beds in 9 specialties and surgical - in 12. Similarly, the differentiation of standards the need for inpatient care is also approved for the children's population. Standards for outpatient care are recommended for 28 specialized types for the adult population and for 25 types for children.

The trend towards specialization was also reflected in the development of the ambulance service (see), where cardiological, resuscitation, trauma, pediatric, anti-shock, toxicological and other specialized teams began to be created, which contributed to the expansion of the volume of assistance provided by doctors on the spot and during transportation the patient in to lay down. - the prof. institution, as well as improving its quality. A network of emergency hospitals is developing at a fairly rapid pace (see Emergency Medical Care Hospital), the main tasks of which are to provide specialized emergency medical care to the population.

Great importance is attached to the development of diagnostic and laboratory services, where the process of specialization is also noticeable. New treatment and diagnostic methods and directions are constantly being developed, new rooms and laboratories are being created.

The development of S. m. item is one of the most complex sections that require appropriate conditions and organizational forms. The experience of Soviet and foreign health care shows that in order to provide highly qualified S. m. p., rational placement of specialized rooms, departments, institutions is necessary, taking into account the principle of honey. zoning. At the same time, it is necessary to provide for a certain stage in the provision of medical care by doctors of basic and narrow specialties. S.'s development of m of the item in specific territories is based on the differentiated standard and target approach to formation of uniform functional and organizational structure of a network to lay down. - the prof. institutions while maintaining the basic principle of organizing Soviet health care - territorial, ensuring the availability of medical care to the entire population.

A special role in the development of S. m. belongs to the chief specialists (therapists, surgeons, pediatricians, obstetrician-gynecologists, etc.) of the ministries of health, regional (regional, district) and city departments of health (see Chief Specialist). Their importance is especially great in the countryside, where the existing institute of chief specialists of the central district BCs is an important link in the health care management system. The main experts, to-rymi are, as a rule, heads of departments of the central regional-tsy, except medical, carry out a large volume of work as organizers, consultants and methodologists of the corresponding specialized services of the area.

Of great importance for S.'s improvement of m of the item is also involved in work in policlinics and-tsah as consultants of highly qualified scientific employees of scientific research institutes and the teaching staff of honey. in-t and in-t of improvement of doctors.

The specialization of medical care, among others, put forward the problem of training the appropriate personnel of specialists. Changes made to the system of medical education (see) were due to the need to combine specialized training with general medical education on a broad natural science and socio-hygienic basis. In the USSR the harmonious system of specialization and improvement of doctors is created, edges it is carried out (see), improvement faculties at medical. in-tax, and also by primary specialization at large republican, regional, regional and city-tsakh, system of clinical residency.

At different stages of the development of Soviet health care, in accordance with its tasks for protecting the health of the population, the forms and methods of rendering were improved and improved to lay down. - prof. assistance, but the fundamental foundations and socialist character of its organization remained unchanged, thanks to which the modern one system organizations C. m. p. Specialization of medical care, being a dynamic process, in turn, has a huge impact on the development of the entire Soviet health care system, significantly complementing, first of all, its preventive direction (see Prevention, Primary Prevention). Evolution of organizational forms S. of m and. leads to new effective methods and means of prevention, diagnosis and treatment, to-rye can radically change the current practice of health care, contribute to the further development of science and medical care to the population.

Specialized medical care in military field conditions

Specialized medical care in military field conditions is the highest type of medical care, which most fully uses (in relation to military field conditions) the achievements of honey. sciences in practice of staged treatment of the struck and patients by forces of the corresponding experts in the specialized intended for this purpose to lay down. institutions (departments) with special medical and diagnostic equipment.

As evidenced by the history of military medicine (see Military Medicine), the specialization of medical care in the system of medical and evacuation support of the Armed Forces (see System of medical and evacuation support) was due to the differentiation of medical science, as a result of which a number of independent branches of clinical medicine emerged. E. I. Smirnov expressed this pattern in relation to the organization of surgical care during the war as follows: “since they emerged as independent disciplines Maxillofacial Surgery, neurosurgery, treatment of damage to the bones of the limbs and the chest cavity, that situation for hospitals ceased to exist, when every surgeon was a doctor for all the wounded, and every wounded was a patient of every surgeon.

For the first time, an attempt to specialize medical care for the wounded and sick was made during the Russian-Japanese war of 1904-1905, when in some reserve hospitals deployed in the near rear of the army (in Harbin), specialized beds were allocated for infectious, venereal, mental patients, patients with diseases of the ear, throat and nose. During the First World War 1914-1918. the next step was taken in S.'s organization of m. p. to the wounded and sick. This, in particular, is evidenced by the experience of deploying in 1916 a group of hospitals and infirmaries intended for separate admission various categories the wounded and sick. This is how medical care was organized in Lodz and Zhirardov on the initiative of H. N. Burdenko and in the 5th Army in the Dvinsk region on the initiative of V. A. Oppel. V. A. Oppel pointed out the progressive nature of the specialization of surgical care for the wounded: “My experience of working on various fronts,” he wrote, “leads to the same conclusion: fractional surgical specialties must exist, life itself develops them, so we must go to them to help them develop."

After the Great October Socialist Revolution on the basis of achievements in development National economy, honey. science and Soviet health care, the necessary prerequisites were created for the further development and improvement of the system of medical and evacuation support for troops, an indispensable component of the cut was the specialization of medical care and treatment of the wounded and sick. The principles of staged treatment with evacuation by appointment, which had developed by the beginning of the Great Patriotic War, necessitated the creation of specialized field and evacuation hospitals, starting with army ones to lay down. institutions, which was clearly shown by the real test of these principles during the fighting of the Red Army on the river. Khalkhin Gol (1939) and Soviet-Finnish conflict(1939-1940). On the eve of the Great Patriotic War, the main directions of the organization of specialized medical care were determined, which was reflected in the “Collection of regulations on institutions dignity. wartime service "(1941). Specialization of field hospitals in the army medical unit. services, to-rye in their organizational structure were "general hospitals", was provided by sending to these hospitals "special medical reinforcement groups" that were available in a separate company of honey. strengthening (ORMU) of the army - including neurosurgical groups, maxillofacial, ophthalmic, toxic-therapeutic, etc. Specialization of evacuation hospitals included in the army headquarters and evacuation points of the front was also envisaged.

