In Russia, before the revolution, there was an experience of free emergency medical care (Moscow), which was provided both at the expense of city budgets and charitable donations. For the first time, ambulance stations appeared in 1919 in such large cities as Moscow and Petrograd. In 1923, the Research Institute for Emergency Medicine was organized in Moscow. In 1933, the "Regulations on ambulance stations" were issued. In the 1930s and 1970s, emergency out-of-hospital care was provided both by outpatient clinics and by ambulance stations (AMS).
In 1991, ambulance and emergency care were again separated: ambulance began to be provided by emergency care stations, emergency care - by outpatient clinics.
The ambulance structure includes ambulance stations and substations, ambulance departments within hospitals, emergency hospitals. Ambulance stations as independent healthcare facilities are being created in cities with a population of over 50,000 people. 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 (within a 15-minute accessibility zone). In settlements with a population of up to 50 thousand, emergency medical departments are organized as part of city, central, district and other hospitals.
Ambulance station- a medical institution designed to provide round-the-clock emergency medical care to adults and children both at the scene and on the way to the hospital in conditions that threaten the health or life of citizens or those around them, caused by sudden illnesses, exacerbation of chronic diseases, accidents, injuries and poisonings; "complications of pregnancy and childbirth. The ambulance substation is a structural subdivision of the city ambulance station, and the ambulance department is a structural subdivision of the hospital (city, central district, etc.). Substations and ambulance departments have the same purpose as and stations.
The work of the NSR stations is headed by the chief doctors, and the substations and departments are headed by the heads. Each shift is supervised by a senior doctor.
The structure of the station, as well as the substation, ambulance provides for:
Operational department (at the substation - dispatching room for 1-2 round-the-clock posts);
Department of Communications;
Department of medical statistics with an archive;
Office for the reception of outpatients;
A room for storing medical equipment for teams and preparing medical packs for work;
Premises for storing stock of medicines, equipped with fire and burglar alarms;
Rest rooms for doctors, nurses, drivers of ambulances;
Room for meals for staff on duty;
Administrative and economic and other premises;
Garage, covered parking-boxes, fenced area with a hard surface for parking of cars, corresponding in size to the maximum number of cars working at the same time; if necessary, helipads are equipped.
Other divisions may also be included in this structure.
The main functions of the NSR station:
Round-the-clock provision of timely and high-quality medical care to sick and injured people who are outside medical institutions in case of catastrophes and natural disasters;
Timely transportation (as well as transportation at the request of medical workers) of patients, including infectious, injured and women in labor who need emergency hospital care;
Providing medical care to the sick and injured who applied for help directly to the station;
Ensuring continuity in work with the city's hospitals to provide emergency medical care to the population;
Organization of methodological work, development and implementation of measures to optimize the provision of emergency medical care at all stages;
Interaction with local authorities, the Department of Internal Affairs, the traffic police, fire departments and other operational services of the city;
Carrying out activities to prepare for work in emergency situations, ensuring a constant minimum supply of dressings and medicines;
Notifying the health authorities of the administrative territory and the relevant authorities about all emergencies and accidents in the service area of the station;
Uniform staffing of field teams with medical personnel for all shifts and full provision of them in accordance with the equipment sheet;
Compliance with the norms and rules of sanitary-hygienic and anti-epidemic regimes;
Compliance with the rules of safety and labor protection;
Control and accounting of the work of sanitary vehicles.
The main functional unit of stations, substations
and emergency departments is mobile team(paramedical or medical). The paramedic team consists of 2 paramedics, an orderly and a driver; medical team - 1 doctor, 2 paramedics (or a paramedic and an anesthetist nurse), an orderly and a driver.
In addition, brigades are divided into linear and specialized. Specialized teams appeared in the 1950s and include doctors of the appropriate specialization. There are the following types of specialized teams: pediatric (created with a population of over 100 thousand people); anesthesiology and resuscitation (with a population of over 500 thousand), neurological, cardiological, psychiatric, traumatological, neuro-reanimation, pulmonological, hematological, etc. A doctor working in a specialized team must have at least 3 years of work experience in the specialty. Pediatric teams, in turn, are divided into resuscitation and advisory, hemosorption (providing and toxicological assistance) and neonatological.
Brigades are created in accordance with staff standards with the expectation of providing round-the-clock shift work. Currently, a gradual reorientation is being carried out from the provision of assistance by line doctors to line paramedic teams, the main task of which is to carry out minimal urgent, including anti-shock, measures and transport victims to specialized medical institutions, where they can be provided with the necessary assistance in full.
The mobile ambulance team performs the following tasks:
Immediate departure and arrival to the patient (at the scene of the incident) within the time limit established for this administrative territory;
Establishing a diagnosis, taking measures to stabilize or improve the patient's condition, and, if there are medical indications, transport him to a hospital;
Transfer of the patient and relevant medical documentation to the doctor on duty (paramedic) of the hospital;
Ensuring triage of the sick or injured and establishing the sequence of medical care in case of mass diseases, poisoning, injuries and other emergencies;
Providing and carrying out the necessary sanitary-hygienic and anti-epidemic measures.
Upon discovery of the corpse of a deceased or deceased, the brigade is obliged to involve an ATC officer, to record all the necessary information in the "Call Card". The evacuation of the corpse from the scene is not allowed. In the event of death in the passenger compartment of an ambulance, the brigade is obliged to inform the paramedic of the operational department about the fact of death and obtain permission to transport the corpse to the forensic morgue.
Operational (dispatching) department provides round-the-clock centralized reception of appeals (calls) of the population, timely dispatch of mobile teams to the scene, and operational management of their work. Its structure includes a control room for receiving and transmitting calls and a help desk. The duty personnel of the operational department has the necessary means of communication with all structural divisions of the NSR station, substations, mobile teams, health care facilities, as well as direct communication with the operational services of the city. The department must have automated workplaces, a computer control system.
Receiving calls and transferring them to mobile teams is carried out by a paramedic (nurse) for receiving and transferring calls from the operational department (control room) of the EMS station.
Receiving a call coming in on "03", the paramedic (from the moment of the call, all conversations are recorded on magnetic tape) transfers it to the appropriate substation or directly to the brigade (by phone or walkie-talkie). At the same time, the time of receiving a call, its transmission, and the time of departure of the brigade are recorded. The paramedic does not have the right to independently refuse to receive a call. In addition, the paramedic provides operational management of all field teams (at any time he must know the location of each team); controls the efficiency of the work of the teams (arrival time, call execution time); immediately inform the administration of the institution about all emergencies; communicates with the operational services of the city (ATC, traffic police, fire departments, etc.). The paramedic must clearly know the procedure for dealing with emergencies.
