Emergency medical care is one of the guarantees of medical and social assistance to citizens.

- emergency medical care for sick and injured people with life-threatening and health-threatening conditions and injuries, which is provided at the scene of the incident (on the street, in public places, institutions, at home and on the way of the sick person to the hospital).

Ambulance assistance is provided in cases of acute illnesses, mass disasters, natural disasters, accidents, childbirth and disruption of the normal course of pregnancy, in public places, on the street and at home.

Urgent Care turns out to be sick at home with exacerbation of chronic diseases.

Our country has created a national system for organizing emergency medical care, which includes ambulance and emergency stations, emergency hospitals (or emergency hospitalization departments of a general network of hospital institutions), and air ambulances.

Organizing the work of an ambulance and emergency aid station

Ambulance and emergency aid stations are designed to provide emergency medical care. Ambulance stations do not provide systematic treatment; they are intended to provide emergency care at the prehospital stage (see order of the Ministry of Health of the Russian Federation dated March 26, 2000 No. 100). At ambulance stations, sick leave certificates, certificates and other written documents are not issued to patients or their relatives.

Hospitalization of patients is carried out by emergency hospitals and emergency departments of the general network of hospital institutions.

Ambulance stations are equipped with specialized ambulance transport, equipped with equipment for urgent diagnosis and treatment of life-threatening conditions. The work of ambulance stations is organized in teams. There are linear teams (a doctor and a paramedic), specialized (a doctor and two paramedics), and linear paramedics (usually used for the targeted transportation of patients). In large cities, the following specialized teams usually operate: intensive care, neurological, infectious diseases, pediatric intensive care, psychiatric, etc. All work of the teams is documented, the team doctor fills out call cards, which after duty are handed over to the senior shift doctor for control, and then for storage and statistical processing in the organizational and methodological department. If necessary (at the request of doctors in the general network, investigative authorities, etc.), you can always find the call card and find out the circumstances of the call. If the patient is hospitalized, the doctor or paramedic fills out an accompanying sheet, which remains in the medical history until the patient is discharged from the hospital or until the patient’s death. The hospital returns the tear-off coupon of the accompanying sheet to the station, which makes it possible to keep a record of the ambulance crew's errors, thereby improving the quality of work of the ambulance crews.

At the scene of the call, the ambulance team provides the necessary treatment to the maximum extent available (as well as on the way when transporting the patient). In providing assistance to the sick and injured, the main responsibility rests with the team doctor, who supervises the actions of the team. In difficult cases, the doctor consults with the senior shift doctor by telephone. Most often, the senior shift doctor, at the request of the line team doctor, sends a specialized team to the place of call. Patients in need of emergency care are transported over long distances by air ambulances and helicopters.

Emergency medical care (EMS) 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 round-the-clock emergency medical care for sudden illnesses that threaten the patient’s life, injuries, poisonings, 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 a medical organization (at the place where the team is called, as well as in a 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

Decree of the Government of the Russian Federation of October 22, 2012 No. 1074 “On the Program of State Guarantees for 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 Compulsory Health Insurance in the Russian Federation.” It is significant for the transfer of powers of the Russian Federation in the field of compulsory health 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 and aviation) is carried out at the expense of compulsory medical insurance from January 1, 2013

Basic 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 emergency medical service station is headed by the 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 response 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.

Help Desk

Faik

or, otherwise, information desk, information desk is intended for issuing reference information about sick and injured people who received emergency medical care and/or who were hospitalized by ambulance teams. Such certificates are issued via a special hotline or during a personal visit by 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 the 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, enters brief information into the dispatch service database and invites the team to leave via intercom. 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).

