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Organization of emergency medical work


Ambulance service is one of the most important links in the healthcare system in our country. The volume of medical assistance to the population by medical and paramedical teams is constantly growing.
In rural areas, under the Central District Hospital established emergency departments. Calls to the population there are almost everywhere served by paramedic teams.
In cities, stations have been established, and in large cities - also emergency medical substations. They include linear medical teams serving most of the most diverse challenges, specialized teams (intensive care, resuscitation and traumatology, pediatric resuscitation, toxicological, psychiatric, etc.), as well as paramedical teams. The functions of feldsher teams in cities include mainly transporting patients from one medical institution to another, transporting patients from home to the hospital in the direction of district doctors, delivering women in labor to maternity hospitals, and providing assistance to patients with various injuries when there is no need for resuscitation help, as well as some others. For example, if the reason for the call “stumbled, fell, broke his arm (leg)” - this is a challenge for the paramedic’s team, and if it is known in advance that the victim fell out of the window of the seventh floor or got under the tram, it is more expedient to immediately send such a call specialized brigade.
But it is in the cities. In rural areas, as already noted, almost all calls are made by paramedics. In addition, in real-life conditions, it is sometimes impossible to determine in advance what really happened, and the paramedic, working independently, must be prepared for any, most unexpected situations.
When working as part of a medical team, the paramedic during a call is completely subordinate to the doctor. His task is to clearly and quickly fulfill all assignments. Responsibility for decisions lies with the physician. The paramedic should be familiar with the technique of subcutaneous, intramuscular and intravenous injection, ECG recording, be able to quickly install a system for drip fluid administration, measure blood pressure, count the pulse and the number of respiratory movements, enter the duct, perform cardiopulmonary resuscitation, etc. He should also be able to apply a splint and bandage, stop bleeding, know the rules for transporting patients.
In the case of independent work, the ambulance paramedic is fully responsible for everything, so he must fully master the diagnostic methods at the prehospital stage. He needs knowledge on emergency therapy, surgery, traumatology, gynecology, pediatrics. He must know the basics of toxicology, be able to take birth on his own, assess the neurological and mental state of the patient, not only register, but also tentatively evaluate the ECG.
Emergency care is the pinnacle of medical art, which is based on fundamental knowledge from various fields of medicine, combined by practical experience.
The main regulatory documents:
1) The Constitution of the Russian Federation;
2) Federal Law of November 21, 2011 No. 323-ФЗ “On the Basics of Protecting the Health of Citizens in the Russian Federation”;
3) Decree of the Government of the Russian Federation of October 21, 2011 No. 856 “On the Program of State Guarantees for the Provision of Free Medical Assistance to Citizens of the Russian Federation for 2012”;
4) Order of the Ministry of Health of the USSR dated March 25, 1976 No. 300 “On the standards for equipping healthcare institutions with sanitary transport and on the operating mode of medical transport”;
5) Order of the Ministry of Health of the Russian Federation of 08.04.1998, No. 108 "On emergency psychiatric care";
6) Order of the Ministry of Health of the Russian Federation of March 26, 1999 No. 100 “On improving the organization of emergency medical care for the population of the Russian Federation”;
7) Order of the Ministry of Health of the Russian Federation and the social development of the Russian Federation of 05.02.2004 No. 37 “On cooperation on the issues of ensuring sanitary protection of the territory of the Russian Federation and on measures to prevent quarantine and other especially dangerous infections”;
8) Order of the Ministry of Health of the Russian Federation and social development of the Russian Federation of November 01, 2004 No. 179 “On approval of the procedure for the provision of emergency medical care”;
9) Order of the Ministry of Health of the Russian Federation and social development of the Russian Federation of December 01, 2005 No. 752 “On equipping ambulance transport”;
10) Order of the Ministry of Health of the Russian Federation and social development of the Russian Federation of September 24, 2008 No. 513n “On the organization of the activities of the medical commission of a medical organization”;
11) Resolution of the Chief State Sanitary Doctor of the Russian Federation dated 09.06.2009 No. 43 “On approval of the sanitary and epidemiological rules of SP 3.1. 1.2521-09 ";
12) Order of the Ministry of Health of the Russian Federation and social development of the Russian Federation of August 19, 2009 No. 599n “On approval of the procedure for the provision of planned and emergency medical care to the population of the Russian Federation for diseases of the cardiovascular system circulatory system”;
13) Order of the Ministry of Health of the Russian Federation and social development of the Russian Federation dated December 2, 2009 No. 942 “On approval of the statistical tools of the station (department), emergency hospital”;
14) Order of the Ministry of Health of the Russian Federation and social development of the Russian Federation dated December 15, 2009 No. 991n “On approval of the procedure for the provision of planned and emergency medical care for victims with combined, multiple and isolated injuries accompanied by shock”;
15) Order of the Ministry of Health of the Russian Federation and social development of the Russian Federation of 11.06.2010, No. 445n “On approval of the requirements for completing with the medicines and medical products of the visiting ambulance brigade”.
The main document in accordance with which the work of the ambulance service is built is the Order of the Ministry of Health of the Russian Federation of March 26, 1999 No. 100 “On improving the organization of ambulance care for the population of the Russian Federation”.
In the Russian Federation, a system has been created and is functioning to provide the population with emergency medical care with a developed infrastructure. It includes over 3 thousand stations and emergency departments, in which 20 thousand doctors and more than 70 thousand paramedical workers work.
Every year, the ambulance service performs from 46 to 48 million calls, providing medical care to more than 50 million citizens. It is planned to gradually expand the volume of emergency medical care provided by paramedical teams, with the preservation of medical teams as intensive care teams and other highly specialized teams.
An ambulance station is a medical treatment institution designed to provide round-the-clock ambulance services to adults and children, both at the scene of the incident and on its way to the hospital in conditions that threaten the health or life of citizens or people around them caused by sudden illnesses, exacerbation of chronic diseases, accidents, injuries and poisoning, complications of pregnancy and childbirth.

