Organization of specialized medical care. Organization of specialized medical care for the population. Specialized medical care centers, types, tasks, structure

Specialized medical care is provided by medical specialists in specialized medical institutions at the front using the necessary types of honey. equipment. Specialized medical care is the highest type of qualified medical care, providing for the most complete and widespread use of the latest achievements of a particular field of medical science in the practice of treating the affected and sick.

During the Great Patriotic War, a coherent, scientifically based system of specialized medical care was created in the USSR. In the post-war period, based on the study and critical analysis of the experience gained, specialized medical care was further developed and improved.

In connection with the possible use of weapons of mass destruction, completely new contingents of injured and sick people may appear in need of specialized medical care.

The provision of specialized medical care can be carried out in mobile field hospitals (surgical, therapeutic, infectious, neurological), in a hospital for the lightly wounded and in evacuation hospitals. Depending on the number of incoming injured and sick people in need of one or another type of specialized medical care, and the currently available number of medical institutions, hospitals can be created that are entirely specialized in one profile or have specialized departments.

The specialization of hospitals is carried out both by introducing specialists and the necessary equipment into their staffs, and by giving surgical and therapeutic field mobile hospitals specialized groups of medical reinforcement from a separate detachment of specialized medical care.

One of the main requirements for organizing medical assistance in military field conditions are continuity and consistency in the implementation of treatment and preventive measures based on uniform principles of medical care. helping the injured and sick. Continuity in treatment is achieved primarily by a unified understanding of the pathological processes occurring in the human body during lesions and diseases, and by unified methods for the prevention and treatment of wartime lesions and diseases. At the same time, continuity of medical care and treatment can only be achieved if at each subsequent stage the medical evacuation will know what was done at the previous stage, what medical care was provided and when it was provided to the injured or sick person. This is achieved by clear management of honey. documentation, in particular by carefully filling out the primary medical card and maintaining medical histories (see Medical and evacuation support for troops, Staged treatment).

An important requirement for organizing medical care in military field conditions is also the timeliness of its provision. Medical care should be provided at a time most favorable for the subsequent restoration of the health of the injured or sick person. Of particular importance is the timely implementation of emergency first medical and qualified medical care.

Timely provision of medical care is achieved by including in the active army the necessary regular forces and means of medical services, the fastest removal and removal of the injured and sick from the battlefield or from centers of mass destruction and their transportation to medical stages. evacuation, clear organization of work at stages. The rational arrangement of medical stages is also of no small importance. evacuation.

See also Civil Defense Medical Service.

Specialized medical care

With the entry into force of the Federal Law "On the General Principles of Organization of Legislative (Representative) and Executive Bodies of State Power of the Subjects of the Russian Federation" dated October 6, 1999 N 184-FZ (as amended by the Federal Law dated July 4, 2003 N 95-FZ) establishing that the powers of state authorities of a constituent entity of the Russian Federation on subjects of joint jurisdiction include organizing the provision of specialized medical care in dermatovenerological, tuberculosis, drug treatment, oncology dispensaries and other specialized medical institutions, several issues have acquired particular relevance in the professional community:

what is specialized care?

which medical organizations are classified as specialized;

do only specialized medical organizations provide specialized medical care or, in other words, do specialists from outpatient clinics and multidisciplinary hospitals at various levels provide specialized medical care;

whose ownership should specialized medical organizations be located and, therefore, who bears the expenditure obligations to finance the medical care provided in them?;

Article 40 of the Fundamentals of Legislation on the Protection of Citizens' Health (as amended by No. 122-FZ of August 22, 2004) establishes that “specialized medical care is provided to citizens for diseases that require special methods of diagnosis, treatment and the use of complex medical technologies.

Specialized medical care is provided by medical specialists in medical institutions that have received a license for medical activities.

The types and standards of specialized medical care provided in health care institutions are established by the federal executive body that carries out legal regulation in the field of health care.

Financial support for measures to provide specialized medical care in dermatovenerological, anti-tuberculosis, drug treatment, oncology clinics and other specialized medical organizations (with the exception of federal specialized medical organizations, the list of which is approved by the Government of the Russian Federation) in accordance with these Fundamentals, is an expenditure obligation of the subject of the Russian Federation Federation.

Financial support for measures to provide specialized medical care provided by federal specialized medical organizations, the list of which is approved by the Government of the Russian Federation, in accordance with these Fundamentals, is an expenditure obligation of the Russian Federation."

The law determined that, in contrast to primary health care, specialized medical care is provided in accordance with the standards that, along with the types of medical care, are established by the federal executive body that carries out legal regulation in the field of health care.

Federal Law N 122-FZ eliminated the contradictions in the Fundamentals regarding the delegation of powers to establish standards of specialized medical care by the constituent entities of the Russian Federation, equalizing the rights of the republics within the Russian Federation, regions, territories, the cities of Moscow and St. Petersburg, eliminating the very possibility of such delegation.

However, the provision of specialized medical care in accordance with standards is limited to state and municipal healthcare institutions. The legislator did not oblige private medical organizations and persons engaged in private medical activities to provide medical care in accordance with the standards of medical care.

This contradicts the provisions of the Constitution of the Russian Federation (Article 71) regarding the attribution of standardization to the sphere of competence of the Russian Federation, the establishment of equal rights of organizations of various organizational and legal forms and forms of ownership, and equal rights of citizens to receive medical care.