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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. The medical examination required in such cases was not carried out at the scene of the incident. 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 a stowage bag containing medicines, instruments and dressings. 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 of 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.
The First World War 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 first aid in case of accidents in factories and factories, and then on city streets and 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, the 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 constantly developed, created subsidiary emergency medical care institutions (emergency care at home, emergency psychiatric care), and organized an evacuation center. 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, and the Great Patriotic War began. 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 worked uninterruptedly in wartime 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 Service, on the initiative of its chief L.B. Shapiro, specialized teams were created to provide highly qualified care for severe forms of myocardial infarction.

At the same time, special wards were organized in a number of large Moscow clinical hospitals, 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 was carried out 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. This was a new stage in the development of the Moscow ambulance station.

A specialized service began to develop widely, becoming the prototype of the specialized teams that appeared at ambulance stations of the 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 emergency aid stations, 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. The total number of substations reached forty. The Moscow SyNMP has become one of the largest medical institutions of the former USSR.

Emergency medical care in our country has developed as a system of medical care for health and life-threatening conditions - accidents and sudden acute diseases. Today it is a powerful unified system with an extensive network of emergency stations and hospitals, air ambulance and research institutes.

The beginning of development, the primary rudiments of first aid date back to the early Middle Ages - the 4th century, when so-called hospice houses were organized on the roads leading to Jerusalem to provide assistance to numerous travelers.

In 1092, the Order of Johannes was established in England, whose task included serving the sick in a hospital in Jerusalem and providing first aid to travelers on the roads. At the beginning of the 15th century - in 1417 - a service was organized in Holland to provide assistance to drowning people on the numerous canals cutting through this country.

The first ambulance station was created in Vienna in 1881. The reason for this was a fire in the Bolshoi Theater, during which there were a lot of victims who were left without any help. On the initiative of the Viennese doctor Jaroslav Mundi, an ambulance station was soon organized. In accordance with the project of J. Mundi, the task of this institution included providing first aid to victims and transporting them either to a medical facility or home. This ambulance station did not have its own staff. It existed on a charitable basis and used the help of volunteers - doctors and medical students.

In capitalist countries even today, the emergency medical service reflects all the contradictions inherent in this society. In these countries there is no unified emergency medical service; it is not concentrated in the hands of the state, but is run by a variety of medical institutions, including private ones, and is paid. It is carried out by municipalities, Red Cross societies, insurance organizations, medical colleges, hospitals, etc.

In Russia, the idea of organizing emergency medical care arose much earlier than in Europe, and it belonged to the doctor of medicine G. L. Attenhofer, who lived in St. Petersburg, who back in 1818 petitioned the city authorities with a document he called “Project for an Institution in St. Petersburg to save those who suddenly die or who have put their lives in danger." Unfortunately, this project was not implemented.

The next stage of attempts to organize an ambulance is associated with the name of the famous Russian doctor and humanist F. P. Haas. In 1826, F. P. Haaz tried to introduce the position of “a special doctor to oversee the organization of care for suddenly ill people in need of immediate help.” However, this request was rejected as “unnecessary and useless.” Only in 1844 did F.P. Haaz manage to open a “police hospital for the homeless” in Moscow. Her task was to provide assistance in “sudden cases for the use and initial supply of free assistance.” It was not yet an ambulance, since the hospital did not have transport and provided assistance only to those who were transported to the hospital in one way or another.

The first 3 ambulance stations in Russia were opened in 1898. At each station there was a horse-drawn carriage, dressings, a stretcher, some instruments and medicines. A year later - in 1899 -5 such stations were opened in St. Petersburg. The task of these stations was to provide first aid in case of sudden illnesses and accidents in public places, as well as to transport patients to a medical facility.

As already mentioned, all ambulance stations were founded thanks to monetary assistance (“charitable donations”) from private individuals. However, advanced doctors of that time, fully understanding the need and importance of emergency care, devoted a lot of time and effort to its organization, development and popularization.

In 1889, K. K. Reyer opened courses designed primarily to teach first aid to police officers.