The extremely unfavorable situation that developed as a result of the sudden treacherous attack of fascist Germany on the USSR did not allow organizing the S. m. p. at the beginning of the Great Patriotic War of 1941-1945. to the extent indicated above. However, during the war, the specialization of medical care and treatment of the wounded and sick was one of the most important areas for improving the system of staged treatment with evacuation according to the destination and was further developed.

Medical guide. services of the Red Army carried out a number of measures to streamline the organization of S. m. p. In 1941, they were introduced into the honey. hospital services for the lightly wounded (see). Instead of the unified field mobile hospitals (PPG) in 1942 surgical field mobile hospitals (see) and therapeutic field mobile hospitals (see) were created; three main types of specialized CPPG have been identified - for the wounded in the head; in the thigh and large joints; in the chest and abdomen, which was achieved by strengthening these hospitals by the relevant specialized groups from the ORMU. To ensure the correct organization of the S. m. p. systematic highly qualified leadership, it created the institute of chief, front-line and army specialists, and the positions of specialist inspectors were introduced into the staff of the departments of all evacuation points. Thus, during the Great Patriotic War, a coherent, scientifically based system of S. m. p. and specialized treatment of the wounded and sick was created.

AT post-war years on the basis of studying, critical analysis and generalization of the received experience there is a further development and improvement of S. of m of the item. Development of a network of specialized to lay down in many respects promotes this process. establishments and the centers in system of the Soviet health care, and also essential improvement of technical equipment specialized to lay down. institutions with appropriate diagnostic and medical equipment.

In connection with the adoption by the aggressive imperialist countries of weapons of mass destruction, new types of combat trauma should be expected. The contingents of the affected, in need of S. m. p. and specialized treatment, may have thermal and radiation injuries, lesions with nerve agents and psychomimetic agents, toxins, etc. The appearance in the arsenal of modern nuclear weapons (see), poisonous substances ( see) and toxins caused the allocation in the structure of combat sanitary losses (see) the affected therapeutic profile [eg, radiation sickness (see)] and the need to provide for these affected contingents the corresponding types of S. m.

As well as during the Great Patriotic War, specialized hospitals of two types are intended for rendering S. m of the item and specialized treatment as a part of hospital bases: having constant (regular) specialization, for example. infectious, neurological, hospitals for the treatment of lightly wounded, and specialized hospitals created by strengthening general hospitals with specialized medical facilities. groups from the composition, a detachment of specialized medical care (OSMP).

Specialized medical care in the civil defense system

It is supposed to carry out the specialized medical aid struck and their stationary treatment in to lay down. institutions of hospital bases (see), deployed in suburban areas (see Medical service of civil defense). As a part of hospital base expansion of BC and departments in them of the following profiles is provided: neurosurgical, thoracoabdominal; for the treatment of hip fractures and injuries of large joints; traumatological; burn; therapeutic (for the treatment of those affected by penetrating radiation, toxic substances, toxins, as well as patients somatic diseases); infectious; psychoneurological; hospitals for the treatment of lightly wounded, specialized children's departments. B-tsy unite in hospital collectors. Each hospital collector is calculated to receive the affected in all major specialties. To ensure the provision of care by medical specialists, standard sets of tools and equipment are created.

Bibliography: Barabash V. I., Baronov V. A. and Lobastov O. S. Psychoneurological assistance in the conditions of modern war, JI., 1968; Burdenko N. N. The place of neurosurgery in the general organization of military field Soviet surgery in the Patriotic War, Vopr. neurosurgery., t. 6, no. 6, p. 3, 1942; he, Modern phase military surgery (Organization of special care for the wounded), Hospital. case, no. 1-2, p. 7, 1942; aka Soviet military surgery during the Great Patriotic War, M., 1946; Burenkov S. P., Gol about in-teev V. V. and Korchagin V. P. Health care in the period of developed socialism, planning and management, M., 1982; Military Field Therapy, ed. N. S. Molchanov and E. V. Gembitsky, JL, 1971; Voytenko M. F. Historical sketch of the development of organizational forms of specialized medical care for the injured and sick in the war, L., 1966; he, Organizational questions of activity of medical specialists of a medical profile in the army, L., 1970; Girgolav S. S. Military field surgery during the Great Patriotic War, M., 1944; Gomelskaya G. L. and others. Essays on the development of outpatient care in the cities of the USSR, M., 1971; E l and researcher to and y N. N. Specialized surgical care in the Great Patriotic War, Owls. doctor, Sat., v. 2, p. 1, 1946; Morbidity of the urban population and standards of medical and preventive care, ed. I. D. Bogatyreva. Moscow, 1967. Morbidity of the rural population and standards of medical and preventive care, ed. I. D. Bogatyreva. Moscow, 1973. F. I. Komarov. Specialization and military medicine, Voyen.-med. journal, no. 8, p. 3, 1978; Treatment of lightly wounded, ed. V. V. Gorinevskaya. Moscow, 1946. Treatment of victims with injuries of the chest and abdomen at the stages of medical evacuation, ed. Edited by B. D. Komarova and A. P. Kuzmichev. Moscow, 1979. Minyaev V. A. and Polyakov I. V. Health care of a large socialist city, M., 1979; Fundamentals of the organization of hospital care in the USSR, ed. A. G. Safonova and E. A. Loginova. Moscow, 1976. Petrovsky B.V. A new stage in the development of public health in the USSR, M., 1981; P about l I to about in V. A. and Khromov B. M. Surgical help at stages of evacuation of medical service of civil defense, M., 1969; Guidelines for the treatment of those burned at the stages of medical evacuation, ed. V. K. Sologub. Moscow, 1979. Guide to traumatology for the medical service of civil defense, ed. A. I. Kazmina. Moscow, 1978. Rybasov V. A. Organization of the medical service of civil defense, M., 1970; Smirnov E. I. Problems of military medicine, part 1, p. 222, M., 1944; he, War and military medicine 1939-1945, M., 1979; Tretyakov A.F. Terms of treatment of the wounded in evacuation hospitals, M., 1944; Guidelines for military field surgery, M., 1944; Textbook on the medical service of civil defense, ed. P. N. Safronova. Moscow, 1981. Sh and m about in VN Organization of neurosurgical care during the Patriotic War, Voen. -honey. journal, July-August, p. 3, 1944; 60 years of Soviet healthcare, chief. ed. B. V. Petrovsky. Moscow, 1977. Elstein N. V. Therapists and specialization of medicine, Tallinn, 1973; encyclopedic Dictionary military medicine, v. 5, art. 254, M., 1948.

