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Story 03

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History of ambulance

December 8, 1881

There was a fire at the Vienna Comic Opera Theater.

This incident, which assumed enormous proportions (479 human casualties), presented a terrifying spectacle. In front of the theater, hundreds of burned people lay in the snow, many of whom also received various injuries during the fall. The victims could not receive any medical care for more than a day, despite the fact that Vienna at that time had many first-class and well-equipped clinics. This whole terrible picture shocked the professor-surgeon Jaromir Mundi, who was at the scene of the incident, who found himself helpless in the face of the disaster. He could not provide effective assistance to the victims. The very next day, Dr. J. Mundi began to create the Vienna Voluntary Rescue Society. This society organized a fire brigade, a boat brigade and an ambulance station (central and branch) to provide urgent assistance to victims of accidents. In the first year of its existence, the Vienna Ambulance Station provided assistance to 2,067 victims.

The teams included doctors and medical students.

In the mid-19th century, the rapid growth of industry had a great influence on the influx of population into the cities. The number of enterprises and residential buildings grew, and traffic on the streets increased. In this regard, numerous accidents appeared on the streets, plants and factories. Life in its most dramatic form pointed to the need for a service capable of immediately providing medical assistance to victims of accidents. At first, this function fell on the shoulders of voluntary fire societies and the Red Cross Society. But their capabilities were insufficient. An independent service was needed that could solve these problems.

Soon, an emergency medical station similar to the Vienna one was created in Berlin by Professor F. Esmarch. The activities of these stations were so useful and necessary that in a short period similar stations began to appear in a number of cities in European countries.

1897

An ambulance station appeared in Warsaw.

Then the cities of Lodz, Vilna, Kyiv, Odessa, and Riga followed this example. A little later, ambulance stations began to open in Kharkov, St. Petersburg and Moscow. The Vienna station played the role of a methodological center.

April 28, 1898

The appearance of ambulances on Moscow streets.

Until this time, victims, who were usually picked up by police officers, firefighters, and sometimes cab drivers, were taken to emergency rooms at police houses. Necessary in such cases medical checkup was not carried out at the scene. People with severe injuries were often left for hours without proper care in police houses, necessitating the creation of ambulances.

The first two ambulance stations were opened at the Sushchevsky and Sretensky police stations. There was one carriage at each station. A doctor, a paramedic and an orderly attended to them. Each carriage was equipped with medicines, instruments and dressing material. Both regular police doctors and freelance doctors were on duty. The service radius was limited to the territory under the jurisdiction of the police unit. The duty began at 3 o'clock in the afternoon and ended at the same time the next day. A room was allocated for the medical staff. Each call was recorded in a special journal, which indicated the passport details of the patient being served, what type of assistance he received, where and at what time he was delivered. Calls were accepted only on the streets. Visits to apartments were prohibited.

In the first month of their operation, both stations confirmed their inalienable right to exist. Seeing the need for such work, the chief police chief of the city ordered to expand the service area by these stations, without waiting for the opening of new ones.

The results of the two-month operation of the Sushchevskaya and Sretenskaya stations exceeded all expectations. They carried out 82 calls and 12 transports, which took 64 hours and 32 minutes. An analysis of the work of the stations showed that the first place among those who sought help was occupied by people who were intoxicated. There were 27 of them. Next came the victims of trauma, including those with bruises and bruised wounds - 8 people, with broken limbs - 4, after a fall from a height of 6, etc. By his order 212, the chief police chief obliged him to accept calls first. to the drunk and insensible. The rest, in his opinion, should have been delivered to the emergency rooms in cabs.

June 13, 1898

In the history of Moscow there was the first disaster served by ambulance. On Jerusalem Proezd, in Surovtsev’s house, a stone wall under construction fell. There were nine casualties. Both carriages left. All victims were provided with first aid, five of them were hospitalized.

May 1908

At the suggestion of Moscow University professor P.I. Dyakov, the founding meeting of the Voluntary Emergency Medical Care Society was held with the involvement of private capital. The society's goal was to provide free medical care to victims of accidents.
First World War has changed a lot in the development of emergency medical care. Material resources were reoriented to the front and ambulance stations ceased to exist.

October 1917

After the October events in 1917, Moscow remained without ambulance for two more years.

July 1919

At a meeting of the Collegium of the Medical and Sanitary Department of the Moscow Council of Workers' Deputies, chaired by N.A. Semashko, the following resolution was adopted: To organize an Emergency Medical Service Station in Moscow, where to transfer the former ambulance carriages.

First of all, organize an ambulance in case of accidents in factories and factories, and then on the streets of the city and in in public places. For this purpose, the head of the Station, who is entrusted with the organization of Emergency Medical Services, should be invited to allocate 15 doctors to serve the Station, of whom there should be surgeons, therapists and gynecological surgeons, then orderlies and other personnel.

October 15, 1919

The Moscow emergency medical service station began to operate.

January 1, 1923

The leadership of the Moscow Healthcare offered to head the Emergency Medical Station to A. S. Puchkov, who proved himself to be an outstanding organizer of the Gorevac point during the typhus epidemic during the Civil War.