Calling a specialized team is carried out through the doctor on duty (in the central control room). At the same time, there is a list of indications for calling each of the teams.
Communication department organizes communication between all departments of the NSR station. The station should be provided with urban telephone communication at the rate of 2 inputs per 50 thousand of the population, radio communication with mobile teams and direct communication with medical institutions.
Transport of the NSR station must have special identification marks established by GOST. For the implementation of control trips to the NSR station with the number of calls over 75 thousand per year, one car without special equipment is allocated. At stations with more than 500 thousand departures per year, 2 cars are allocated for this purpose for every 500 thousand calls.
Sanitary vehicles of ambulance crews should be systematically disinfected in accordance with the requirements of the sanitary and epidemiological service. In cases where an infectious patient is transported by transport of EMS stations, the car is subject to mandatory disinfection, which is carried out by the staff of the hospital that received the patient.
The station (substation, department) of the NSR can operate in the mode of daily operation and in the emergency mode. In station tasks in daily work mode includes:
- organization and provision of emergency medical care to sick and injured people at the scene and during their transportation to hospitals;
– carrying out systematic work to improve the professional knowledge and practical skills of medical personnel;
- development and improvement of organizational forms and methods of providing emergency medical care to the population, the introduction of modern medical technologies, improving the quality of work of medical personnel.
V emergency mode the station operates under the instructions of the Territorial Center for Disaster Medicine (see lecture VII). In emergency mode, the SMP station:
Sends mobile teams to the emergency area
brigades according to the work plan to eliminate the health consequences of emergencies;
Carries out medical and evacuation measures in relation to victims during the liquidation of emergency situations;
Ensures the implementation of the necessary sanitary-hygienic and anti-epidemic measures in the prescribed manner.
The injured (sick) delivered by mobile ambulance teams must be immediately handed over to the duty personnel of the hospital admission department with a note in the "Call Card" of the time of their arrival.
In order to coordinate treatment and preventive work, improve continuity in servicing patients, the administration of the EMS station holds regular meetings with the management of health facilities located in the service area.
The station (substation, department) of the SMP does not issue documents certifying temporary disability, and forensic medical reports, does not conduct an examination of alcohol intoxication. However, if necessary, it can issue certificates of any form indicating the date, time of treatment, diagnosis, examinations, assistance provided and recommendations for further treatment. The station (substation, department) of the EMS is obliged to issue oral certificates to the population about the location of the sick and injured in person or by phone.
6.8. Organization of emergency medical care.
One of the most significant components of the health care system in providing care to the population at the prehospital stage is the ambulance service (AMS).
The section deals with the history of the formation of the service and its role in the overall system of providing medical and preventive care.
A significant place is given to the organization of the NSR in the conditions of the city and the countryside (institution, structure, categories, states, main tasks, functions, rights and obligations of individual units and officials).
The section ends with data on its further specialization.
Service ambulance is a relatively new form of out-of-hospital care for the civilian population. Perhaps, for the first time, the idea of its organization arose after hundreds of people suffered during a fire in the Vienna Theater in 1881, who for a long time did not receive any help, although clinics and hospitals worked in the city. After this tragic incident, the Viennese doctor Yarmir Mundi proposed to organize a point of constant duty of doctors ready to go to the crash site and provide medical assistance. He called it an "ambulance station". Later, the idea became widespread, and emergency medical facilities began to appear in many countries.
The initiator of the creation of emergency medical care in Russia was the head of the hospital at the Alexander community of the Red Cross, Karl Karlovich Reiner. In November 1881, he proposed to organize stations in St. Petersburg. The first institutions began to function in Moscow in 1886 after the events on the Khodynka field, when more than 2 thousand people died during mass celebrations and the distribution of gifts in connection with the coronation of Nicholas II. people and tens of thousands were injured. Due to the lack of medical care, the wounded died at the scene.
At the beginning of 1889, five stations were opened in St. Petersburg. As in Moscow, the impetus for their organization was a disaster - a severe flood in the spring of 1898.
In 1902, points for providing medical care in case of accidents were opened in Kiev on a voluntary basis. In 1903, in Odessa, a donation from the millionaire M.M. Tolstoy began to provide medical care in case of accidents.
On April 25, 1910, at the initiative of Professor N.I. Obolensky, a station was opened in Kharkov and the first association of emergency doctors was organized.
A more detailed history of ambulance stations is presented in the book "Emergency Ambulance" edited by prof. V.V. Nikonova, Kharkov 1997, the materials of which we gratefully used.
During the years of Soviet power, there was a gradual development of the service ambulances, especially in cities. In rural areas, it was in its infancy.
At the end of the 70s, the development of service in all the republics of the former Union was determined by the Decree of the Council of Ministers of the USSR of 09/22/77. " On the further improvement of public health”, and in Ukraine issued by the decree of the Ministry of Health No. 870 of 12/14/77, which regulated their implementation.
The documents emphasized the need for interconnection between the clinic and the station, the development of its material and technical base, the creation specialized types of SMP, training of medical personnel and their improvement, introduction subordinates and continuation of internship terms up to two years.
The opening of special departments of ambulance and urgent care. In 1980 in Kharkov, at the Institute for the Improvement of Doctors, the first department was opened, then in Leningrad (1982), in Kiev, in Simferopol (1988).
The further development of the ambulance service was determined by the Decree of the Council of Ministers of the USSR No. 773 of 19.08.82. " About additional measures to improve medical care for the rural population". It spoke of the need organization of ambulances and emergency medical care in rural areas.
Decree of the Ministry of Health of the USSR No. 1490 dated 12/24/84. "About measures for the further development and improvement of emergency and emergency medical care for the rural population" Regulations on the station (department) were approved.
For many years we had two independent services to serve the urban population - ambulance and emergency medical care. It was unified only in small towns and rural areas.
Emergency care was characterized by insufficient efficiency, sometimes it was impossible to distinguish between the functions of these services. There were cases of duplication of departures. This led to its liquidation in 1970 with the transfer of the relevant responsibilities to the SMP.
The unified system for providing emergency medical care had its pros and cons. The main drawback was the unreasonable increase in the workload of the ambulance teams due to shortcomings in the work of outpatient clinics, which themselves withdrew from its provision.