E. A. Loginova, A. L. Lindenbraten; A. S. Georgievsky (military), V. I. Mikhailov, Yu. I. Tsitovsky (MSGO).

Types of medical care (first medical, pre-medical, medical, qualified, specialized)

Federal Agency for Health and Social Development of the Russian Federation

GOU VPO Altai State Medical University of Roszdrav

Department of Faculty Therapy

Speciality

- Economics and management in a healthcare enterprise

course work

in the discipline "Modern medical technologies"

on the topic: Types of medical care (first medical, pre-medical, medical, qualified, specialized)

Barnaul - 2011

Introduction

1. First aid

2. First aid

3. First aid

4. Qualified medical care

5. Specialized medical care

6. Development of medical care

Conclusion

Bibliography

INTRODUCTION

General concept"medical assistance" to a person in a state of danger to life and health" means therapeutic and preventive measures carried out in order to save the life of the wounded or sick, as well as to quickly restore their health.

Medical care is a combination of medical and preventive measures carried out in case of diseases, injuries, pregnancy and childbirth, as well as in order to prevent diseases and injuries.

Distinguish next levels medical care:

· First aid

· First aid

· First aid

·

·

First aidcarried out by people who do not necessarily have a special medical education. The first aid level does not involve the use of any special medical instruments, medicines or equipment.

First aidprovided by persons with special training in the provision of medical care. This is the average medical staff (paramedic, nurse) or pharmacist, pharmacist. This is their level of knowledge and skills.

First aidis provided by a doctor who has the necessary tools, medicines, and the amount of such assistance is regulated by the conditions for its provision, i.e. where she ends up - outside of hospital conditions or in a clinic, an ambulance, in a hospital emergency department.

Qualified medical careturns out to be highly qualified doctors in multidisciplinary hospitals or trauma centers;

Specialized medical carecan be rendered directly high level in the conditions of specialized clinics, institutes and academies.

A feature of medical care is the combination of treatment and prevention, as a result of which it is called treatment-and-prophylactic. The same name is given to institutions that provide medical care to the population. Medical institutions include hospitals, polyclinics and outpatient clinics, dispensaries, antenatal clinics and maternity hospitals, medical units and health centers, sanatoriums, medical and obstetric centers, etc.

The theme of my work is "Types of medical care (first medical, pre-medical, medical, qualified, specialized)". In the literature, even in regulatory documents, the concepts of first aid, first aid, Ambulance. It's not the same thing. These are completely different sometimes even legal concepts. In my work, I will try to reveal them as fully as possible.

1. FIRST AID

The health and life of victims and suddenly ill often depends on the timeliness and quality of the assistance provided by people who usually have nothing to do with medicine, but they are more often than doctors or paramedics are nearby. This is first aid. It depends on the level of medical knowledge, skills and abilities of witnesses and participants in the incident. First aid is a type of medical care that includes a set of simple medical measures performed directly at the scene of an accident or near it in the order of self-help and mutual assistance.

First aid- a set of urgent simple measures to save a person's life and prevent complications in the event of an accident or sudden illness, carried out at the scene by the victim himself (self-help) or by another person nearby (mutual assistance). First aid includes measures to stop the impact of factors that can aggravate the condition of the injured (sick) or lead to death, eliminate phenomena that directly threaten their lives (bleeding, asphyxia, etc.), taking measures to prevent complications and ensure the evacuation of victims (patients) without a significant deterioration in their condition.

First aid can be provided at the site of injury by the victim himself (self-help), his comrade (mutual assistance), sanitary combatants. First aid measures are: temporary stoppage of bleeding, application of a sterile dressing on the wound and burn surface, artificial respiration and indirect heart massage, administration of antidotes, administration of antibiotics, administration of painkillers (in case of shock), extinguishing burning clothing, transport immobilization, warming, shelter from heat and cold, putting on a gas mask, removing the affected from the infected area, partial sanitization.

First aid is aimed at maintaining the life of the injured (patient) and preventing the development of complications. It includes the extraction of victims from the seats of fire, from under the rubble; extinguishing burning clothes and incendiary mixture that has fallen on the body; a temporary stop of bleeding, the imposition of a sterile dressing on the wound (burn) surface; the use of antidotes in case of damage by toxic substances; elimination of asphyxia by freeing the upper respiratory tract from mucus, blood and foreign bodies, fixation of the tongue when it retracts; applying an occlusive dressing using a rubberized shell of an individual dressing bag; the introduction of an anesthetic using a syringe tube; immobilization using improvised means; the use of antibiotics and certain other drugs; partial special treatment of open areas of the body and clothing adjacent to them.