Accepted the offer A.S. Puchkov was amazed at the state of affairs. The Station, which was without leadership, was a pitiful sight: a battered ambulance, three small rooms, a stationery book for recording calls and two telephones. The ambulance, as it was intended when it was created, only responded to accidents. Sudden illnesses that occurred at home, no matter how severe they were, remained unattended. The situation was especially bad for those who became seriously ill at night. A.S. Puchkov, with his characteristic energy, immediately set to work. First of all, the Tsentropunkt and the Ambulance Station were merged into a single institution under the same name, Moscow Ambulance Station. A special reporting system was created. Books, call forms, sheets for recording the operation of machines, and, finally, an accompanying sheet were developed, returned back to the Station from the hospital to monitor the diagnoses of emergency doctors. Now all stations in the country use this.

Under the leadership of A.S. Puchkov, the Moscow Ambulance Station was constantly developing, creating subsidiary emergency medical care institutions (emergency care at home, emergency psychiatric care), organized an evacuation point. Over the course of several years, several substations were opened, construction of new ones began, but grandiose plans for the development of the ambulance did not come true, the Great Patriotic War. The life of the Station flowed according to the laws of war. As a result of brilliantly organized work, she was practically prepared for the suddenly complicated situation. A.S. Puchkov immediately transferred himself to a barracks position and never left work. A headquarters was organized under his leadership. The Station employees worked for two or three days continuously. The scheme of tactical actions in servicing mass casualties has fully justified itself. It turned out to be acceptable and rational in air defense conditions. The Moscow station was the only one in the country that operated in war time uninterruptedly and with the same number of brigades as in peacetime.

1960

The post-war activities of the Station are characterized by large organizational events. In the early 60s, at the Ambulance, on the initiative of its chief L.B. Shapiro, specialized teams were created to provide highly qualified assistance for severe forms myocardial infarction.

At the same time, in a number of large Moscow clinical hospitals, special wards were organized where ambulance teams delivered patients, bypassing the emergency department. This made it possible to resolve the issue of uniform tactics for patient management and continuity at the emergency - hospital stage. During these years, contact with leading clinics in Moscow expanded, joint scientific work with academicians V.N. Vinogradov and N.K. Bogolepov, with professors D.A. Arapov, B.A. Petrov, S.G. Moiseev, P.L. Sukhinin, V.V. Lebedev. It was new stage development of the Moscow ambulance station.

A specialized service began to develop widely, becoming the prototype of specialized teams that appeared at ambulance stations former USSR. New types of teams have appeared at the Moscow station - neurological and pediatric, functionally based in clinics and research institutes.

Subsequently, the Emergency Medical Service Station was merged with regional centers emergency care, the work of the operations department was reorganized, and the positions of senior dispatchers and senior tow trucks were introduced. Much attention was paid to strengthening the substation dispatch service. For greater efficiency in work, the positions of second dispatchers were introduced. In conditions of intensive growth of the Station, such auxiliary departments as the communications department, technical department, and repair service were developed. Total number substations reached forty. The Moscow SyNMP has become one of the largest medical institutions of the former USSR.

Ambulance health care(SMP) is one of the types of primary health care. Emergency medical services institutions annually carry out about 50 million calls, providing medical assistance to more than 52 million citizens. Emergency medical care is 24-hour emergency medical care for sudden illnesses, life-threatening patient, injuries, poisoning, intentional self-harm, childbirth outside medical institutions, as well as accidents and natural disasters.

general characteristics

The characteristic features that fundamentally distinguish emergency medical care from other types of medical care are:

the immediate nature of its provision in cases of emergency medical care and the delayed nature in case of emergency conditions(emergency medical care);

trouble-free nature of its provision;

free procedure for the provision of emergency medical services;

diagnostic uncertainty under time pressure;

pronounced social significance.

Conditions for providing emergency medical care:

outside medical organization(at the place where the brigade is called, as well as in the vehicle during medical evacuation);

outpatient (in conditions that do not provide round-the-clock medical supervision and treatment);

inpatient (in conditions that provide round-the-clock observation and treatment).

Guiding Documents

Government Decree Russian Federation dated October 22, 2012 No. 1074 “On the Program of State Guarantees for the provision of free medical care to citizens for 2013 and for the planning period of 2014 and 2015.”

Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation.”

Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation.”