In order to eliminate the accumulated shortcomings, it was planned to organize points (departments) for providing medical care at home in polyclinics, and to create a service of on-duty therapists and pediatricians in territorial polyclinics. In connection with the transfer of medical care for patients with acute diseases and exacerbations of chronic polyclinics, it was decided to replace the name "Stations (departments) of emergency and emergency medical care" in the nomenclature of healthcare institutions with - "Stations (departments) of ambulance" and create an appropriate association in the republican, regional, regional centers.
Decrees of the Council of Ministers of the USSR and Decrees of the Ministry of Health of the USSR have lost their legal force in our time, but the accumulated extensive experience in organizing the work of the service is taken into account even now.
In order to further improve the service in 1989, the Ministry of Health of Ukraine issued a similar decree. It pays serious attention to its organization in every rural area, equipping large cities and regional centers with computers, creating automated control systems " Emergency and advisory medical care”, provision of vehicles and medical equipment.
But the implementation of the decree has deteriorated significantly in recent years due to the difficult economic situation in the country. But there are also some developments. For example, centers for emergency care and disaster medicine (Kyiv, Dnepropetrovsk, Zaporozhye) have been further developed. On the basis of institutes and faculties for the improvement of doctors, departments of disaster medicine were opened (Kyiv, Zaporozhye, Kharkov).
In some medical schools of large cities of Ukraine, the creation of departments for the training of paramedics EMS according to specially developed programs, which will make it possible in the future to carry out the planned restructuring of ambulance brigades- to increase the number of paramedics (up to 35-40% of their total number) with the right to self-treat patients. It is especially necessary in view of the specifics of the structural service of calls and hospitalization of patients, especially in villages.
Unlike cities in rural areas, where part of the paramedic teams reaches 90%, 70-75% of patients are hospitalized in their areas. Good training of paramedical personnel will make it possible to further improve the quality of diagnostics and treatment at the prehospital stage in the villages.
Serviceambulance in Ukraine it is represented by special institutions - stations, substations (points), emergency hospitals.
SMP is an emergency out-of-hospital medical care to the maximum extent in case of sudden illnesses and accidents on the spot and during transportation to hospitals.
Assistance to patients with acute illnesses or exacerbations of chronic, who are on outpatient care of the territorial polyclinic, refers to emergency medical care. She turns out to be the doctor on duty at the polyclinic (from the polyclinic), who, together with the nurse, go on a call to the patient to provide emergency medical care at home.
Ambulance station according to " Regulations on the ambulance station” (Decree of the Ministry of Health of Ukraine No. 175 of 06/19/96) is a medical institution that provides round-the-clock emergency medical care to adults and children at the pre-hospital stage in case of accidents and conditions that threaten life or health.
She provides emergency medical care when needed. place of call, during transportation to medical institutions, direct handling. Its level of provision is determined by medical and economic standards.
The station is in operation round the clock duty and readiness to provide emergency medical care to the population defined service area and in the event of an emergency, and beyond.
Mobile teams are sent to other regions of Ukraine only by order of the local health authority to which they are subordinate.
The station is an integral part of the system of emergency medical care in emergency situations and ensure its operation when necessary. To do this, the station must have a constant monthly supply of medicines, dressings, emergency medical equipment, stretchers, equipment, packing boxes, kits for the formation of additional field teams for the purpose of their use on the spot and when traveling to other regions in case of emergency (catastrophes, accidents, natural disasters, mass poisoning, etc.), as well as stable and autonomous power supply, uninterrupted wire and radiotelephone operational communications and emergency vehicles.
Station does not issue sick leave, does not decide issues of temporary, long-term disability of patients and victims, does not conduct examinations forensic, alcohol or drug intoxication, can't stand therefore, regarding decisions, written references, does not fulfill advisory surveys and does not give recommendations for further treatment.
Leads the station head physician, who bears personal responsibility for all types of its activities. The station is subordinate to local health authorities, and if it is part of an association or a territorial center for emergency medical care, to their leaders.
Figure #26.SMP station control scheme
Chief Physician
Deputy for Technology Senior Physician
chief paramedic
Statistics department Central control room
Head specialist. services
Substations General SMP service
Cardiology service
Anti-shock service
Pediatric Service
Neurological service
Psychiatric service
Communication Service
At the present stage of development of the ambulance, in connection with the organization of associations and hospitals of the ambulance with powerful hospitals, the reprofiling of at least 50% of general medical teams into intensive care teams, the place of the station itself in the medical support system is changing to a certain extent. It becomes the initial link for rapid diagnostics, intensive care, and, if necessary, prompt and targeted hospitalization of patients.
Main tasksambulance stations (departments):
providing medical care to the sick and injured at the scene and during transportation to the hospital as soon as possible after receiving the call;
transportation of patients, if necessary, emergency care (with the exception of infectious), victims, women in labor, premature babies, together with their mothers, according to the applications of doctors and the administration of healthcare facilities.
The station provides emergency medical care in case of sudden diseases that threaten the life of the patient (acute disorders of the cardiovascular system and central nervous system, respiratory organs, abdominal cavity), as well as during childbirth outside specialized departments and institutions.
Main functions ambulance stations:
reception of calls from the population and their provision;
provision of emergency medical care to patients and victims at the prehospital stage in accordance with medical and economic standards;
transportation of sick and injured persons who require medical escort to hospitals of healthcare facilities;
preparation and dispatch of mobile teams outside the service area to participate in the elimination of the medical and sanitary consequences of emergencies;
keeping records of free beds in hospitals of healthcare facilities and determining places for emergency hospitalization;
diagnostic and advisory and reference and information services to the population by telephone;
accumulation and renewal of stocks of medicines, dressings, medical products, packing-sets for work in everyday conditions and in case of emergencies;
ensuring interaction with other medical institutions, law enforcement agencies, fire brigades, emergency medical care in emergencies, other rescue and operational repair services;
ensuring continuity and interconnection with medical facilities in the provision of emergency medical care;
promptly informing health authorities and other interested organizations about accidents, disasters, emergencies and other specific situations.
Depending on the number of the population that lives in the territory of cities and rural administrative regions (Decree of the Ministry of Health of Ukraine No. 175 of 19.06.96), or calls, the stations are divided into the following categories:
Accordingly, the staffing and management apparatus is formed. When serving more than 2 million people or more than 100 thousand calls, the stations are classified as non-categorical.