First medical (paramedic) assistance includes the following three groups of activities:

) Immediate cessation of exposure to external damaging factors (electric current, high or low temperature, squeezing with weights), removal of the victim from adverse conditions.

) Providing first aid to the victim, depending on the nature and type of injury, accident or sudden illness (stopping bleeding, bandaging a wound, artificial respiration, heart massage, etc.).

) Organization of the speedy delivery of the victim to a medical institution.

First aid includes, if necessary, the simplest measures to revive the body (first aid resuscitation). It is known that after the moment of death of a person, various organs and tissues of his body do not die immediately, but gradually, therefore, their functions, including blood circulation and respiration, in some cases can be restored. Revival is possible in short span time after the onset of the so-called. clinical death, i.e. after respiratory and circulatory arrest: usually within 6-8 minutes. Later, biological death occurs, and the probability of revival decreases sharply, and the full restoration of life, including mental activity, is practically impossible (except for those who are frozen or drowned in cold water). Clinical death can be caused by trauma, poisoning, hypothermia, electrical injury, myocardial infarction, etc. The “lifeless posture” helps to determine the fact of the absence of breathing and cardiac activity, that is, the position of the body, which is not characteristic of a living person; respiratory movements of the chest are absent, the pupils are wide, the heartbeat is not audible.

To restore breathing, you must first free the body from restrictive clothing and ensure the patency of the upper respiratory tract so that air can freely pass into the lungs. Artificial respiration in the absence of medical instruments and devices is carried out using the mouth-to-mouth or mouth-to-nose methods, i.e. air is blown into the victim's lungs. Requires a rhythmic repetition of vigorous breaths at a frequency of 12-15 times per minute.

An indirect heart massage is performed with a complete cardiac arrest and with agonal disturbances in the rhythm of its contractions. Artificial ventilation of the lungs provides ample oxygen saturation of the blood, so the task of a heart massage is to ensure the movement of blood through the body, deliver oxygen to the vital organs of a person, and thereby restore independent cardiac activity and respiration.

An indirect heart massage is performed as follows: by sharp pressure of the palm on the sternum of the victim, the assisting person causes squeezing of the stopped heart between the sternum and spine and reduces it in volume, which leads to the release of blood into the aorta and pulmonary artery. The cessation of pressure leads to the expansion of the chest, the heart restores its volume, is again filled with blood coming from the vessels. Thus, artificially induced contractions of the heart occur, ensuring its work as a pump, and artificial circulation.

It should be remembered that the provision of artificial blood circulation and artificial respiration, even if they do not lead to the restoration of an independent heartbeat and respiration, prolongs the state of clinical death and delays biological death, this can be critical to the effective operation of the ambulance crew.

The provision of first aid as soon as possible is of decisive importance for the further course and outcome of the lesion, and sometimes even saving lives. With severe bleeding electric shock, drowning, cessation of cardiac activity and respiration, and in a number of other cases, first aid should be provided immediately.

When providing first aid, personal and improvised means are used. Standard means of providing first aid are dressings - bandages, medical dressing bags, large and small sterile dressings and napkins, cotton wool, etc. To stop bleeding, hemostatic tourniquets are used - tape and tubular, and for immobilization special tires - plywood, ladder, mesh, etc. When providing first aid, some medicines are used - a 5% alcohol solution of iodine in ampoules or in a vial, a 1-2% alcohol solution of brilliant green in a vial, validol tablets, valerian tincture, ammonia in ampoules , sodium bicarbonate (baking soda) in tablets or powder, petroleum jelly, etc. For personal prevention of lesions by radioactive, toxic substances and bacterial agents, a first-aid kit is used in the lesions individual (AI-2).

General principles first aid for injuries and acute diseases are as follows:

stop and prevent further impact on the victim of the damaging factor, while ensuring the safety of the rescuer;

take measures to restore and maintain the vital functions of the victim's body as quickly and fully as possible.

It is important at the same time to observe the postulate of Hippocrates - "do no harm." Therefore, it is necessary to clearly master not only the correct sequence of actions, but also what absolutely cannot be done in this or that state.

After providing the necessary medical assistance, you should quickly deliver the victim to a medical facility or call an ambulance to the scene. The sooner medical assistance is provided, the greater the chance of saving the victim.

First of all, do not rush to act, first assess the situation, determine priority tasks, and then act.

The first is administrative action. Ensure the safety of yourself and the victims: drive away the dog, separate the fighters, call the police, firefighters, extinguish the flames, mark the scene of the incident on the roadway, help get out or pull the victim out of the broken car ...

Second, evaluate real threat for the life of the victim (impaired consciousness, difficulty breathing, weakness of cardiac activity, bleeding, pain shock) and take immediate action.

Third, after making sure that the victim is in a safe place and his life is not threatened by blood loss or airway obstruction, wait for the ambulance to arrive and start providing first aid.

If a person's life is not threatened by any real danger, that is, he is conscious, the injuries received are minor, breathing and pulse are easily recognized. Remove restrictive clothing, give sedatives and painkillers, treat the wound, comfortably lay a limb with signs of a fracture or dislocation in an elevated position, apply cold to the injured area. Do not forget about the possibility of taking some drugs "under the tongue" (sublingually), as they act faster and with less harm to the gastrointestinal tract (especially important for abdominal injuries). Read the instructions for use. These drugs include analgin and valocordin - they are in every first aid kit.

If the injury is serious, active movements, consciousness fuzzy give the victim a safe position.

