EMERGENCY MEDICAL SERVICE — the emergency medical care at medical emergencies and injuries rendered to patients and victims at home on the street, at the enterprises and in institutions, S. of m of the item is provided with the stations, substations and hospitals of emergency medical service (see. Emergency medical service hospital ), the having necessary equipment, transport and shots. The concept «emergency medical service» connected with earlier existing organizational form of assistance to patients at home at medical emergencies with forces and means territorial to lay down. networks, in a crust, time is not applied.
Medical emergencies it is accepted to call such patol. changes in a human body, to-rye lead to sharp deterioration in health, can threaten life and, therefore, demand emergency to lay down. died. Here belong directly life-threatening patol. states; directly not life-threatening patol. states, but at to-rykh such threat can become real at any time; states, at to-rykh lack of timely medical aid can cause permanent changes in an organism; states at to-rykh in the shortest possible time it is necessary to alleviate suffering of the patient; the states demanding urgent medical intervention for the benefit of people around in connection with behavior of the patient.
Service C. of m of the item in our country as an integral part of the state system health care (see) it was created only after Great October socialist revolution. Till this time separate attempts of its organization were connected with an initiative of individuals or charitable about - century. The organization C. of m of the item to the population was under construction since first years of development of socialist health care according to its main principles — statehood, free of charge and general availability of the qualified medical aid, close connection of practical activities with achievements of medical science. The structure and content of work of institutions C. of m of the item changed at different stages of its formation and development.
In the first years of existence of the Soviet state so-called points of «the night room help» at out-patient clinics and policlinics functioned. Stations of ambulance were organized in 1919 in Moscow, Leningrad, Kiev and Odessa. In the late twenties in a number of the large cities, in particular in Moscow and Leningrad, points of «the night room help» were merged with the stations of ambulance and received the name of points of acute management. In 1936 — 1969 the emergency extra hospital help was given by both stations of ambulance, and points of acute management at policlinics. In 1978 reorganization of system of acute management was complete and all functions on rendering the emergency help are transferred to service C. of m of the item.
In 1923 in Moscow Ying t of emergency medical service of N. V. Sklifosovsky (nowadays Scientific Research Institute of Emergency Medicine of N. V. Sklifosovsky) designed to develop scientific problems C. of m of the item was created.
Process of differentiation in medical science and practice found the reflection in intensive specialization of S. of m of the item to the population. For the purpose of the maximum approach of the specialized help to the contingent of seriously ill patients and victims, for improvement of the emergency diagnosis and methods of rendering S. of m of the item in the cities and large rural districts specialized crews were organized: resuscitation, cardiological, neurologic, toxicological, pediatric, crews of an intensive care, etc.
A new organizational form of rendering S. of m of the item would be merging of the stations from emergency medical service. Such association creates real premises for rapprochement of levels and promotes use of uniform tactics and a technique of rendering the emergency medical aid at pre-hospital and hospital stages, provides bystry training of specialized crews, increase is promoted by a wedge, training of doctors and provides attraction in this system of specialists.
The resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of national health care» was important for S.'s development by m of the item (1977), in Krom the close attention is paid to this question: measures for development of network and improvement of work of institutions C. of m of the item are planned, in particular increase in number kardiol is provided. crews, establishment of side benefits to doctors of the fast medical help.
«About additional measures for improvement of public health care» it is entrusted (1982) councils of ministers of federal republics to provide with the resolution of the Central Committee of the CPSU and Council of ministers of the USSR in 1983 — 1985 expansion of network of stations and substations of emergency medical service and their equipping, and in rural districts to carry out actions for development of emergency medical service.
S.'s development by m of the item is characterized not only by emergence of new organizational forms, but also considerable proliferation of service and strengthening of its material and technical resources (increase in the park a dignity. cars, improvement of means of communication, improvement of equipment by pieces of the medical equipment, etc.). In 1980 in the USSR the St. 4 thousand stations (departments) emergency medical service functioned, to-rymi more than 80 million calls were executed.