The stations of the regional centers and the city of Sevastopol are organizational and methodological institutions for the services of the respective administrative territories, therefore their status is increased by one category. Republican organizational and methodological center is the Kiev NSR.
To provide emergency medical care, field teams, the number and type of which is determined by the chief physician as necessary, but not less than 0.7 per 10 thousand people. Each station (except for IV and V categories) must have specialized teams:
cardioresuscitation;
psychiatric;
neurological;
intensive care and resuscitation, including children's resuscitation.
For execution main tasks and functions as part of the station are created the following divisions:
control room for receiving applications and transferring calls to mobile teams;
a subdivision for accounting for free beds in medical facilities and organizing the regulation of the flow of emergency hospitalization of patients within the prescribed staffing;
advisory service for information of the population on urgent medical issues;
transport division with a fleet of ambulances and other vehicles;
division of medical statistics;
training classes to ensure systematic training of medical workers and drivers of ambulance vehicles on the provision of emergency care at the prehospital stage.
The structure of the ambulance station has operational department (control room), which receives and provides calls.
Registration of the needs of the population and management of brigades is carried out with the help of sufficient and reliable radiotelephone communication with the call sign "03".
All work of the operational department begins with medical evacuator. It is to him that the population appeals. The medical evacuator (dispatcher) of the operational department, when answering a phone call, must, first of all, give his personal number, clarify the reason for the call, address, surname, age of the subscriber, enter the data into the call card with a time stamp. In case of any doubts or the need for consultation, he switches the applicant to the remote control senior doctor. The phone call is not interrupted during this, which allows you to fully resolve a variety of situations.
Challenge card is transferred to the senior dispatcher of the operational department for making a decision on the direction of the brigade with a preliminary determination of its profile. By telephone call from a doctor, as well as in the event of a poisoning or accident, immediately determine the presence places in the respective hospital and transmit a call to execute to the dispatcher.
If there are no free teams in this direction, the call is served by a team from the nearest substation or the senior dispatcher on the radio searches through the operational department for the team that was freed after the call was made.
If in large ambulance stations a dispatcher is appointed to provide the population with information about the time the brigade leaves for the call.
After making a call, the team notifies the dispatcher about the assistance provided to the sick or injured ( "delivered to the hospital", "left at home"). In case of accidents, more detailed information is provided. They are recorded in the call card and transferred to the dispatcher to the help desk of the operational department for subsequent information from the police and relatives.
Even this schematic list testifies to the hard work of a large number of people around the clock to organize the provision of the fastest medical care.
As noted earlier, the bark care station also transports the sick and injured at the request of doctors of medical institutions, transportation of women in labor. This provides special unit, which includes a doctor on duty, a group of medical evacuators to receive calls, a dispatcher for managing ambulance transport teams, a paramedic and a driver. Crews are assigned to ambulance substations.
work nursing staff at the ambulance station senior paramedic. He is responsible for the training of middle and junior medical staff, oversees the timely replenishment of medicines, the replacement of used equipment, systematically monitors the health of the equipment and trains the staff to use it correctly.
Before the mandatory probation, the senior paramedic acquaints the new employees with the nature of the future work, with the equipment of the teams and machines. After determining the level of mastering the material and mastering practical skills, he forms groups with which the senior paramedic and doctors of specialized teams conduct a cycle of classes according to a special program.
In the future, once or twice a month, the senior paramedic, in the presence of doctors from specialized teams, conducts classes with paramedical staff, informing and acquainting workers with new medicines and new methods of resuscitation.
The senior paramedic controls the provision of units and services with the necessary equipment, apparatus, medical supplies and other property.
He also monitors the implementation of sanitary-hygienic and anti-epidemic regimes, the implementation of aseptic and antiseptic rules.
Ambulance station has the right to:
refuse assistance to the population in case of unreasonable appeal and transfer calls, if necessary, to outpatient clinics;
send mobile teams only to the borders of the lesions if they pose a threat to the life or health of the members of the brigade;
to hospitalize patients or victims to the nearest health facility for emergency medical care, regardless of the availability of free beds, subordination, forms of ownership;
demand from health facilities twice a day information about the availability of free beds;
in emergency situations, mobilize and send employees to any regions of Ukraine to participate in the elimination of medical and sanitary consequences;
cooperate with state, non-state institutions in the planning and implementation of measures to provide emergency medical care.
main source financing of the ambulance station is the local budget. Additional may be funds received:
from institutions, organizations and the population for the provision of paid medical services;
as a result of the economic activity of the station, which does not contradict the current legislation and is provided for by this Regulation;
for the lease and sale of used, obsolete and unused property in accordance with applicable law;
from individuals, charitable foundations, organizations;
budget financing allocated for the elimination of the consequences of emergency situations.
An ambulance substation (point) is a structural subdivision with the rights of a department, which provides timely emergency medical care at the prehospital stage to the adult and children's population in life-threatening or health-threatening conditions.
It is organized in the service area of the ambulance station. with considering:
15-minute in urban and 30-minute in rural areas transport accessibility to the line of the service area;
population;
availability and condition of transport routes;
saturation with transport enterprises and agricultural complexes;
the availability of medical facilities and the material base for their placement.
The service area is determined and, if necessary, changed by the management of the ambulance station.
Leads and is responsible for all activities manager substation.
The ambulance station, in accordance with the current regulations, carries out work planning, determines the staff, provides personnel, vehicles, equipment, equipment, medicines.
The control room of the substation receives calls from the control room of the ambulance station and ensures their implementation.
The list of the main functions of the substation for providing emergency medical care to the sick and injured, their hospitalization, transportation of women in labor, newborns and other functions, they are detailed in the section " The main functions of the ambulance station».
In addition to those listed above, to the ambulance substation tasked with collecting the necessary information about cases of mass lesions and injuries of people, road accidents, criminal and suicidal cases, identification of patients suspected of quarantine and especially dangerous infections, AIDS, mental illness, sudden death and identification of factors harmful to people's health informing relevant bodies, services, institutions, enterprises.
If it is impossible to serve the call of the substation on its own and means has the right to inform the senior medical officer on duty at the ambulance station about this and ask for help.
The substation operates in around the clock mode. Shifts on duty teams are held, as a rule, at 7-00 and 19-00. From 11:00 a.m. to 11:00 p.m., when the largest number of requests are received, a daytime team works additionally. If there are several substations in the city Change of duty should not take place at all substations at the same time.