Help the victim to take a comfortable position, in which the pain is the least. If consciousness is absent or confused, put the victim on his side, if breathing is difficult to throw back his head, make sure that breathing is free. For example, with a fracture of the pelvis and hip joints, you should take the frog pose. To do this, the victim must be laid on his back on a hard, flat surface, bending his legs at the knees, slightly spreading them to the sides and placing a roller under his knees

Stop bleeding from a wound. To do this, apply a pressure bandage or tourniquet if blood flows in a pulsating stream from a wound on the leg or arm. The pressure of the tourniquet should be sufficient for you to observe the cessation of bleeding. After 2 hours (not later!) Relax the applied tourniquet, if bleeding continues, tighten it again.

With a sudden cessation of cardiac activity, the signs of which are the absence of a pulse, palpitations, pupillary response to light (dilated pupils), immediately proceed to indirect massage heart and artificial lung ventilation.

In case of fractures of the limbs, use transport splints that fix two adjacent to the broken segment of the joint. Do not allow support on the "broken" leg, you can use improvised means of additional support (cane, crutch).

Fourth. If calling an ambulance is not possible, consider ways to deliver the victim to the nearest medical facility (on their own, in a car unsuitable for ambulance transportation, on a stretcher, in a prone position, sitting, standing ...). Transportation itself can lead to even greater traumatic injuries, therefore, correlate the nature of the injury and the means of evacuation available to you. So, for example, the transportation of victims with a spinal injury should be carried out only in the supine position on a hard shield, and with a chest injury only while sitting.

It is necessary to monitor the tourniquet and the bandage. The swelling that grows on the first day can lead to tissue compression, the bandage must be cut and replaced with a new one. Periodically, after 2 hours (not later!) after application, relax the tourniquet, to do this, slowly relax the applied tourniquet, wait 5 minutes, if bleeding continues and it has obvious signs of arterial bleeding, tighten it again.

When injured, the victim is given first aid. The task of first aid is to, by carrying out the simplest measures, save the life of the victim, reduce his suffering, prevent the development possible complications, alleviate the severity of exercise injury or illness.

2. FIRST AID

Conventionally, pre-medical care can be divided into assistance provided by paramedical staff: paramedic, midwife, nurse, and assistance provided by people who do not have special medical training, in the order of first aid.

First aid is the beginning of the treatment of injuries, because. it prevents complications such as shock, bleeding, infection, additional displacement of bone fragments and injury to large nerve trunks and blood vessels.

It should be remembered that the further state of health of the victim and even his life largely depends on the timeliness and quality of first aid. For some minor injuries, medical assistance to the victim may be limited to only the volume of first aid. However, for more serious injuries (fractures, dislocations, bleeding, damage to internal organs, etc.), first aid is initial stage, since after its provision, the victim must be taken to a medical institution. First aid is very important, but will never replace qualified (specialized) medical care if the victim needs it.

The first pre-medical emergency aid is a complex of the simplest measures aimed at saving lives and preserving human health, carried out before the arrival of a doctor or the delivery of the victim to the hospital.

First aid turns out to be a paramedic with standard medical equipment. It is aimed at combating the life-threatening consequences of injuries (diseases) and preventing severe complications. In addition to first aid measures, it includes: elimination of asphyxia by introducing an air duct, artificial ventilation lungs using portable devices, inhalation of oxygen, control over the correct application of the tourniquet, correction or, if indicated, the application of the tourniquet again; applying and correcting bandages; reintroduction painkillers, antidotes, the use of antibiotics, cardiovascular and other medicines available on the equipment of the paramedic; improvement of transport immobilization using standard and improvised means; partial special treatment of open areas of the body and degassing of clothing adjacent to them; if possible, warming the affected and sick.

The main tasks of first aid are:

a) taking the necessary measures to eliminate the threat to the life of the victim;

b) prevention of possible complications;

c) ensuring the most favorable conditions for the transportation of the victim.

First aid to the victim should be provided quickly and under the guidance of one person, since conflicting advice from outside, fuss, disputes and confusion lead to the loss of precious time. At the same time, the call of a doctor or the delivery of the victim to the first-aid post (hospital) must be carried out immediately.

The algorithm of actions to save the life and preserve the health of the victim should be as follows:

a) the use of personal protective equipment by a paramedic or nurse (if necessary, depending on the situation);

b) elimination of the cause of the impact of threatening factors (withdrawal of the victim from the gassed area, release of the victim from the action of electric current, extraction of the drowning person from the water, etc.);

c) urgent assessment of the condition of the victim ( visual inspection, inquire about well-being, determine the presence of signs of life);

d) call for help from others, and also ask to call an ambulance;

e) giving the victim a safe position for each specific case;

f) take measures to eliminate life-threatening conditions (resuscitation, stop bleeding, etc.)

g) do not leave the victim unattended, constantly monitor his condition, continue to support vital functions his body before the arrival of medical workers.

The first aid provider should know:

basics of work in extreme conditions;

signs (symptoms) of violations of vital important systems organism;

rules, methods, techniques for providing first aid in relation to the characteristics of a particular person, depending on the situation;

methods of transporting victims, etc.

The caregiver must be able to:

assess the condition of the victim, diagnose the type, features of the lesion (injury), determine the type of necessary first aid, the sequence of appropriate measures;

correctly carry out the entire complex of emergency resuscitation care, monitor the effectiveness and, if necessary, adjust resuscitation measures taking into account the condition of the victim;

stop bleeding by applying a tourniquet, pressure bandages, etc .; apply bandages, scarves, transport tires for fractures of the bones of the skeleton, dislocations, severe bruises;

provide assistance in case of electric shock, including in extreme conditions (on power line poles, etc.), in case of drowning, heat stroke, sunstroke, acute poisoning;

use improvised means when providing PDNP, when transferring, loading, transporting the victim.

Medical institutions providing first aid are feldsher health centers at enterprises and feldsher-obstetric stations in countryside. The decisive role in the provision of first aid at industrial enterprises belongs to health centers. However, it is not always possible for a health worker to provide the necessary assistance on time. Concerning great importance has self-help and mutual help.