The system of institutions C. of m of the item for urban population in the majority of settlements developed and developed by the principle of their territorial division taking into account architectural and planning division into districts. The main establishment of service C. of m of the item is the station of emergency medical service providing the emergency help to the population at a pre-hospital stage, transportation of the victims and patients needing transportation on a dignity. motor transport (see. Motor medical ambulance ) in medical institutions.
The network system accepted in the cities provides creation of the central station and substations. Substations first pomoshchp are deployed across all territory of the city taking into account population of planning zones. At the same time places of mass accumulation of people, flows of their movement, intensity of the movement of vehicles are considered. The main criterion for power rating of substations, and also their dislocation in the settlement is the settlement possibility of arrival of medical crew in any point of the fixed zone not later than through-15 min. after receipt of a call.
In rural districts of S. of m of the item it is carried out by the departments which are a part central regional hospitals (see), and also departments of the emergency and planned and advisory medical care regional hospitals (see), and also republican with the stations of sanitary aircraft given them (see), first of all for the population of the remote and hardly accessible areas. Also the service of rescue on waters equipped with boats is created (see. A water medical ambulance), equipped, as well as cars of emergency medical service, means of communication for management of them from the central control offices.
According to tasks of the Food programme of the USSR and the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About additional measures for improvement of public health care» (1982) in the eleventh five-years period the organization in rural districts of service C. of m of the item comes to the end, large measures for providing rural institutions C. of m of the item with shots, a dignity are carried out. transport, means of communication, objects of a medtekhnnka (see. Food programme).
Efficiency of the organization of service C. of m of the item is defined by a number of factors: optimum development and rational placement of network of stations and departments of emergency medical service; accurate work of the dispatching service which is carrying out call acceptance and the direction of crews of medics to destination as soon as possible; accurate system of hospitalization of patients and victims (the centralized accounting of empty seats in-tsakh, maternity homes and others to lay down. institutions); interrelation and succession in treatment of ambulance crews sick with doctors and doctors of hospitals; drawing up forecasts of need for crews and resources; the scientific and methodical management of stations of emergency medical service from in-t or hospitals; existence in structure of the stations of emergency medical service of specialized mobile teams (cardiological, rheumatological, pediatric, toxicological, etc.).
The organization of work of stations of emergency medical service is regulated by the orders M3 of the USSR and federal republics, to-rymi regulations on work of stations, standards of security their dignity are approved. motor transport and medical staff, lists of the necessary equipment and equipment of all types of sanitary vehicles and the instruction about work of medical staff.
The main functions of stations of emergency medical service are: rendering medical aid, including specialized, the victim and the patient in the shortest possible time from the moment of emergence patol. states on site incidents and in the course of transportation of the patient; the most bystry delivery of patients in corresponding to lay down. establishment; carrying out in the greatest possible volume to lay down. the actions directed to recovery of the vital functions of an organism; ensuring succession in rendering medical aid by the station of ambulance and other medical institutions; studying of the reasons of accidents and sudden emergence of life-threatening states and development of offers on their prevention, and also the offers directed to improvement of services C. of m of the item; transportation of patients, victims, women in labor in to lay down. institutions accompanied by the medic on special a dignity. transport.
The main structural divisions of stations of emergency medical service are: management (administrative part), operations section, department of hospitalization, transport department, mobile teams, department of statistics. The operations section carries out call acceptance and their transfer on execution, management of mobile teams, etc. The centralized call acceptance on a phone number, uniform for all country, «03» is conducted by the dispatcher having secondary medical education. In the large cities for call acceptance in operations sections of the station install the panels equipped with indicating panels and the electronic clock. The department of hospitalization keeps account of bed fund in the city and provides regularity of the emergency hospitalization according to existence of empty seats, a profile of institutions and location of the patient or victim. The transport department provides mobile teams a dignity. transport. The department of statistics is engaged in the analysis of activity of the station of ambulance.