The SMP team is working with a minimum number of visits to the substation, by receiving calls from the substation, central control room while driving.
From the emergency departments of hospitals, the team does not transport patients to their homes. This issue can only be resolved by a senior doctor.
Performance The main tasks and functions of the substation are provided by the relevant departments:
offices of the head, senior doctor and paramedic;
dispatching station;
point of replenishment and assembly of medicines, dressings, medical products and kits;
a room for storing medicines, potent and narcotic drugs;
a room for emergency medical care with direct access to the substation;
rooms for classes with substation personnel;
rest room for duty crews and drivers.
Emergency medical care is one of the guarantees for the implementation of medical and social assistance to citizens.
- emergency medical care for patients and victims of conditions and injuries that threaten human life and health, 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 is provided in cases of acute illnesses, in case of mass catastrophes, natural disasters, accidents, childbirth and violation 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 an exacerbation of chronic diseases.
In our country, a nationwide system for organizing emergency medical care has been created, which includes ambulance and emergency stations, emergency hospitals (or emergency departments of a general network of hospital institutions), and air ambulance.
Organization of the work of the ambulance station
For the provision of emergency medical care, ambulance and emergency stations are provided. Ambulance stations are not involved in systematic treatment, they are designed to provide emergency care at the prehospital stage (see order of the Ministry of Health of the Russian Federation of March 26, 2000 No. 100). Ambulance stations do not issue sick leaves, certificates and other written documents to patients or their relatives.
Hospitalization of patients is carried out by emergency hospitals and emergency hospitalization departments of the general network of hospital institutions.
Ambulance stations are equipped with specialized ambulances equipped with equipment for urgent diagnosis and treatment of life-threatening conditions. The work of ambulance stations is organized by brigade. There are brigades linear (a doctor and a paramedic), specialized (a doctor and two paramedics), linear paramedics (usually used for targeted transportation of patients). In large cities, the following specialized teams usually operate: resuscitation, neurological, infectious diseases, pediatric resuscitation, psychiatric, etc. All the work of the teams is documented, the brigade 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 to the organizational and methodological department. If necessary (at the request of general network doctors, investigating authorities, etc.), you can always find a 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 death of the patient. The hospital returns the tear-off slip of the accompanying sheet to the station, which makes it possible to keep records of the errors of the ambulance team, thereby improving the quality of work of the ambulance teams.
At the place of the call, the ambulance team carries out the necessary treatment in the maximum available volume (as well as on the way when transporting the patient). In providing assistance to the sick and injured, the main responsibility lies with the team doctor, who directs the actions of the team. In difficult cases, the doctor consults with the senior shift doctor by phone. Most often, the senior doctor of the shift, at the request of the doctor of the linear team, sends a specialized team to the place of the call. Patients in need of emergency care are transported over long distances by air ambulance aircraft, helicopters.
The organization of medical care for rural residents is based on the same principles as for the urban population. However, the peculiarities of living in rural areas influence the formation of the system of its provision. The main difference in providing medical care to the rural population is its staging:
Fig.1 Stages of providing medical and preventive care to the rural population
- first stage- these are health care institutions of a rural settlement, which are part of a complex therapeutic area. At this stage, rural residents receive pre-medical care, as well as the main types of qualified medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental). One of the most important structural subdivisions of health care institutions (district, district, central district hospital), to which a rural resident first of all applies, is feldsher-midwife station.
- second phase providing medical care to the rural population is carried out by health care institutions of the municipal district, among which the leading place is occupied by central district hospital (CRH). The Central District Hospital provides the main types of specialized qualified medical care and at the same time performs the functions of a health management body on the territory of the municipality.
- third stage- these are health care institutions of the subject of the Federation, among them the main role is played by regional (territorial, district, republican) hospitals. At this stage, specialized medical care is provided in all major specialties.
Rural medical station- a complex of medical and preventive institutions providing medical assistance to the rural population (the first link).
The structure of a rural medical site includes a rural district hospital (or outpatient clinic), paramedical, paramedical and obstetrical stations, paramedical health centers at enterprises and state farms located on the territory of the site, collective farm maternity hospitals, seasonal and permanent nurseries, nursery gardens.
All medical institutions of rural medical districts are organizationally united and work according to a single comprehensive plan under the guidance of the head of the district - the chief physician of the rural district hospital or outpatient clinic.
The average population in a medical site ranges from 5-7 thousand inhabitants, with an optimal site radius of 7-10 km (the radius is different depending on the geographical location - in the north 50-100). The number of settlements is also different, depending on the nature of the distance, the average population and the development of the road network.
Tasks of the rural medical site:
Provision of medical and preventive care to the population;
introduction into practice of modern methods of prevention, diagnosis and treatment of patients;
Development and improvement of organizational forms and methods of medical care for the population, improving the quality and efficiency of medical and preventive care;
Organization and implementation of a complex of preventive measures among the population of the site;
Carrying out therapeutic and preventive measures to protect the health of mother and child;
Studying the causes of general morbidity and morbidity with temporary disability and developing measures to reduce it;
Organization and implementation of clinical examination of the population, especially children and adolescents;
Implementation of anti-epidemic measures (vaccinations, identification of infectious patients, dynamic monitoring of persons who were in contact with them, etc.);
Implementation of current sanitary supervision of the state of industrial and communal premises, water supply sources, children's institutions, public catering establishments;
Carrying out therapeutic and preventive measures to combat tuberculosis, skin and venereal diseases, malignant neoplasms;
Organization and implementation of measures for sanitary and hygienic education of the population, promotion of a healthy lifestyle, including rational nutrition, increased physical activity;
Fighting alcohol, smoking and other bad habits;
Wide public involvement in the development and implementation of measures to protect public health.
Responsibilities of a rural medical doctor:
conducting outpatient reception of the population:
Inpatient treatment of patients in a rural district hospital;
Assistance at home;
Providing medical assistance in case of acute diseases and accidents;
Referral of patients to other medical institutions for medical reasons;
Conducting an examination of temporary disability and issuing certificates of disability;
Organization and conduct of preventive examinations;
Timely taking on dispensary registration of patients;
Carrying out a complex of medical and recreational activities, ensuring control over medical examination;
Active patronage of children and pregnant women;
Carrying out a complex of sanitary and anti-epidemic measures;
Carrying out sanitary and educational work;
Preparation of a sanitary asset;
Organization and conduct of planned visits of doctors to FAPs.