First aid provided by people who do not have special medical training consists in carrying out the simplest measures at the scene of the incident (in the workshop, on the street, at home) before the arrival of the paramedic.

Training of the population in some methods of medical care according to special programs is carried out by organizations of the Red Cross, as well as in courses at enterprises. These programs include tourniquet training, pressure bandage, pressing large vessels, overlay simple dressings, artificial respiration techniques, splinting for fractures. Particular attention should be paid to the practical demonstration of first aid. The system of organizing self-help and mutual assistance includes training workers in the rules for providing first aid in relation to production conditions, and the creation of sanitary posts.

Sanitary posts for the provision of first aid in the shops are created from among well-trained workers; these posts are especially necessary in the areas of the workshop, remote from the health center. The sanitary post should be equipped with the necessary materials for first aid: stretchers, individual aseptic bags, cotton-gauze bandages, splints, hemostatic tourniquets, alcohol solution iodine, ammonia, tincture of valerian, etc. It is important that each worker of the workshop is aware of the location of the sanitary post. Workers should be familiar with safety regulations.

In rural areas, the organization and provision of first aid is carried out by the FAP. During the period of sowing and harvesting campaigns, sanitary posts are organized in each brigade; tractor and combine operators are provided with individual aseptic bags and are trained to use them. Along with training agricultural workers and collective farmers in the rules of self-help and mutual assistance, they should also be introduced to the rules of agricultural labor safety and the most common causes of injury.

3. FIRST AID

First aid -a type of medical care that includes a set of therapeutic and preventive measures performed by doctors (as a rule, at the stage of medical evacuation) and aimed at eliminating the consequences of lesions (diseases) that directly threaten the lives of the affected (patients), as well as the prevention of complications and the preparation of the affected (patients) if necessary, further evacuation.

First aid is provided by a doctor at the first-aid post and is aimed at eliminating or mitigating the consequences of injuries (lesions), life-threatening diseases, preventing the development of complications or reducing their severity, as well as preparing the injured and sick for further evacuation. It includes such medical measures as stopping external bleeding by applying a clamp, eliminating acute respiratory failure, anti-shock measures, transport immobilization, preventive measures wound infection, bladder puncture, application of symptomatic medications and etc.

4. QUALIFIED MEDICAL CARE

Qualified medical care -a type of medical care, including a complex of comprehensive therapeutic and preventive measures performed by medical specialists of various profiles, in specialized medical institutions using special equipment, the main types of specialized medical care provided in various emergency situations, is neurosurgical, ophthalmological, traumatological, toxicological, pediatric, etc.

Qualified assistance is provided in separate medical institutions. It is aimed at eliminating the life-threatening consequences of lesions and diseases, preventing the development of complications and preparing those in need for further evacuation and is divided into surgical and therapeutic. Skilled surgical care includes final stop bleeding; complex therapy acute blood loss, shock, traumatic toxicosis; elimination of asphyxia; primary surgical treatment of wounds; laparotomy in case of damage to the abdominal organs; decompressive craniotomy; amputation with detachments, crush injuries and ischemic necrosis of the limbs and other urgent measures. Qualified therapeutic assistance includes complex therapy for cardiovascular insufficiency, cardiac arrhythmias, acute respiratory failure; the introduction of antidotes; the use of painkillers, desensitizers, antiemetics, anticonvulsants and bronchodilators, as well as tranquilizers, neuroleptics and other medications.

5. SPECIALIZED MEDICAL CARE

The most characteristic modern trend in the development of medical care is specialization. Outpatient and inpatient medical care is provided not only in the main specialties: therapy, surgery, traumatology, pediatrics, neuropathology, ophthalmology, otorhinolaryngology, dentistry, obstetrics and gynecology, but also in many specialties: cardiology, rheumatology, gastroenterology, pulmonology, endocrinology, oncology, allergology, urology, nephrology, proctology, etc.

Specialized medical care -a type of medical care that includes a complex of comprehensive therapeutic and preventive measures performed by medical specialists of various profiles in specialized medical institutions using special equipment for patients with a certain pathology.

Specialized care provided by medical specialists in specially designated specialized hospitals with appropriate equipment is exhaustive. The main types of specialized medical care are: surgical, including neurosurgical, ophthalmological, maxillofacial, otorhinolaryngological, thoracoabdominal, urological, care for burned and lightly injured; therapeutic, including radiological, toxicological, psychoneurological, dermatovenereological, assistance to patients with somatic diseases and infectious patients; assistance to patients with tuberculosis, mildly ill.

The specialization of medical care is the result of scientific and technological progress and a historically determined process of the development of medical science and healthcare practice, which led to the separation of separate specialties.

Specialized medical care is an integral part of the organization of medical and preventive care and the entire health care system, which largely determines the path of its development. Specialization in medicine leads to the differentiation of medical specialties, the scientific substantiation of the principles of organizing medical care, changing the functions of medical and preventive institutions, their typification and structure, strengthening the material, technical and personnel base of health care, etc. From the level of specialization, forms and methods of organizing specialized types of medical care depends on the quality of prevention, diagnosis and treatment of various diseases and the effectiveness of rehabilitation of patients.

Simultaneously with the differentiation of scientific knowledge and practical medicine, the process of integration is also developing, contributing to the complexity of the treatment and diagnostic process. Specialization and integration in practical healthcare largely determine the improvement of the organizational forms of specialized types of medical care. The creation of specialized offices, departments, institutions, diagnostic centers, the introduction of a team method of work, the principles of stages and medical zoning, as well as other organizational forms and methods, are a reflection of these processes.