Order of the Ministry of Health of the Russian Federation dated March 26, 1999 N 100 “On improving the organization of emergency medical care for the population of the Russian Federation”

Order of the Ministry of Health and Social Development of the Russian Federation dated November 1, 2004 N 179 “On approval of the Procedure for providing emergency medical care”

Federal Law of November 29, 2010 No. 326-FZ “On Mandatory health insurance In Russian federation". It is significant for the transfer of powers of the Russian Federation in the field of compulsory medical insurance to government bodies of the constituent entities of the Russian Federation, as well as the inclusion of emergency medical care (with the exception of specialized - sanitary and aviation) in the compulsory medical insurance system throughout the Russian Federation from January 1, 2013 . The transition to financing in the compulsory health insurance system is an important stage in the development of the emergency medical care system in the Russian Federation. Emergency medical care (with the exception of specialized medical care) is provided within the framework of the basic compulsory medical insurance program. Financial support for emergency medical care (with the exception of specialized - sanitary-aviation) is carried out at the expense of compulsory medical insurance from January 1, 2013

Main functions

Emergency medical care is provided to citizens in conditions requiring urgent medical intervention (accidents, injuries, poisoning and other conditions and diseases). In particular, emergency medical care stations (departments) carry out:

24-hour provision of timely and high-quality medical care in accordance with standards of medical care sick and injured people who are outside medical institutions, including during catastrophes and natural disasters.

Implementation of timely transportation(as well as transportation at the request of medical workers) of patients, including infectious diseases, injured people and women in labor in need of emergency hospital care.

Providing medical care to sick and injured people who seek help directly at the emergency medical service station, in the office for receiving outpatients.

Notice municipal health authorities about all emergencies and accidents in the service area of ​​the ambulance station.

Ensuring uniform staffing of mobile emergency medical teams with medical personnel across all shifts and their full provision in accordance with the approximate list of equipment for the mobile emergency medical team.

Along with this, the ambulance service can transport donated blood and its components, as well as transportation of specialized specialists for emergency consultations. The emergency medical service carries out scientific and practical (there are a number of research institutes for ambulance and emergency medical care in Russia), methodological and sanitary educational work.

Forms of territorial organization

Ambulance station

Emergency Department

Emergency Hospital

Emergency Department

Ambulance station

The ambulance station is headed by chief physician. Depending on the category of a particular ambulance station and the volume of its work, he may have deputies for medical, administrative, technical, and civil defense and emergency situations.

Most large stations They consist of various departments and structural units.

The ambulance station can operate in 2 modes - daily and in mode emergency. In an emergency situation, management of the station passes to the Regional Center disaster medicine.

Operations department

The largest and most important of all departments of large ambulance stations is operations department . The entire operational work of the station depends on his organization and management. The department negotiates with people calling an ambulance, accepts or refuses calls, transfers orders for execution to field teams, controls the location of teams and ambulance vehicles. Heads the department senior duty doctor or senior shift doctor. In addition to this, the division includes: senior dispatcher, dispatcher in direction, hospitalization manager And medical evacuators. Senior duty doctor or senior shift doctor manages the duty personnel of the operational department and the station, that is, all operational activities of the station. Only a senior doctor can decide to refuse to accept a call to a particular person. It goes without saying that this refusal must be motivated and justified. The senior doctor negotiates with visiting doctors, doctors of outpatient and inpatient medical institutions, as well as with representatives of investigative and law enforcement agencies and emergency response services (firefighters, rescuers, etc.). All issues related to the provision of emergency medical care are resolved by the senior doctor on duty. Senior dispatcher supervises the work of the control room, manages dispatchers according to directions, selects cards, grouping them by area of ​​receipt and by urgency of execution, then he hands them over to subordinate dispatchers to transfer calls to district substations, which are structural divisions of the central city ambulance station, and also monitors the location of field ambulances brigades Dispatcher for directions communicates with the duty personnel of the central station and regional and specialized substations, transmits call addresses to them, controls the location of ambulance vehicles, the working hours of field personnel, keeps records of the execution of calls, making appropriate entries in call records. Hospitalization manager distributes patients to inpatient medical institutions, keeps records of available beds in hospitals. Medical evacuators or ambulance dispatchers receive and record calls from the public, officials, law enforcement agencies, emergency services, etc., the completed call registration cards are handed over to the senior dispatcher; if any doubt arises regarding a particular call, the conversation is switched to the senior shift doctor. By order of the latter, certain information is reported to law enforcement agencies and/or emergency response services.

Department of Hospitalization of Acute and Somatic Patients

This structure transports sick and injured people at the request (referrals) of doctors from hospitals, clinics, emergency rooms and managers health centers, to inpatient medical institutions, distributes patients to hospitals. This structural unit is headed by a doctor on duty; it includes a reception desk and a dispatch service, which supervises the work of paramedics transporting sick and injured people.

Department of Hospitalization of Maternity Women and Gynecological Patients

This unit carries out both the organization of provision, direct provision of emergency medical care and hospitalization, as well as the transportation of women in labor and patients with “acute” and exacerbation of chronic “gynecology”. It accepts applications both from doctors in outpatient and inpatient medical institutions, and directly from the public, representatives of law enforcement agencies and emergency response services. Information about “emergency” women in labor flows here from the operational department. The outfits are performed by obstetrics (the team includes a paramedic-obstetrician (or, simply, an obstetrician (midwife)) and a driver) or obstetric-gynecological (the team includes an obstetrician-gynecologist, a paramedic-obstetrician (paramedic or nurse (nurse)) and a driver) located directly at the central city station or district or at specialized (obstetrics and gynecology) substations. This department is also responsible for transporting consultants to gynecological departments, obstetrics departments and maternity hospitals for emergency surgical and resuscitation interventions. The department is headed by a senior doctor. The department also includes registrars and dispatchers.