FAP is organized in settlements with a population of 700 or more at a distance to the nearest medical institution of more than 2 km, and if the distance exceeds 7 km, then in settlements with a population of up to 700 people.
The feldsher-obstetric station is entrusted with a large complex of medical and sanitary tasks:
Carrying out activities aimed at preventing and reducing morbidity, injuries and poisoning among the rural population; reduction in mortality, primarily in children, maternal, working age;
Improving the sanitary and hygienic culture of the population;
Provision of pre-medical medical care to the population;
Participation in the current sanitary supervision of institutions for children and adolescents, communal, food, industrial and other facilities, water supply and cleaning of populated areas;
Carrying out house-to-house rounds according to epidemic indications in order to identify infectious patients, persons in contact with them and suspicious of infectious diseases.
The FAP may be entrusted with the functions of a pharmacy for the sale of finished dosage forms and other pharmaceutical products to the public.
The work of the FAP is directly headed by the head, whose main tasks are:
Organization of medical and preventive and sanitary and preventive work, as well as providing the population living on the site with medicines and medical products;
Outpatient reception and treatment of patients at home;
Provision of pre-hospital medical care in case of acute diseases and accidents (injuries, bleeding, poisoning, etc.) with subsequent referral of the patient to the nearest medical institution;
Preparing patients for admission by a doctor at a feldsher-obstetric station and conducting medical examinations of the population, preventive vaccinations;
Carrying out anti-epidemic measures, in particular door-to-door rounds according to epidemic indications in order to identify infectious patients, persons in contact with them and suspected of infectious diseases;
Carrying out sanitary and educational work among the population;
Organization of medical care for children in nurseries, kindergartens, nursery-kindergartens, orphanages, schools located on the territory of the FAP and not having relevant paramedical workers in their staff.
A person who has received a secondary medical education in the specialty "General Medicine" and has a certificate in the specialty "General Medicine" is appointed to the position of head of the FAP.
In addition to the head, a midwife and a patronage nurse work at the feldsher-midwife station.
Midwife at a medical and obstetric station is responsible for the provision and level of pre-medical care for pregnant women and gynecological patients, as well as for sanitary and educational work among the population on issues of maternal and child health.
The midwife is directly subordinate to the head of the feldsher-obstetric station, and the methodological guidance of her work is carried out by the obstetrician-gynecologist of the medical institution, who is responsible for providing obstetric and gynecological care to the population in the territory of the FAP.
Patronage Nurse of the Feldsher-Obstetric Station carries out preventive measures to improve the health of the children's population. To this end, it performs the following tasks:
Carries out patronage of healthy children under the age of 1 year, including newborns at home, monitors the rational feeding of the child;
Carries out measures for the prevention of rickets and malnutrition;
Conducts preventive vaccinations and diagnostic tests;
Carries out preventive work in nurseries, kindergartens, nursery-kindergartens, orphanages, schools (located on the territory of the FAP and not having relevant paramedical workers in their states);
Provides pre-medical care to children in case of acute illnesses and accidents (wounds, bleeding, poisoning, etc.) followed by a doctor's call or referral of the child to an appropriate medical institution;
Prepares sick children to be seen by a doctor at a feldsher-obstetric station;
Conducts house-to-house rounds according to epidemic indications in order to identify infectious patients, persons in contact with them and persons with suspected infectious diseases, etc.
Due to the fact that the FAP provides medical care to the entire rural population, and not just the female, the room in which it is located should consist of two halves: paramedical and obstetrical.
In the absence of a midwife and a patronage nurse in the state of the feldsher-obstetric station, their duties are performed by the head of the FAP. In the absence of a patronage nurse position in the state, the midwife, in addition to her duties, monitors the health and development of children in the first year of life.
Despite the important place of FAPs in the system of primary health care, the leading medical institution at the first stage of rural health care is district hospital, which in its composition may have a hospital and a medical outpatient clinic. The nature and scope of medical care in a district hospital is determined by the capacity, equipment, and availability of specialist doctors. However, regardless of its capacity, its tasks primarily include the provision of outpatient care to therapeutic and infectious patients, assistance in childbirth, medical and preventive care for children, emergency surgical and trauma care.
The organization of outpatient care for the population is the most important section of the work of the district hospital. It can be an outpatient clinic, which is part of the structure of the hospital, or independent. The main task of this institution is to carry out preventive measures to prevent and reduce morbidity, early detection of patients, medical examination, and provision of qualified medical care to the population.
Doctors receive adults and children, make house calls and emergency care. Paramedics can also take part in the reception of patients, however, outpatient care in a rural medical outpatient clinic should mainly be provided by doctors. In the district hospital, an examination of temporary disability is carried out, and if necessary, patients are sent to the MSE.
Doctors of the central (city, district) hospital go to outpatient clinics and FAPs according to a certain schedule for consultations. Recently, in many subjects of the Russian Federation, there has been a process of reorganization of district hospitals and outpatient clinics into centers of general medical (family) practice.
The capacity of the CRH depends on the size of the population, its provision with other hospital facilities, other medical and organizational factors, and is established by the administration of municipalities. As a rule, the capacity of the CRH is from 100 to 500 beds.
Fig.2 Approximate organizational structure of the central district hospital
Profile and number of specialized departments within the CRH depend on its power, but the optimal number of them should be at least five: therapeutic; surgical with traumatology, pediatric, infectious, maternity and gynecological (if there is no maternity hospital in the area).
Chief Physician of the Central District Hospital is the head of health of the municipal district. Organizes the work and manages the activities of middle and junior medical staff head nurse hospitals.
Methodological, organizational and advisory assistance to doctors of complex therapeutic areas, paramedics of FAPs is carried out by specialists from central district hospitals. Each of them, according to the approved schedule, goes to the complex therapeutic site for medical examinations, analysis of dispensary work, selection of patients for hospitalization.
In order to bring specialized medical care closer to the rural population, inter-district medical centers . The functions of such centers are performed by large CRHs capable of providing the population of a given municipal district with the missing types of specialized, highly qualified inpatient or outpatient medical care.
There is a polyclinic in the structure of the Central District Hospital, which provides primary health care to the rural population in the direction of paramedics FAPs, outpatient doctors, centers of general medical (family) practice.
The provision of out-of-hospital and inpatient medical and preventive care to children in a municipal district is entrusted to children's consultations (polyclinics) and children's departments of central district hospitals. The preventive and curative work of children's polyclinics and children's departments of district hospitals is carried out on the same principles as in urban children's polyclinics.