6. DEVELOPMENT OF MEDICAL CARE

The development of medical care at the present stage is characterized by a constant trend towards specialization of both out-of-hospital and inpatient care, expressed in the expansion of the network of specialized institutions, an increase in the number of specialist doctors of various profiles, outpatient appointments, departments and beds in hospitals. Various specialized teams function in the ambulance service, which contributes to the expansion of the volume and nature of the assistance provided by doctors on the spot and during the transportation of the patient to a medical institution, and most importantly, to improve the quality of medical care. A network of emergency hospitals is developing, the main tasks of which are to provide specialized emergency inpatient medical care to the population. Great importance is attached to the development of diagnostic and laboratory services, where specialization also takes place, new diagnostic areas are constantly being identified, new rooms and laboratories are being created.

Trends in the development of specialized medical care at the present stage are characterized, first of all, by the construction of large multidisciplinary and specialized hospitals, specialized centers, dispensaries, etc., which allows them to create specialized structural units equipped with modern equipment and provided with highly qualified specialists. The organization of specialized departments, centers contributes to the improvement of the qualifications of medical staff, the quality of medical care, the more rational use of the bed fund, personnel of specialists and medical equipment. In modern urban general hospitals medical assistance to the population is provided in all major specialties. There is a development and strengthening of regional (regional, republican) hospitals, where qualified highly specialized medical care is provided. A special role in the provision of certain types of specialized care belongs to dispensaries (cardiological, narcological, oncological, dermatovenerological, anti-tuberculosis, psycho-neurological, endocrinological, medical and physical education), which can provide both out-of-hospital and inpatient medical care, as well as specialized hospitals - infectious diseases, ophthalmological, psychiatric, tuberculosis, etc.

The development of out-of-hospital specialized medical care requires appropriate conditions and organizational forms. The experience of Russian and foreign health care shows that in order to provide highly qualified out-of-hospital specialized medical care, it is necessary to rationally locate specialized rooms, departments, institutions, taking into account the phasing in the organization and the principle of medical zoning. At the same time, it is necessary to provide for the approach to the population of the main and centralization of highly specialized types of medical care. At the first stage, in medical outpatient clinics, territorial polyclinics, medical and sanitary units, the following main medical profiles should be received: therapeutic, surgical, obstetric-gynecological, pediatric, dental. At the second stage, in polyclinics of central district hospitals, large city polyclinics, diagnostic centers receptions are organized in narrower specialties (neurology, traumatology, cardiology, ophthalmology, otorhinolaryngology, etc.). The third stage is highly specialized departments, centers created to provide allergological, gastroenterological, nephrological, pulmonological, rheumatological, endocrinological, urological and other types of medical care on the basis of large city multidisciplinary and regional (regional, republican) hospitals, to-rye can also perform the functions of interregional , inter-republican. The fourth stage - all-Union and republican specialized centers, organized, as a rule, on the basis of clinics of institutes, providing organizational, methodological and advisory assistance to the population of a union republic or the whole country.

A special role in the development of specialized medical care belongs to the chief specialists of health departments, regional (territorial, district) and city health departments (general practitioners, surgeons, pediatricians, obstetrician-gynecologists, etc.). Their importance is especially great in rural areas, where the chief specialists of the central district hospitals are an important part of the healthcare management system. They, besides diagnostic and treatment, do a lot of work as organizers, consultants and methodologists of the relevant specialized services. Their main tasks are the development and implementation of measures aimed at preventing diseases, improving the efficiency and quality of medical care, introducing into the practice of medical and preventive institutions the latest methods of diagnosis, treatment and rehabilitation of patients, rational and efficient use of human and material resources of health care.

The specialization of medical care, among others, put forward the problem of training the appropriate personnel of specialists. The changes made to the system of medical education were due to the need to combine specialized training with general medical education on a broad natural science and socio-hygienic basis. A coherent system of specialization and improvement of doctors has been created in Russia, which is carried out by institutes for the improvement of doctors, advanced training faculties at medical universities, bases of primary specialization at large republican, regional, regional and city hospitals, as well as a system of clinical residency.

At different stages of the development of health care, in accordance with its tasks, at each stage, the forms and methods of preventive care were improved and improved, however, the fundamental foundations and the socialist nature of its organization remained unchanged, thanks to which a modern unified system for organizing specialized medical care was created and is successfully functioning.

Great attention is paid to the further development of specialized medical care in the national project "Health", which notes that an indispensable condition for further reducing the incidence and mortality of the population, improving the quality of medical care is the development and strengthening of its specialized types. It is planned to create a network of interregional (regional) centers with departments and branches for microsurgery, pacing, joint prosthetics, organ and tissue transplantation, cardiovascular surgery for the treatment of patients with chronic kidney failure and etc.; to increase the number of inter-district specialized hospitals, dispensaries, departments in order to meet the needs of the rural population in specialized care. In particular, inter-district ophthalmological departments will be developed, the provision of medical care to patients with eye diseases will be improved. Cardiology dispensaries are being modernized in all regional and regional centers, the number of cardiology rooms in polyclinics and departments in hospitals has been expanded. The work of oncological centers is being improved, the construction of oncological dispensaries and radiological buildings is being expanded. In order to improve the level of surgical care, cardiosurgical, vascular, orthopedic, traumatological, neurosurgical, urological, proctological, burn and other highly specialized surgical departments are being developed and strengthened.