Infectious diseases department

This department provides emergency medical care for various acute infections and transports infectious patients. He is in charge of the distribution of beds in infectious diseases hospitals. Has its own transport and visiting teams.

Department of Medical Statistics

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

Communications Department

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

Inquiry Office

Faik

or, otherwise, information desk, information desk intended for issue reference information about sick and injured people who received emergency medical care and/or who were hospitalized by ambulance teams. Such certificates are issued by a special telephone number “ hotline»or during a personal visit of citizens and/or officials.

Other divisions

An integral part of both the central city ambulance station and regional and specialized substations are: economic and technical departments, accounting, personnel department and pharmacy. Direct emergency medical care for sick and injured people is provided by mobile teams (See below Types of teams and their purpose) both from the central city station itself and from district and specialized substations.

Ambulance substation

District (city) ambulance substations, The staff of large regional substations includes manager, senior shift doctors, senior paramedic, dispatcher. defector, sister-hostess, nurses And field staff: doctors, paramedics, paramedics-obstetricians. Manager carries out general management of the substation, controls and directs the work of field personnel. They report on their activities to the chief physician of the central city station. Senior substation shift doctor carries out operational management of the substation, replaces the manager in the absence of the latter, monitors the correctness of the diagnosis, the quality and volume of emergency medical care provided, organizes and conducts scientific and practical medical and paramedic conferences, and promotes the implementation of the achievements of medical science into practice. Senior paramedic is the leader and mentor of the nursing and maintenance personnel of the substation. His responsibilities include:

drawing up a duty schedule for a month;

daily staffing of field teams;

maintaining strict control over the correct operation of expensive equipment;

ensuring the replacement of worn-out equipment with new ones;

participation in organizing the supply of medicines, linen, furniture;

organization of cleaning and sanitation of premises;

control of the timing of sterilization of reusable medical instruments and equipment, dressings;

keeping records of working hours of substation personnel.

Along with production tasks The responsibilities of the senior paramedic also include participation in organizing the everyday life and leisure of medical personnel, and timely improvement of their qualifications. In addition, the senior paramedic participates in the organization of paramedic conferences. Substation Manager receives calls from the operational department of the central city station, departments of hospitalization of acute surgical, chronic patients, department of hospitalization of women in labor and gynecological patients, etc., and then, in order of priority, transfers orders to visiting teams. Before the start of the shift, the dispatcher informs the operational department of the central station about the vehicle numbers and personal data of the members of the field teams. The dispatcher records the incoming call on a special form and enters brief information into the dispatch service database and via intercom, invites the team to leave. Control over the timely departure of teams is also entrusted to the dispatcher. In addition to all of the above, the dispatcher is in charge of a reserve cabinet with medicines and instruments, which he issues to the teams as needed. There are often cases when people seek medical help directly at an ambulance substation. In such cases, the dispatcher is obliged to invite a doctor or paramedic (if the team is a paramedic) of the next team, and if emergency hospitalization of such a patient is necessary, obtain an order from the dispatcher of the operational department to take place in the hospital. At the end of duty, the dispatcher draws up a statistical report on the work of the field teams over the past 24 hours. If there is no staffing position for a substation dispatcher or if this position is vacant for some reason, his functions are performed by the responsible paramedic of the next brigade. Pharmacy defect takes care of the timely supply of field teams with medicines and instruments. Every day, before the start of the shift and after each departure of the team, the defector checks the contents of the storage boxes and replenishes them with missing medications. His responsibilities also include sterilizing reusable instruments. To store the stock of medicines, dressings, instruments and equipment specified by the standards, a spacious, well-ventilated room is allocated for the pharmacy. If there is no defector position or if his position is vacant for some reason, his duties are assigned to the senior paramedic of the substation. Sister-hostess is in charge of issuing and receiving linen for staff and service contingent, monitors the cleanliness of instruments, and supervises the work of nurses.

Smaller and smaller stations and substations have a simpler organizational structure, but perform similar functions .

Types of emergency medical teams and their purpose

In Russia there are several types of emergency medical services brigades:

urgent, popularly called “ambulance” - doctor and a driver (as a rule, such teams are attached to district clinics);

medical - doctor, two paramedic, orderly and driver;

paramedics - two paramedics, an orderly and a driver;

obstetric - obstetrician (midwife) and driver.

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

Teams are also divided into linear (general-profile) - there are both medical and paramedic teams, and specialized (medical only).

In the event of an emergency, when a person urgently needs the help of a doctor, we routinely dial the well-known number 0-3 and wait for the ambulance to arrive. We know for sure that the doctor will come and help. We can't even imagine what could be different. But, as you understand, this was not always the case.

This is now an emergency medical service state institute, is a network of branched stations, small substations, hospitals, air ambulances, and scientific institutes.