In 1896, N. A. Velyaminov developed the project “Organization of first aid in St. Petersburg.” And in 1908, in Moscow, on the initiative of the famous surgeon P.I. Dyakonov, an ambulance society was organized. Famous surgeons G.I. Turner and I.I. Grekov paid a lot of attention to the development of emergency care in St. Petersburg. G. I. Turner was the first head of the city ambulance station, and I. I. Grekov was the first head of the central ambulance station.

At the beginning of the 20th century, ambulance stations were opened in seven more cities of Russia. All of them were served by orderlies. Only in 1912 in St. Petersburg, 50 doctors agreed to voluntarily participate in the work of the ambulance. Until 1912, all ambulance services were served by horse-drawn transport. Only in the second decade of the century did the first ambulances appear.

Only the Great October Socialist Revolution marked the beginning of the most important transformations in all areas of healthcare and ensured the creation and development of an entire system for providing emergency medical care to the population of our country.

Already on 10/26/17, a medical and sanitary department was created under the Military Revolutionary Committee of the Petrograd Council of Workers' and Soldiers' Deputies to provide emergency medical care to the rebellious workers of Petrograd. This department was headed by Dr. P. B. Khavkin, later the chief physician of the Leningrad Ambulance Station.

From the very first days of Soviet power, emergency care became a state matter and its work was based on all the main principles of Soviet healthcare - free, accessible to all, planned, preventative, and the use of the latest achievements of science and technology.

First of all, it is necessary to point out the ubiquity of the ambulance service. However, the matter, naturally, is not only about quantitative growth. Simultaneously with the increase in the number of stations, their technical re-equipment began. This is a dynamic process that is constantly ongoing. The ambulance case was put on a scientific basis.

In 1928, the Moscow Research Institute of Emergency Medicine named after. N.V. Sklifosofsky, and in 1932 - the Leningrad Research Institute of Emergency Medicine, which later received the name of its founder - the famous Soviet surgeon Hero of Socialist Labor I. I. Dzhanelidze. These institutes became centers for the organization and development of the ambulance service.

A powerful leap in the development of the ambulance service was the creation of specialized teams. The first specialized ambulance team - psychiatric - was organized in 1928 in Moscow, and in 1931 in Leningrad. Ambulance services began to be provided with modern transport. However, such brigades became widespread only in the late 50s and early 60s. So, in 1957-1958. In Leningrad, a specialized ambulance team was created to provide assistance to patients with severe trauma and shock. The experience of specialized anti-shock teams made it possible to organize specialized cardiological, toxicological, and pediatric teams in Moscow, Leningrad, and then in other cities. Thanks to this, specialized emergency medical care was able to get much closer to the seriously ill and injured, which significantly improved treatment results. Finally, in recent years, intensive care teams have begun to be organized, designed to provide highly qualified emergency care to various categories of seriously ill and injured people. The need to create such teams is due to the relatively low percentage of calls made by specialized teams - a situation where specialized teams are used without taking into account their capabilities.

The profession of an emergency physician can perhaps be called one of the most difficult and responsible among all medical specialties. After all, he must have a good knowledge of not only theory, but also be fluent in many practical skills. There are often situations when an emergency doctor has only a few minutes to make a diagnosis, and at the same time he does not have the opportunity to use laboratory or instrumental diagnostic methods or consult with his colleagues. Therefore, he must have a perfect knowledge of such medical specialties as therapy, neurology, surgery, gynecology and obstetrics, resuscitation, and be familiar with the pathology of the ENT and visual organs.

What qualities should an emergency physician have?

Based on the characteristics of the work, any ambulance and emergency doctor should have the following qualities:

Good physical and mental health;
Excellent medical observation and logic;
Quick reaction and ability to remain calm in any situation;
Knowledge of basic emergency conditions, the ability to diagnose and treat them at the prehospital stage;
The ability to find contact both with the patient himself and with his relatives. Indeed, in some cases, they may also need to consult an emergency doctor;
Modesty, discipline, decency, cleanliness;
Ability to maintain authority among all team members.