The main base unit of the station of emergency medical service is the mobile team. Distinguish S.'s crews of m of the item and crew on transportation of patients. S.'s crews of m of the item share on linear and specialized (cardiological, neurologic, traumatologic, toxicological, pediatric, etc.). The doctor, the paramedic and the hospital attendant are a part of crew of S. of m of the item (in the nek-ry cities — the doctor and 2 paramedics); in structure of crew on transportation of patients — the paramedic, and on transportation of women in labor and ginekol. patients — the paramedic-midwife.
The organization of specialized crews has the features. In the capitals of federal republics, the regional centers, the large industrial cities at the stations of emergency medical service which are carrying out the large volume of work narrow-purpose specialized crews are created; in towns — teams of doctors of wider profile — the crew of an intensive care (CIC).
Overall performance of a mobile team in many respects is defined by equipment of special sanitary vehicles. Equipment and equipment of salon dignity. the car intended for linear crews allow to carry out oxygen therapy, an anesthesia by nitrous oxide (see. Inhalation anesthesia ), auxiliary or artificial ventilation of the lungs (see. Artificial respiration ), indirect cardiac massage (see), a temporary stop of bleeding (see), a transport immobilization (see), parenteral and intravenous administration of pharmaceuticals (see. Venipuncture ), gastric lavage (see) and an enteroclysis (see. Intestinal washings ), an ECG (see. Elektrokardiografiya ), express analyses, etc. For this purpose dignity. cars of specialized crews are provided with additional equipment.
Providing stations (departments of emergency medical service) with telephone communication, a radio communication and the alarm system is of great importance for operational service of patients and victims (sound and light). Stations of emergency medical service are provided with direct radiotelephone communication with substations, hospitals, policlinics, bodies of health care, militia, GAI and other field and special services.
For development of the scientific problems connected with the organization C. of m of the item in Moscow, Leningrad, Kharkiv and other cities are created nn-you and scientific centers C. of m of N, scientific subject to-rykh are coordinated by Academic medical council of M3 of the USSR (see. Academic medical council ). The important role in implementation of the plan of scientific works and implementation of their results in practice is allocated for the Moscow city Scientific Research Institute of Emergency Medicine of Sklifosovsky and the Leningrad city Scientific Research Institute of Emergency Medicine of the prof. Yu. Yu. Dzhanelidze (see. Research institutes ), in to-rykh big research and organizational and methodical work on improvement of work of emergency medical service is carried out.
The service C. of m of the item in other socialist countries proceeds from the same tasks, as in the USSR. The stations of emergency medical service existing in these countries have a dignity. motor transport, dignity. aircraft, boats and the necessary equipment, are provided with the qualified medical shots.
In the majority of the capitalist countries the harmonious comprehensive system of rendering S. of m of the item is not created. It is carried out various, including private, institutions, has the various organizational forms. Villages of m of the item to the population in these countries will organize various by the nature of the organization activity: municipalities, about-in Red the Cross, professional, insurance companies, medical colleges,-tsy, out-patient clinics, etc.
The organization and features of separate types of specialized S. of m of the item (psychiatric, cardiological, traumatologic, reanimatologichesky, etc.) see in articles Cardiology , Mental health services , Resuscitation , Resuscitation , Traumatology etc.
Bibliography: B. D. and Kustov E. A. mosquitoes. 60 years of emergency medical service, Owls. medical, No. 12, page 25, 1982; Bases of the organization of emergency medical service (a pre-hospital stage), under the editorship of B. D. Komarov, M., 1979; Bases of the organization of the stationary help in the USSR, under the editorship of A. G. Safonov and E. A. Loginova, page 335, M., 1976; Bases of the organization of the emergency stationary medical care, under the editorship of B. D. Komarov, M., 1981; Petrovsky B. V. Achievements of the Soviet health care for years of the ninth five-years period, M., 1976; Seren-co A. F., Ermakov V. V. and Petrakov B. D. Bases of the organization of the polyclinic help to the population, page 254, M., 1982.
B. D. Komarov, E. A. Kustova.