But such familiar emergency medical care, whose history goes back to the Middle Ages, was formed over many years until it took on a modern, familiar look to everyone. Let's briefly recall the stages of the formation of such an important, necessary and most humane service.

How it all began?

The origins of this important medical service date back to the Middle Ages. More precisely, by the 4th century, when the first points were created where they provided assistance to travelers going to Jerusalem. Hospice houses appeared along the roads, where they were provided with emergency medical care.

But the first real ambulance was created in 1881 after a fire in the Vienna theater, when a large number of people found themselves without the necessary medical assistance. Then, at the request of the Viennese doctor Jaroslav Mundi, a station was created where volunteer doctors provided assistance. These were mainly students and doctors who worked for free on their own initiative, on a voluntary basis. This station existed with money from philanthropists.

The formation of ambulance in Russia

Back in 1826, the chief physician of Moscow prisons, F.P. Haaz, petitioned to organize in Moscow the position of a doctor with the authority to organize the care of patients who needed urgent medical care. However, his request was rejected by high officials as unnecessary and useless.

Only in 1844 was the first hospital for homeless citizens opened in Moscow. She was not yet the ambulance we imagine her to be. These were the first attempts to organize doctors to provide assistance to all those in need. The hospital did not have transport and did not go to the sick. There they provided assistance to those people who were brought there by relatives, passers-by or police.

The first real ambulance stations were opened only in 1898. There were three of them, they had transport for travel (horse-drawn carriages), the necessary dressings, simple medicines, stretchers, etc. And a year later, five similar stations opened in St. Petersburg. They provided first aid and transported patients to hospitals.

All these stations existed with the money of philanthropists and the doctors worked in them on a voluntary basis. But they understood the necessity and significance of such work. Therefore, the most advanced doctors of that time provided assistance to the sick at the stations.

With the advent of the 20th century, similar medical institutions began operating in seven more different cities of Russia. All of them were equipped with horse-drawn transport and worked on a voluntary basis. The first cars appeared at stations only in the second half of the century.

After October revolution the transformation and renewal of the entire healthcare system, including ambulance stations, began. As a result, a whole general developed system of providing emergency medical practice for all citizens of the country arose.

In addition, scientific institutes emerged and successfully developed, conducting both scientific and practical work to provide assistance to patients. So, in 1928, the Research Institute named after. Sklifosovsky, and in 1932 the Leningrad Research Institute of Emergency Medicine opened its doors. These two institutions became the main ones in organizing and scientific development this important national health service.

Later, with the development of emergency services, mobile teams of doctors appeared who provided specialized care to patients. For example, teams of psychiatrists came on call. On-site psychiatric care was organized first in 1928. And only at the end of the 50s, on-site teams of cardiologists, toxicologists, and pediatricians started working in Moscow and Leningrad. Medical teams have appeared, specializing in visiting patients with severe injuries and in a state of shock.

All of them were provided by the state with modern cars and the best equipment medicines, dressings, equipment. Thanks to the good organization of their work, ambulance and emergency medical care became as accessible as possible for every patient, which, of course, had the most positive effect on the results of subsequent treatment.

In the 70s of the last century, the entire unified emergency medical service was reorganized. As a result of the improvements, two parallel services emerged. The first carried out emergency assistance victims on the streets, enterprises, public places. The second worked in clinics and also went to patients’ homes.

This vital service is currently undergoing further development. Now it is a powerful service, equipped with modern medical supplies(medicines, equipment, technology). In the extensive network of the service, more than 70 thousand doctors and mid-level medical workers work in the cities and towns of our country, who save the lives of more than 50 thousand citizens annually.

An urgent call to a doctor often requires hospitalization of the patient in a hospital. However, it is not always necessary to immediately transport the patient to the hospital, so many cars with a red cross go not only to emergency calls. This may also include emergency medical care at home.

For a long time - from the moment the first ambulance stations appeared in Russia (1897) until the mid-20s of the 20th century - ambulances only responded to calls coming from the streets or industrial enterprises. It was not so much a lack of transport as a matter of established traditions: at home, patients were usually served by doctors in private practice, and later by doctors from various medical institutions (hospitals, points medical care and clinics). During the day, medical care, at least in large cities, was not difficult to obtain, but at night, when most medical institutions were closed, “acute” patients at home had to rely solely on their own strength.

There was a need to organize a night emergency medical service. The emergency room was organized on the basis of the Moscow Ambulance Station in 1926 on the initiative of Alexander Sergeevich Puchkov, the creator and head of the Moscow Ambulance. Emergency doctors worked in the evening and at night - until eight in the morning. They responded to calls on motorcycles with sidecars, but after several serious traffic accidents in which doctors were injured, Fiat, Adler and Mercedes-Benz passenger cars became the vehicles for this unit.

Calls to the emergency room were received by the Central Ambulance Station. Gradually, it could no longer cope with the flow of calls, so since 1933, emergency medical care was separated from the Ambulance Station into an independent service. One emergency room was established in each of the ten districts of the city. They were subordinate to district health departments (district health departments). The ambulance began to accept house calls received from 7 pm to 9 am on its own.

