From Big Medical Encyclopedia

EMERGENCY MEDICAL SERVICE HOSPITAL — the treatment and prevention facility intended for providing victims and patients with specialized types of medical care according to the emergency indications.

Creation of such BCs is provided by the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of health care and development of medical science in the country» (1968). B-tsy emergency medical service combine with stations of emergency medical service (see. Emergency medical service ), such associations work in many cities of the country; their number in 1982 reached 87. Merging of hospitals and stations provides the emergency help to persons in need in it to persons on the basis of uniform tactics not only in a hospital, but also at a pre-hospital stage, increases level to lay down. works and qualifications of doctors, including mobile teams.

Enters tasks of BC of emergency medical service, in addition to direct rendering medical aid to the population, organizational and methodical participation in activity of others to lay down. - the prof. of institutions concerning the emergency medical aid.

They are the head institutions responsible for a state and quality of the emergency stationary help to the population in the territories assigned to them, Besides, they carry out a dignity. - a gleam. work among the population will also organize professional development of medical staff concerning rendering medical aid at medical emergencies, regulate activity to lay down. institutions and departments of the operating round the clock emergency medical service, are bases for the city (republican) scientific specialized centers — toxicological, burn, traumatologic, neurosurgical and resuscitation.

In structure there would be a hospital with medical and auxiliary divisions, the station (department) of emergency medical service, an administrative part.

The hospital provides reception of the patients and victims delivered by crews to emergency medical service and addressing directly in-tsu for the emergency medical aid and also rendering such help to them in full using sovr. diagnostic aids and treatment. Work of a hospital will be organized according to regulations on work of hospitals of city BCs. It has therapeutic, surgical, traumatologic, neurologic, gynecologic and pediatric beds. Besides, in emergency medical service would have to function: the center of resuscitation (see. Resuscitation ), intended for removal from serious condition of persons with life-threatening disturbances of breath and blood circulation (the quantity of beds in it is defined at the rate of 0,12 on 10 thousand population of the city); chambers of an intensive care in profile departments for the subsequent maintaining the patients who received the help in the center of resuscitation, underwent difficult operations, patients with severe injuries, etc. (the quantity of beds in them makes 10 — 12% of bed fund therapeutic, surgical, travmatol., ginekol., neurosurgical departments); laboratory of express diagnosis.

The round-the-clock receipt in-tsu emergency medical service of patients and victims of accidents, their state heavy, as a rule, need of urgent rendering to much of them of the help on to vital indications (see) and complexity of diagnosis attach special significance to its reception. Its constant readiness for reception of such patients is necessary.

In reception round-the-clock work of diagnostic laboratories, carrying out functional diagnosis, rentgenol shall be ensured. researches, express methods of a research (clinical, biochemical, bacteriological, hematologic, serological). On sovr. to data, more than 20% which came to reception with acute abdominal pains need the emergency carrying out a wedge, blood tests and urine, more than 5% — in radiological and more than 1% — elektrokardio-logical researches. The increasing value is gained in the emergency diagnosis by endoscopic methods of a research (see. Endoscopy ), hl. obr. concerning foreign bodys and injuries of a gullet, went. - kish. bleedings, alleged damages of bodies of a mediastinum, chest and abdominal cavity. The express and diagnostic service of reception applies radiological and endoscopic diagnostic methods to destination of the responsible doctor on duty and with his obligatory participation, especially at seriously ill patients with not clear a wedge, the diagnosis.

Use of special methods of a research is dictated by difficulty of establishment of primary diagnosis, especially at the beginning of development of an acute disease, need of specification of localization of damage at the severe combined injury. In case of not clear diagnosis of patients place in the diagnostic chambers created at reception.

The emergency advice in reception is provided by crew on duty from specialists doctors, in to-ruyu the therapist, the surgeon, the traumatologist, the neuropathologist, the obstetrician-gynecologist enter.

Specialized departments-tsy of emergency medical service are constructed by the block principle. In each department of a surgical profile there is a surgery block, at Krom resuscitation beds are developed.

For-tsy emergency medical service the standard projects approved by M3 of the USSR at the rate on 560 beds at population of the city from 300 to 500 thousand inhabitants are developed and on 800 beds for larger cities. In the cities with the population less than 300 thousand render the emergency stationary medical aid city and central regional-tsy (see. Municipal hospital , Central regional hospital ).

The main quantitative indices reflecting the volume of activity-tsy of emergency medical service are: total number of the patients who addressed and brought to reception, number of the hospitalized patients p number hospitalized in relation to all come to reception (percent of selection on a bed). These indicators differentiate on channels of arrival of patients (percent delivered by means to emergency medical service and independently addressed) and on a profile of diseases. Analyze also the frequency of failures in hospitalization. The indicator of frequency of failures should be differentiated for causes of failures (wrong diagnosis, non-core delivery, etc.).

Registration and reporting documentation (in particular, a registration form No. 74) allows to analyze especially structure of patients, the Crimea only the ambulatory care was given in reception (see. Extra hospital help ). At the same time it is reasonable to study these indicators both on the main profiles of diseases, and on channels of receipt.

During the studying of quality of service of patients in a hospital it is necessary to analyze the organization of all medical and diagnostic process at 3 of its stages: from the moment of arrival of the patient in reception to the direction in specialized department; from receipt in specialized department before establishment of the clinical diagnosis; during treatment of the patient in a hospital (applied to lay down. actions, terms of stay, results of treatment). The organization of flows of patients and rendering medical aid to them in reception, including identification of the patients needing only an ambulatory care and also clearness in holding diagnostic actions for timely transfer of patients in specialized departments affects these indicators. Success of hospitalization in emergency medical service, in turn, would depend on terms of hospitalization of patients. Therefore detailed studying of this indicator is necessary for complex and objective assessment of efficiency of activity-tsy. With the same purpose it is necessary to differentiate terms of hospitalization (from the beginning of a disease or an injury before receipt in a hospital) and the delivery periods which are urgently hospitalized (from the moment of the request of the patient for medical aid before receipt in a hospital).

Efficiency of use of bed fund is characterized by such indicators as average duration of stay of the patient on a bed (on a hospital in general and on profiles of beds), average employment, function (turn) of a bed and mean time of idle time of a bed (in days). In the analysis of each of these indicators on separate-tsam or group of BC they always should be compared with average values of similar indicators on the city, the area, area. It is also desirable to carry out the analysis of all indicators for perhaps longer period for their assessment in dynamics.

See also Hospital .

Bibliography: Messel M. A. Organization of work of the city station of emergency medical service, page 228, JI., 1968; The Organization of emergency medical service, under the editorship of B. D. Komarov and P, M. Isakha-nova, page 44, M., 1980; Bases of the organization of emergency medical service (A pre-hospital stage), under the editorship of B. D. Komarov, page 7, M., 1979; Bases of the organization emergency stationary medical pomoshchp, 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, page 105, M., 1976; P at the h - to about in A. S. The organization of emergency medical service in Moscow, M., 1959, bibliogr.; Serenko 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.