Responsibilities of an emergency physician

Before starting duty, the emergency physician must personally take the necessary medical instruments and medicines.

The responsibilities of the emergency physician include monitoring the condition of all team members. If, while on duty, a doctor notices signs of alcohol intoxication or ill health in any of them, he is obliged to immediately remove them from work and inform the manager and dispatcher about this.

After receiving a call, the emergency doctor must check with the dispatcher the patient’s name, age and address. Departure is carried out within one minute from the moment of its receipt. It is prohibited to turn off radio communications during the entire trip.

If it is impossible to respond to a call on time, the ambulance doctor is obliged to immediately inform the dispatcher about this, which allows the call to be transferred to another team in a timely manner.

The responsibilities of an emergency physician include:

Conducting and providing competent and free medical care to patients;
Transportation of injured and sick people to hospital;
The ability to correctly assess the general condition of the patient and choose the most optimal method of carrying and transportation for him. Carrying a patient on a stretcher is one of the types of medical care and, accordingly, is another responsibility of the emergency physician;
If you refuse hospitalization, take all measures to convince both the patient and his relatives of its necessity. If this cannot be done, then provide the necessary assistance, make a record of refusal of hospitalization in the call card and inform the dispatcher about this to transfer the active call to the local doctor of the clinic;
While en route and in the event of an accident, the ambulance doctor is obliged to stop the car, inform the dispatcher about it and begin providing assistance;
When providing medical assistance, he must act decisively and quickly, providing it in full. If necessary, the emergency doctor has the right to call a specialized team to the patient;
Consultation with an emergency physician can only be provided orally. He does not have the right to issue any certificates or conclusions to patients, their relatives or any officials.

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Comments on the material (30):

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I quote Nadezhda:

Hello! How can you thank the ambulance crew? The ambulance doctor was the only one out of 5 doctors who made the correct diagnosis for the child, which was later confirmed by a blood test. Unfortunately, I didn’t ask the doctor’s name, I only know the date and time when they came to us. (there was a temperature of 39 and a rash)

Hello, Nadezhda.
You can call an ambulance and convey your gratitude, describing the time and place of the team’s arrival. You can write a letter of gratitude to the address of the ambulance station from where the team came to you.

Nadezhda doctor / February 27, 2018, 11:47 pm

I quote Elena:

On February 25, 2018, I called emergency help for my husband (born 1952). ...
What kind of team came, what was the result, what measures did they take, what recommendations? Isn't it natural to know? As it turns out, it’s natural not to know! It seems that such an order allows assistance to be reduced to nothing.

The emergency team is called in case of life-threatening conditions.
As for blood pressure, the doctor told you correctly, the upper figure of 140 (systolic pressure) is still normal. Even if this is increased blood pressure for your husband compared to his worker, it is not critical.

I quote Galina:

The son lost consciousness and the vomit partially entered the respiratory tract. The ambulance doctors saved him, of course. And they decided that he had consumed something, hence poisoning. Since our son was beaten three months ago and had an open head injury, we asked him to pay attention to his head. The doctor didn’t listen, he said it would happen later. They took him to toxicology. After 10 hours the operation was performed. After three days of coma, the son died. 31 years old. Why don’t emergency doctors want to hear from relatives? Is it their fault that they were delivered to the wrong department? Time has passed. The diagnosis is acute non-traumatic subdural hemorrhage. If the operation is performed after 4-6 hours, then there is an 80% chance of survival.

Hello.
No, the emergency doctor is not to blame, because he cannot and should not make an accurate diagnosis, he does not have the ability to do this. An emergency doctor may suggest a diagnosis, but in the hospital it is confirmed or refuted, where the diagnostic possibilities are different.

I quote SERGEY:

Good day! Please tell me, if I trained as a paramedic, can I become a therapist or emergency medical technician?

Good afternoon, Sergey.
If you train to be a paramedic, you can work as a paramedic. To work as a doctor, you need to study to become a doctor.

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