Moreover, each point served the territory of the region, divided between several clinics. If it turned out that the patient needed urgent hospitalization, the emergency doctor himself called an ambulance. Since 1928, psychiatrists began to be on duty at the Moscow ambulance station at night, and since 1938, experienced pediatricians who provided advisory assistance to emergency doctors, and in difficult cases They themselves went to examine the patient.

In Leningrad, the history of emergency medical care was different. The Leningrad “ambulance” grew out of the so-called “housing aid points” (night medical duty from 18 pm to 9 am). In 1927, all previously existing emergency aid stations were closed, and in each district of the city, at six regional ambulance stations, new “headquarters” were organized, which came under the direct subordination of the head of the Leningrad ambulance station, Meer Abramovich Messel. In the early years, Leningrad ambulance doctors also used motorcycles to travel to patients, which were replaced by cars only in 1934. At the same time, an unsuccessful (and senseless) attempt was made to rename “emergency care” to “night medical care” using the “administrative command” method. In 1938, the Leningrad "ambulance" was again reorganized on the basis of the principles of operation of a similar service in Moscow.

Post-war years marked by the appearance of the first “specialized” emergency vehicles. " Career guidance The design of these ordinary-looking passenger cars was expressed in the application of red crosses in a white circle on the windows and a simpler and cheaper interior decoration - expensive materials were replaced with quick-wash leatherette. As a rule, such cars had derated engines capable of running on low-octane gasoline.

The first in this line was the medical Moskvich-400-420M in 1947. Subsequently, not a single generation of Moscow small cars could do without a similar modification. It is interesting that the Moskvich-407M package included a first aid kit, which is mandatory for all cars today, as “professional equipment”. It should be noted that such cars - sedans with minimal modifications - were used not only by emergency services, but also by local doctors who made house calls.

In addition to emergency vehicles, ambulances with sedan or limousine bodies (Pobeda, ZiMa and ZiSy-110) equipped for transporting bedridden patients were produced in large quantities in the USSR. All of them had one drawback: it was inconvenient to load a stretcher with a patient into the converted cabin through the trunk roof.

The appearance at the Gorky Automobile Plant of a station wagon based on the 21st Volga made it possible to create a modification of the GAZ-22 ambulance, more or less adapted for work “on the line”. The production of such machines began in the summer of 1962. By this time, the production of much more spacious UAZ and RAF minibuses and better suited for working as ambulances had already been mastered, but there was a catastrophic shortage of them, so the sanitary station wagons of the Gorky Automobile Plant in many cities formed the basis of the vehicle fleet of emergency stations and hospitals. However, the shortage of specialized minibuses gradually disappeared, and the production of GAZ-22 continued. As a result, Volgas, which were less in demand in the emergency medical service, ended up in the emergency room.

In 1970, the GAZ-21 family gave way to the next generation Volga, and in 1975, production of a new sanitary modification, GAZ-24-0Z, began, adapted for transporting only a stretcher with a patient.

Due to the limited financial capabilities of the Soviet healthcare system and the resulting lack of “narrowly targeted” transport, the cars that were given to medical institutions did not have a clear specialization. In some places, an emergency room doctor was content with a Moskvich with a red cross on the windshield, and in some places, local pediatricians could be given a Volga station wagon for routine visits to sick children.

In the 1970s, regional emergency care centers in Moscow were again transferred to the structure of the Emergency Medical Care Station. The unification was accompanied by a number of difficulties: there were not enough premises and transport; The style of work of the specialists was completely different. Ultimately, the Moscow emergency service ceased to exist. IN last years an attempt is being made to revive this service. In St. Petersburg, ambulance and emergency care have been preserved as two separate services. Using almost the same transport and equipment, they differ in the composition of the teams (in the ambulance, as a rule, only a doctor and a driver), the nature of the calls served, the channels for receiving calls and administration.

When a person’s life and health are in danger as a result of an accident, emergency or, for example, acute condition in case of a fracture or injury, he requires emergency medical care. This is a type of assistance that is provided to citizens around the clock who require urgent medical intervention at the scene of an incident and on the way to medical institution. Usually these problems are solved by special departments at medical institutions in cities and villages. What functions do these departments perform and how the process is organized will be discussed below.

Description of the problem

Emergency medical care is urgent assistance to victims who are in life-threatening and health-threatening conditions or have severe injuries, it is provided by medical personnel at the scene of the incident, for example, in a public place or on the street. Also, such medical assistance is provided in case of acute pathologies, mass disasters, accidents, childbirth or natural disasters.

It is organized based on the characteristics of the locality, in particular, its location, density and composition of the population, location of hospitals, condition of roads and other points. Such assistance to victims serves as a guarantee of medical and social assistance to people.

Legislation

All over the world, emergency medical care is provided free of charge. Since the end of the nineteenth century, private and public organizations, such as the Red Cross, have had this privilege. Relatively recently, the first state institutions for the provision of emergency services were created, which initially had an orderly and a paramedic, and over time, medical personnel.