The provision of obstetric and gynecological care to women in a municipal district is entrusted to antenatal clinics, maternity and gynecological departments of central district hospitals.
The functional duties of paramedical workers of the Central District Hospital do not fundamentally differ from the duties of paramedical personnel of city hospitals and outpatient clinics.
Regional (regional, district, republican) hospital is a large multidisciplinary medical institution designed to provide fully qualified specialized assistance not only to rural residents, but also to all residents of the subject of the Russian Federation. It is a center for organizational and methodological management of medical institutions located on the territory of the region (krai, district, republic), a base for specialization and advanced training of doctors and paramedical personnel.
Fig. 3 Approximate organizational structure of the regional (regional, district, republican) hospital
The functional responsibilities of middle and junior medical personnel do not fundamentally differ from those in a city or central district hospital. At the same time, the organization of the work of the regional hospital has its own characteristics. One of them is the presence in the hospital regional advisory polyclinic (OKP) , where residents of all municipal districts of the region come for help. For their accommodation, a boarding house or hotel for patients is organized at the hospital.
As a rule, patients are sent to the regional advisory polyclinic after a preliminary consultation and examination by regional specialist doctors.
There are 4 categories of hospitals by capacity:
The regional hospital is due to the presence in its composition departments of emergency and planned advisory assistance , which, using the means of air ambulance or ground vehicles, provides emergency and advisory assistance with travel to remote settlements. In addition, the department ensures the delivery of patients to specialized regional and federal medical institutions.
The Department of Emergency and Planned Consultative Assistance works in close connection with the Regional Center for Disaster Medicine.
In this case, practical work on the implementation of sanitary tasks is carried out by teams of specialized medical care of constant readiness.
Unlike the city, in the regional hospital functions of the organizational and methodological department much wider. In fact, it serves as a scientific and methodological basis for the health management body for the introduction into practice of advanced organizational forms and methods of medical care for the population.
The organizational activities of the department include holding regional paramedical conferences, summarizing and disseminating the experience of advanced institutions, organizing comprehensive medical examinations of the population, scheduled visits, compiling and publishing instructive, methodological and regulatory materials. Organizational forms of scientific and practical work include planning scientific research, introducing the results of scientific developments into the practical work of medical institutions, communication with the departments of medical universities and departments of research institutes, organizing scientific conferences and seminars, attracting doctors to participate in the work of scientific societies, publishing materials and others. In recent years, modern telemedicine technologies have been widely used to improve the quality and efficiency of consulting patients in other healthcare institutions, holding scientific and practical conferences and other events.
Emergency(SMP) is a type of primary health care.
Emergency- round-the-clock emergency medical care for sudden illnesses that threaten the life of the patient, injuries, poisoning, deliberate self-harm, childbirth outside medical institutions, as well as catastrophes and natural disasters.
Ambulance, including emergency specialized, medical care is provided under the following conditions:
a) outside a medical organization - at the place where an ambulance brigade is called, including specialized ambulance, medical care, as well as in a vehicle during medical evacuation;
b) on an outpatient basis (in conditions that do not provide for round-the-clock medical supervision and treatment);
c) stationary (under conditions that provide round-the-clock medical supervision and treatment).
Ambulance, including emergency specialized, medical care is provided in the following forms:
a) emergency - in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient's life;
b) urgent - in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life.
The reasons for calling an ambulance in an emergency form are:
a) violations of consciousness that pose a threat to life;
b) respiratory disorders that pose a threat to life;
c) disorders of the circulatory system that pose a threat to life;
d) mental disorders accompanied by the patient's actions that pose an immediate danger to him or other persons;
e) sudden pain syndrome posing a threat to life;
f) sudden violations of the function of any organ or system of organs that pose a threat to life;
g) injuries of any etiology that pose a threat to life;
h) thermal and chemical burns that pose a threat to life;
i) sudden bleeding that poses a threat to life;
j) childbirth, threatened miscarriage;
k) duty in case of a threat of an emergency situation, provision of emergency medical care and medical evacuation in the event of liquidation of the medical and sanitary consequences of an emergency situation.
In the event of a call for an ambulance in an emergency form, the nearest free general field mobile ambulance team or a specialized mobile ambulance team is sent to the call.
The reasons for calling an ambulance in an emergency are:
Sudden acute diseases (conditions) without obvious signs of a threat to life, requiring urgent medical intervention;
Sudden exacerbations of chronic diseases without obvious signs of a threat to life, requiring urgent medical intervention;
statement of death (with the exception of the opening hours of medical organizations providing medical care on an outpatient basis).
In the event of a call for an ambulance in an emergency form, the nearest free general field mobile ambulance team is sent to the call in the absence of calls for an ambulance in an emergency form.
The SMP is carried out by citizens of the Russian Federation and other persons located on its territory free of charge in accordance with the State Guarantees Program.
In the structure of the NSR includes stations, substations, SMP hospitals, as well as SMP departments as part of hospital facilities.
NSR stations as independent medical and preventive institutions are being created in cities with a population of over 50 thousand people. In cities with a population of more than 100 thousand people, taking into account the length of the settlement and the terrain, NSR substations are organized as subdivisions of stations (in the zone of 20-minute transport accessibility). In settlements with a population of up to 50 thousand, emergency care units are organized as part of central district, city and other hospitals.
The station (substation, department) of the SMP is a medical and preventive institution that operates in the mode of daily work and emergency situations (ES).
Heads the work of the NSR station chief doctor, and substations and departments - head.
Deputy chief physician for medical affairs and operational work.
Calls are received and transferred to mobile teams duty paramedic (nurse) for receiving and transmitting calls of the operational department of the EMS station .
In the structure of an ambulance station, an emergency department of a polyclinic (hospitals, emergency hospitals), it is recommended to provide for:
a) operations department
b) communications department (radio post);
c) unit for ensuring the transportation of infectious patients;
d) self-supporting department;
e) pharmacy (pharmacy warehouse);
f) remote advisory post (center);
g) transport division;
h) department of informatization and computer technology (in ambulance stations, ambulance departments of polyclinics (hospitals, emergency hospitals) provided with an automated registration and call processing system with software);
i) organizational and methodological department of emergency medical care;
j) line control department (line control service);
k) department (office) of statistics with an archive;
l) department of hospitalization;
m) ambulance substations;
o) branches (posts, route points) of emergency medical care;
n) an office for preparing for the work of medical packing.