Ambulance stations are created in cities with a population of over 50 thousand people as independent medical institutions.
In settlements with a population of up to 50 thousand, emergency medical departments are organized as part of city, central district and other hospitals.
In cities with a population of more than 100 thousand people, taking into account the length of the settlement and the terrain, ambulance substations are organized as subdivisions of stations (with the calculation of 15-minute transport accessibility).
The main functional unit of the substation (station, department) of the ambulance is the visiting team (paramedic, medical, intensive care and other narrow specialized specialized teams). Brigades are created in accordance with standard standards, with the expectation of ensuring round-the-clock shift work.
Appendix No. 10 to the Order of the Ministry of Health of the Russian Federation of March 26, 1999 No. 100 “Regulations on the medical assistant of the visiting ambulance brigade”
A specialist with secondary medical education in the specialty “General Medicine”, who has a diploma and a corresponding certificate, is appointed to the post of paramedic of the ambulance team.
In the performance of emergency medical care duties as part of the feldsher team, the feldsher is the responsible executor of all work, and as part of the medical team he acts under the guidance of a doctor.
The paramedic of the emergency ambulance team is guided by the legislation of the Russian Federation, regulatory and methodological documents of the Ministry of Health of the Russian Federation, the Charter of the ambulance station, orders and instructions of the station administration (substation, department).
The paramedic of the visiting ambulance team is appointed and dismissed in the manner prescribed by law.
Responsibilities
The paramedic of the emergency ambulance team is obliged:
1) to ensure the immediate departure of the brigade after receiving the call and its arrival at the scene within the established temporary standard in this territory;
2) provide emergency medical care to patients and victims at the scene of the incident and during transportation to hospitals;
3) to administer medications to patients and victims for medical reasons, to stop bleeding, to carry out resuscitation measures in accordance with the approved industry norms, rules and standards for emergency medical personnel;
4) be able to use the available medical equipment, master the technique of applying transport tires, dressings and methods of conducting basic cardiopulmonary resuscitation;
5) master the technique of taking electrocardiograms;
6) know the location of medical institutions and service areas of the station;
7) to ensure the patient is carried on a stretcher, if necessary, to take part in it (in the conditions of the work of the team, the patient is carried on a stretcher as a form of medical care). When transporting the patient to be close to him, providing the necessary medical care;
8) if it is necessary to transport the patient in an unconscious state or in a state of intoxication, make an inspection for documents, valuables, money with an indication in the call card, hand them over to the in-patient department of the hospital with a mark in the direction of the receipt of the duty personnel;
9) when providing medical care in emergency situations, in cases of violent injuries, to act in the prescribed manner (inform the internal affairs authorities);
10) ensure infectious safety (comply with the rules of the sanitary-hygienic and anti-epidemic regime). If a patient is identified with a quarantine infection, provide him with the necessary medical care, observing precautions, and inform the senior shift doctor about the patient's clinical, epidemiological and passport data;
11) ensure the correct storage, recording and disposal of drugs;
12) at the end of the duty, check the condition of the medical equipment, transport tires, replenish drugs, oxygen, nitrous oxide expended in the process of work;
13) inform the administration of the ambulance station about all emergency incidents that occurred during the call;
14) at the request of internal affairs officers, stop to provide emergency medical care, regardless of the location of the patient (victim);
15) keep approved accounting and reporting documents;
16) in the prescribed manner to improve their professional level, improve practical skills.
Rights
The paramedic of the emergency ambulance brigade has the right:
1) to call, if necessary, the medical emergency team;
2) to make proposals on improving the organization and provision of emergency medical care, improving the working conditions of medical personnel;
3) to improve their qualifications in the specialty at least 1 time in 5 years. Pass in
established procedure certification and recertification;
4) take part in medical conferences, meetings, seminars conducted by the administration of the institution.
Responsibility
The paramedic of the emergency ambulance brigade is responsible in the manner prescribed by law:
1) for ongoing professional activities in accordance with the approved industry norms, rules and standards for paramedical ambulance personnel;
2) for unlawful acts or omissions that entailed damage to the patient’s health or death.
In accordance with the Order of the Ministry of Health of the Russian Federation No. 100, visiting teams are divided into paramedical and medical. The paramedic team includes two paramedics, an orderly and a driver. The medical team includes a doctor, two paramedics (or a paramedic and a nurse anesthetist), a nurse and a driver.
However, the order further states that "the composition and structure of the brigade is approved by the head of the ambulance station (substation, department)." In almost real working conditions (for reasons that are understandable in our economic conditions of life), a medical team is a doctor, a paramedic (sometimes also a nurse) and a driver, a specialized team is a doctor, two paramedics and a driver, a paramedic team is a paramedic and a driver (maybe also a nurse).
In the case of independent work, the paramedic is the direct boss for the driver during the execution of the call, therefore he must also represent his rights and obligations.
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Organization of emergency medical work

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