A little later, the first ambulance units were created in Russia, but they did not have documentation that regulated their activities. The creation of the Medical Care Law, which described the first legal norms, formed the basis for future bills, including the one that is currently being followed. Today, emergency medical care standards have been developed that guide doctors.

Characteristic

The main features that distinguish this type of medical care are:

• Free provision of it and the procedure for providing health care.
• Its trouble-free implementation.
• Diagnostic risk assessment when there is not enough time.
• Great social significance.
• Providing assistance outside of a medical facility.
• Transportation to the clinic, provision of treatment and round-the-clock monitoring.

Functions

According to the approved standards for emergency medical care, it carries out:

1. 24-hour assistance to injured and sick people who are outside the hospital.
2. Transportation and transportation of patients, including women in labor.
3. Reliable provision of emergency medical care to people who turned to the EMS station.
4. Notifying the relevant authorities about emergencies and accidents in places where victims are served.
5. Ensuring that the team is fully staffed with medical personnel.

Also, the emergency medical team can transport donor blood and specialized specialists if necessary. SMP also conducts health education and research work.

One of the effective components of the healthcare system is emergency medical care - in some big cities It also transports the remains of people who died in public places to the morgue. IN in this case Special teams and vehicles with refrigeration units, which are popularly called hearses, respond to calls. In small towns, such teams are part of the city morgue.

Work organization

As a rule, emergency medical care is provided by emergency medical services stations, which do not provide continuous therapy, but are intended to provide assistance before hospitalization of patients in accordance with Order of the Ministry of Health No. 100 of March 26, 2000. At such stations, sick leave certificates, certificates, and other documents are not given to patients and their relatives. Hospitalization of victims is carried out in the city clinical emergency hospital.

At such stations there is specialized transport, which is equipped with diagnostic and therapeutic equipment, which is used for emergency diagnosis and treatment of pathologies.

Ambulance crews

Any clinical Hospital emergency medical services includes mobile teams. It can be:

• Linear teams, when a doctor and one paramedic work.
• Specialized, when a doctor and two paramedics travel.
• Linear paramedics who provide transportation of victims.

In large cities, there are usually such ambulance teams as intensive care, infectious diseases, pediatric, psychiatric, and so on. The activities of each of them are documented in special cards, which are then handed over to the chief emergency physician, and then to the archive for storage. If necessary, you can always find such a map and study the circumstances of calling the brigade. When a victim is hospitalized, the doctor fills out a special sheet, which he inserts into his medical history.

Emergency medical assistance is called by telephone number “03”. At the call site, the joint venture team conducts necessary treatment, the doctor who coordinates the actions of the employees bears all responsibility. He can also conduct emergency treatment in an ambulance if necessary.

Types of ambulance teams

EMS teams are:

1. Line emergency medical teams are a mobile group of doctors that provide medical care for non-life-threatening and health-threatening conditions, for example, changes in blood pressure, hypotensive crises, burns and injuries. They transport victims of fires, mass accidents, disasters, and so on. To carry out the activities of the field team, a class A or B vehicle is used.
2. Resuscitation teams provide emergency medical care in ambulances, which are equipped with diagnostic and treatment equipment, as well as medications. The team at the scene is conducting a blood transfusion, artificial respiration, splinting, stopping bleeding, cardiac massage. It is also possible to carry out emergency diagnostic measures in the car, for example, an ECG. This approach makes it possible to reduce the risk of complications in victims, as well as reduce the number of deaths during transportation of patients to medical institutions. The ambulance resuscitation team also includes an anesthesiologist and resuscitator, nurses and an orderly. To carry out the activities of the field team, a class C vehicle is used.
3. Specialized teams provide assistance in a specific narrow profile. These could be psychiatric, pediatric, advisory, or aeromedical teams.
4. Emergency team.

Urgent measures

There are many cases that require calling an ambulance. The main reasons for which a call is inevitable include:

• The need for a doctor to arrive urgently.
• Hospitalization and transportation of the victim to a medical facility.
• Serious injuries, burns and frostbite.
• Pain in the heart, stomach, high blood pressure.
• Loss of consciousness and convulsive syndrome.
• Development respiratory failure, suffocation.
• Arrhythmia, hyperthermia.
• Incessant vomiting and diarrhea.
• Intoxication of the body in any pathology.
• Exacerbation of chronic diseases.
• State of shock, thromboembolism.

It is also the responsibility of the staff to conduct an alcohol intoxication examination.

NSR station

The head of the city emergency medical service station is the chief physician. He may have several deputies who are responsible for the technical part, economic, administrative, medical, and so on. Large stations may include different departments and divisions.

The largest is the operational department, which manages operational work the entire station. Employees of this department talk with people who call emergency services, receive and record calls, and transmit information to ambulance teams for execution. This division includes:

• An on-duty doctor who negotiates with visiting doctors, law enforcement agencies, fire departments, and so on. The doctor resolves all issues related to emergency care.
• Dispatchers (senior, by referral, by hospitalization) transfer calls to regional substations, monitor the localization of field teams, record the execution of calls, as well as keep track of available beds in medical institutions.