The task has been set to radically improve the provision of dental care to the population, primarily to children, to ensure full satisfaction of the need in all its forms. Allergological rooms and immunological laboratories should be organized in each region and territory. It is planned to implement extensive measures to prevent the most common diseases nervous system and mental disorders: further organization and improvement of the work of departments for patients with acute disorders cerebral circulation, the creation of centers in large cities rehabilitation treatment for the rehabilitation of people with diseases of the nervous system, expansion of the network of neuropsychiatric dispensaries, hospitals and their departments in rural areas. There must be a fundamental improvement in the work on early detection and effective treatment persons suffering from alcoholism and drug addiction. It is planned to strengthen and develop pulmonological, gastroenterological, endocrinological, hematological and other assistance. paramedic medical assistance medical

A large role in the provision of specialized medical care belongs to the nursing staff working in specialized rooms, departments and institutions. This imposes certain requirements on the training of nursing staff and the organization of their work. For example, a nurse working in surgical department must have completed an appropriate specialization in surgery. She must know desmurgy well, master the technique of subcutaneous, intradermal and intravenous injections, temporary stop of bleeding, be able to properly carry out immobilization, master the plaster technique, know how to sterilize syringes, material, tools, storage rules and their expiration dates. Nurses of various specialized offices (otorhinolaryngological, ophthalmological, infectious diseases, etc.) must be proficient in certain methods of examining patients of the appropriate profile and performing procedures, etc.

CONCLUSION

Medical assistance to the population is based on the territorial-district and production principles.

The district principle ensures continuity in the observation of the patient by the same doctor, active identification of patients with initial forms of the disease, and comprehensive preventive measures. The leading method of work of medical institutions is dispensary.

In the system of organizing qualified free public medical care, there are therapeutic and preventive care for the urban population, including medical care provided in medical units and health centers; medical assistance to the rural population; medical care for children; obstetric and gynecological care, etc. By its nature, medical care can be out-of-hospital (including home care), inpatient and sanatorium-resort.

One of the important links of community care is emergency and emergency medical care, which is organically linked with polyclinics and hospitals. To provide this type of medical care, a wide network of specialized institutions has been created - stations, substations, departments and hospitals.

Emergency medical care, in addition, should be provided by any medical institution, regardless of departmental affiliation. Inpatient medical care is provided in general, multidisciplinary and specialized hospitals, maternity hospitals, hospitals of medical units, dispensaries, research medical institutes, as well as in clinics of medical universities.

In the general complex of health-improving and preventive measures, sanatorium-resort care is of great importance.

Medical assistance, with the exception of cases of self-help and mutual assistance, is provided only by persons with a special medical education, while important role belongs to the nursing staff. The high qualification of paramedical personnel is a necessary condition for the effective functioning of the medical care organization system.

BIBLIOGRAPHY

1.Evdokimov N.M. Provision of first medical aid. -M., 2001

2.Eliseev O.M. A guide to first aid and emergency care. - St. Petersburg: Ed. LLP "Leyla", 1996.

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.Brief Medical Encyclopedia. M .: / Publishing house "Soviet Encyclopedia", second edition, 1989.

6.Directions, main activities and parameters of the priority national project "Health". Approved by the Presidium of the Council under the President of the Russian Federation for the implementation of priority national projects (Minutes No. 2 of December 21, 2005)

7.Organization and tactics of the medical service. / Ed. N.G. Ivanova and O.S. Lobastova, St. Petersburg, 1988.

8.First aid: reference book M., 2001

.Order of the Ministry of Health and Social Development of the Russian Federation (Ministry of Health and Social Development of Russia) dated April 16, 2010 N 243n M. / On the organization of the provision of specialized medical care.

10.Safonov A.G., Loginova E.A. Inpatient medical care (basics of organization). M., 2003. -180s.

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12.Federal law "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens", M., 2006

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Specialized medical care is provided by specialist doctors in specialized medical institutions of the front using the necessary types of honey. equipment. Specialized medical care is the highest type of qualified medical care, which provides for the most complete and widespread use of the latest achievements of a particular field of medical science in the practice of treating the affected and sick.

During the Great Patriotic War, a harmonious, scientifically based system of specialized medical care was created in the USSR. In the post-war period, based on the study and critical analysis of the experience gained, further development and improvement of specialized medical care takes place.

In connection with the possible use of weapons of mass destruction, completely new contingents of the injured and sick may appear in need of specialized medical care.

The provision of specialized medical care can be carried out in field mobile hospitals (surgical, therapeutic, infectious diseases, neurological), in a hospital for the lightly wounded and in evacuation hospitals. Depending on the number of incoming injured and sick people in need of one form or another of specialized medical care, and the number of medical institutions available at the moment, hospitals can be created that are entirely specialized in one profile or have specialized departments in their composition.

Specialization of hospitals is carried out both by introducing specialists and the necessary equipment into their staffs, and by giving surgical and therapeutic field mobile hospitals specialized medical reinforcement groups from a separate detachment of specialized medical care.

One of the main requirements for the organization of honey. assistance in military field conditions, are continuity and consistency in the conduct of therapeutic and preventive measures based on uniform principles for the provision of honey. help the injured and the sick. Continuity in treatment is achieved primarily by a common understanding of the pathological processes that occur in the human body during lesions and diseases, and by uniform methods for the prevention and treatment of lesions and diseases in wartime. At the same time, the continuity of medical care and treatment can be carried out only if, at each subsequent stage, honey. evacuation will know what was done at the previous stage, what kind of medical care and when was provided to the injured or sick. This is achieved by a clear management of honey. documentation, in particular, by carefully filling out the primary medical card and maintaining medical histories (see Medical and evacuation support for troops, Staged treatment).

An important requirement for the organization of medical care in military field conditions is also the timeliness of its provision. Medical assistance should be provided at the most favorable time for the subsequent restoration of the health of the injured or sick person. Special meaning has a timely urgent action first medical and qualified medical care.

The timeliness of the provision of medical care is achieved by including the necessary regular forces and means of the medical service in the troops of the active army, the fastest removal and removal of the injured and sick from the battlefield or from the centers of mass destruction and their transportation to the stages of honey. evacuation, clear organization of work at stages. Equally important is the rational arrangement of the stages of honey. evacuation.

See also Civil Defense Medical Service.