Mobile brigades ambulance in composition subdivided into medical and paramedical, according to your profile subdivided into general profile, specialized, emergency advisory, obstetric, aeromedical. Specialized mobile teams ambulances are divided into teams of anesthesiology-resuscitation, pediatric, pediatric anesthesiology-resuscitation, psychiatric, obstetric-gynecological.
The paramedic teams include two paramedical workers, a nurse and a driver. The medical team consists of a doctor, two paramedical workers, an orderly and a driver.
The mobile ambulance team performs the following functions:
a) carries out an immediate departure (entry on a flight, departure) to the place where an ambulance is called;
b) provides emergency medical care based on the standards of medical care, including the establishment of a leading syndrome and a preliminary diagnosis of a disease (condition), the implementation of measures that contribute to the stabilization or improvement of the patient's condition;
c) determines the medical organization for the provision of medical care to the patient;
d) carries out medical evacuation of the patient in the presence of medical indications;
e) immediately transfers the patient and the relevant medical documentation to the doctor of the admission department of the medical organization with a note in the emergency call card of the time and date of admission, the name and signature of the recipient;
f) immediately informs the paramedic for receiving ambulance calls and transferring them to ambulance teams (a nurse for receiving ambulance calls and transferring them to ambulance teams) about the completion of the call and its result;
g) ensure the sorting of patients (injured) and establish the sequence of medical care in case of mass diseases, injuries or other conditions.
Field work requirements:
- efficiency(after receiving a call, the team leaves within the first 4 minutes, arrives at the place of the call along the optimal route and reports on arrival to the operational department, spends the minimum time on quality assistance in full)
- quality emergency medical care(correct recognition of diseases and injuries, implementation of the necessary therapeutic measures, the right tactical decision)
- quality medical documentation(full description in call map history and data of an objective examination of the patient, as well as additional studies (rapid tests, ECG); logical and consistent formulation of the diagnosis (ICD-10); standard timestamps from the beginning to the end of the call; upon delivery to the hospital, mandatory filling cover sheet(f.114 / y) with a brief description of "when and what happened", the patient's condition, assistance provided and additional information)
- interaction with employees of other ambulance teams, as well as with employees of medical and preventive and law enforcement institutions(carried out both in the interests of the patient and the workers of the field team; strict execution of job descriptions and other regulatory documents)
The main tasks of the stations (substations, branches) of the NSR are:
· provision of round-the-clock emergency medical assistance to sick and injured people who are outside medical institutions, in case of catastrophes and natural disasters;
timely transportation of sick, injured and women in labor to hospitals of hospitals;
Providing medical care to the sick and injured who applied for help directly to the station (substation, department) of the EMS;
training and retraining of personnel on the provision of emergency medical care;
· in the emergency mode - carrying out medical and evacuation measures and participation in the work to eliminate the medical and sanitary consequences of emergency situations.
SMP does not issue documents, certifying temporary disability and forensic medical conclusions, does not conduct an examination of alcohol intoxication (but can issue certificates of arbitrary form indicating the date, time of treatment, diagnosis, examinations, medical care provided and recommendations for further treatment).
Statistical reporting of the NSR station:
Ambulance call log (f.109 / y)
Ambulance call card (form 110/y)
Accompanying sheet of the ambulance station with a coupon for it (f.114 / y)
Diary of the work of the station (department) of ambulance (f.115 / y)
Report of the station (department), emergency hospital (f. 40 / y)
SMP indicators:
The indicator of the provision of the population with the NSR
The indicator of the timeliness of visits of ambulance teams
The indicator of discrepancy between the diagnoses of the EMS and hospitals
Number of repeat calls
The indicator of the proportion of successful resuscitations
The indicator of the share of lethal outcomes
The Emergency Medical Service (EMS) is a subdivision of the Territorial Emergency Medical Service.
Emergency medical care to the population in large cities of the Russian Federation is provided by the departments (rooms) of emergency medical care of the APU. Emergency Department is a structural subdivision of the APU, designed to provide round-the-clock medical care in places of permanent and temporary residence of the adult and child population, in case of acute diseases and exacerbation of chronic diseases that do not require urgent medical intervention. Emergency medical care at home is provided on a territorial basis around the clock by mobile teams of emergency medical departments organized in one or more polyclinics for the population of a given administrative district. The boundaries of the service area of emergency medical departments are approved by the health management authority of the administrative district.
The main tasks of the emergency department are:
Round-the-clock provision of timely medical care in places of permanent and temporary residence for adults and children, in case of acute diseases and exacerbation of chronic diseases that do not require urgent medical intervention;
Provision of medical care to the sick and injured who applied independently directly to the department (outpatients);
Making active calls to patients in need of dynamic medical supervision, ensuring continuity in work with the city's medical institutions to provide emergency medical care to the population;
Notification of the health authorities of the territory and the relevant administrative authorities about all emergencies and accidents in the service area of the department;
Delivery of patients to social institutions (boarding houses, etc.) according to the directions of doctors of territorial polyclinics;
Transportation of patients for consultations, examinations, hemodialysis to healthcare facilities, etc.
The department of emergency medical care is headed by the head of the department, who is appointed and dismissed by the chief physician of the medical institution, the structural unit of which is the department of emergency medical care.
The main functional unit of the emergency department is a mobile team (medical, ambulance transport for transporting patients). The medical team consists of a doctor specializing in emergency medical care, a paramedic (nurse), an orderly and a driver. A paramedic and a driver work as part of the paramedic team for transporting patients. The number of shifts in the work of mobile teams, their profile, mode (schedule) of work are determined by the higher organization by subordination, taking into account the appeal of the population to the department, the density of the hourly flow of calls, the number of calls by day of the week, months of the year, the number of patients subject to emergency and planned hospitalization.
Receiving calls and transferring them to mobile teams is carried out by a paramedic (nurse) for receiving and transferring calls from the dispatching department of emergency medical care. Victims (patients) delivered by mobile teams of the emergency department should be immediately transferred to the duty staff of the admission department of the hospital with a note in the “Call Card” of the time of their arrival.
The emergency medical department does not issue documents certifying temporary disability and forensic medical opinions, does not conduct an examination of alcohol intoxication, but gives oral certificates in person or by telephone about the location of patients and victims. If necessary, writes out certificates of any form indicating the date, time of treatment, diagnosis, examinations, medical care provided and recommendations for further treatment.