The hospitalization department for victims transports patients at the request of doctors from various medical institutions. This unit is headed by the doctor on duty, it also includes a reception desk and a control room that coordinates the activities of paramedics and transports victims.

The hospitalization department for pregnant women, as well as those with acute gynecological pathologies, transports women in labor and sick people. The unit receives calls from the public, medical institutions, law enforcement and fire services. Obstetricians, paramedics, and gynecologists respond to calls. This department also delivers specialized specialists to gynecology departments and maternity hospitals for urgent surgical interventions.

Also, the city emergency hospital has an infectious diseases department that provides assistance in cases of poisoning, acute infections, transports patients to the infectious diseases department.

Also, the departments of the ambulance station include statistics, communications, information desk, as well as accounting and human resources departments.

Calling an ambulance

Emergency medical care is urgent assistance to victims, which can be called by telephone number “03” by adults and children under fourteen years of age. The rules for calling an ambulance should help improve the quality of care for victims and ensure the timeliness of medical care. For all citizens, this type of medical care is free, regardless of insurance or registration. This order was issued by the Ministry of Health No. 388 of 2013.

When calling an ambulance, you must clearly answer all the dispatcher’s questions, give the victim’s name, age, call address, as well as indicate the reason for the call and leave your contact information. Doctors may need them if clarification questions arise. The person who called the EMS team must:

• Organize a team meeting.
• Ensure unobstructed access to the victim and conditions for providing assistance.
• Report the incident accurately and clearly.
• Provide availability information allergic reactions, taking medications, alcohol.
• Isolate pets, if any.
• Provide the necessary assistance to doctors in transporting the patient to the car.

The question of hospitalization is decided only by the doctor. Relatives have the right to consent to medical intervention, refusal of hospitalization with written confirmation in a special medical card.

Ambulance and reality

Many people are familiar with cases when an ambulance arrives at a place very late, and sometimes it has to be called several times. Why is this happening?

The ambulance arrival limit is up to ten minutes. This limit is observed in cities, but incidents often occur outside the city. This is due to the fact that the dispatcher directs the crews using the GPS system, which is why confusion arises. Sometimes, when calling an ambulance, the dispatcher sends a team that is not located at the substation in the corresponding area, but a regional one, which takes much longer to travel. Also, the speed of arrival is influenced by weather conditions, road conditions, etc. It also happens that all teams are busy at the time they are called. But this is often due to the fact that people call an ambulance for any reason, even the most insignificant.

What to do if a person becomes ill?

People often make mistakes when providing first aid. The following actions are strictly prohibited:

1. Give the victim medications, as he may be allergic to the drug, which will worsen his situation.
2. Give, water and spray water, especially in case of an accident. This is due to the fact that the victim may be damaged internal organs, and such action may lead to fatal outcome. If a person is conscious and asks for a drink, he needs to moisten his lips with water. You should also not splash water, especially if the person is lying on his back and unconscious. Water may get into Airways and a person may choke.
3. Shake and hit on the cheeks. The injured person may have internal organs damaged or a broken spine. Impacts can cause vertebral displacement and damage spinal cord. A person can receive such serious injuries even if he falls from his own height.
4. Trying to sit up a person who is unconscious. In this case, the victim’s brain does not receive enough oxygen, and blood circulation is impaired. In this case, the victim must be placed on his side in order to prevent tongue retraction and aspiration of vomit.
5. Put something under your head to raise it. In an unconscious person, the facial muscles are relaxed, so the tongue may sink, which will lead to suffocation. The victim can breathe best when his chin is facing up.

Results

The ambulance department has several teams, among which one is a general one, which makes calls in emergency cases. When all teams are busy and a call is received, the first available medical team is dispatched; in some cases, a specialized team from the city EMS service may be dispatched.

In large cities, every day the ambulance station receives about two hundred calls, usually one hundred of them are dispatched. Medical transport is equipped with radio communications, modern diagnostic and treatment equipment, for example, electrocardiographs and defibrillators, medications, which make it possible to provide quick help to the victims.

All calls from people arriving at the station are received by the dispatch service, they are sorted by direction, urgency, priority, and then transferred to the teams for execution. To properly provide assistance to an injured person who called an ambulance, it is necessary:

• Objectively assess the need for a call based on the patient’s condition.
• Clearly state information about what happened, what worries the victim, the patient’s address, contact information.

Before the arrival of the EMS team, it is necessary to follow the recommendations given by the dispatcher. When hospitalizing the victim, it is necessary to collect a change of clothes and linen, toiletries, and shoes. If there are pets in the room, they must be isolated so that they do not interfere with doctors performing medical procedures.

Ambulance service personnel must perform the following tasks:

• Providing primary care.
• Making a preliminary diagnosis.
• Cupping emergency conditions.
• Hospitalization of the victim to the clinic.

The ambulance service does not issue sick leave certificates, certificates, and also does not prescribe treatment and does not leave any documents, except for directions for funeral service workers. A request for documentation can only be submitted by the patient who received medical care.