Contradictory provisions of the articles of the Law regarding licensing also remain. The legislator retained the rule establishing that institutions providing specialized medical care are licensed. However, there are no instructions on the licensing of institutions whose medical activities relate to primary health care. Licensing legislation establishes the norm for licensing medical activities without dividing them into types. In this regard, it is necessary to make appropriate amendments to industry legislation.

Thus, this article of the law also does not answer the questions, but only confirms their validity.

The medical community expected to find answers to these questions in Orders of the Ministry of Health and Social Development of Russia dated October 7, 2005 N 627, which approved a new nomenclature of healthcare institutions and dated October 13, 2005 N 633 “On the organization of medical care.”

At the same time, these Orders have further complicated the understanding and implementation of legislation on the division of powers.

Thus, the new Order on a unified nomenclature of state and municipal healthcare institutions is not much different from the old one. In the Order of 06/03/2003 N 229 (hereinafter referred to as the 2003 Nomenclature), all types of children's medical institutions are named as a separate line, and in the Order of 10/02/2005 N 627 (hereinafter referred to as the 2005 Nomenclature) they are indicated “including”, which is not changes things. The Russian Children's Clinical Hospital of the Russian Ministry of Health was excluded from the list of institutions as an independent type of institution and included in the republican hospitals, including children's. The 2005 Nomenclature excludes central district hospitals (former water workers' hospitals), as well as all types of railway hospitals, since they do not belong to either the state or municipal health care system.

At the same time, the Ministry of Health and Social Development of Russia is a federal government body that implements state policy and carries out legal regulation in the field of healthcare. Based on the powers vested in him, he must determine the nomenclature of healthcare organizations for all departments, levels of government, as well as healthcare systems, including private ones.

In addition, the 2005 Nomenclature clarifies the name of the medical institution providing nursing care - nursing home (hospital), and excludes the type of hospital "1.2. Clinics", which is completely legal.

Section "1.1.2. Specialized hospitals" has not changed.

From this structure of the Order it follows that regional, republican, and regional hospitals included in section 1.1.1. are not specialized and cannot be financed from the budget of a constituent entity of the Russian Federation. Also, the Order does not classify leper colonies as specialized institutions, which is incorrect in essence, as well as hospitals. At the same time, Order No. 633 states that hospitals provide specialized medical care.

From the edition of N 95-FZ and the Order of the Ministry of Health and Social Development of Russia it follows that the constituent entities of the Russian Federation can only finance dispensaries and specialized hospitals named in section 1.1.2. Nomenclatures 2005 and centers for specialized types of medical care, named in the section “Centers, including scientific and practical” (section 1.4).

In the logic of the Order, diabetes and drug rehabilitation centers, also named in section 1.4 of the 2005 Nomenclature, are not specialized health care organizations, while drug treatment and endocrinology dispensaries are classified by law, therefore, as the Order, as health care organizations providing specialized medical care.

A number of special types of healthcare institutions are excluded from the “centers” section: the National Medical and Surgical Center of the Ministry of Health of Russia, the regional center for the prevention and control of AIDS and infectious diseases, the clinical center, the outpatient dialysis center as an independent institution.

The word “organizations” was removed from the name of centers for specialized types of medical care, rehabilitation centers became one of the types of health care institutions, and not an exclusive health care institution of the Administration of the President of the Russian Federation, district medical centers and medical centers of the Ministry of Health of Russia became district medical centers.

Ambulance and emergency care stations have been excluded from the section "Emergency medical care and blood transfusion institutions", the Russian Rehabilitation Center "Childhood" of the Ministry of Health of Russia has been excluded from the section "Institutions for the protection of motherhood and childhood", a new type of health care institution "Center for Adolescent Reproductive Health" has been introduced. . Children's homes are united, including specialized ones. At the same time, paragraph 8 of the Note contains a list of specialized children's homes, from which it may follow that they are specialized healthcare institutions and should be classified as expenditure powers of the constituent entities of the Russian Federation. In pursuance of this clause, these children's homes were transferred to the jurisdiction of the constituent entities of the Russian Federation.

Let's try to find in the Order of the Ministry of Health and Social Development of Russia dated October 13, 2005 N 633 “On the organization of medical care” the answer to the question of what applies to specialized medical care and what to primary health care?

The order divides medical care into primary health care, medical care for women during pregnancy, during and after childbirth, emergency medical care, specialized medical care, emergency specialized care (sanitary and aviation) and high-tech (expensive) medical care.

Particularly noteworthy is the fact that the Order classifies 31 types of medical care as primary health care, ranging from therapy to cardiovascular surgery, which in the section “Specialized Medical Care” are named as specialized types of medical care.

The Order also specifies a list of institutions providing primary health care. These include outpatient clinics (at the same time, they are excluded as an independent type of institution from the 2005 Nomenclature), general medical (family practice) centers, district hospitals, district hospitals, central district hospitals, nursing homes, hospices, clinics, including children's , city clinics, including children's, centers, medical units, city hospitals, children's homes, antenatal clinics, maternity hospitals, emergency hospitals, perinatal centers.

In order to understand the concept of primary health care, you should refer to the norms of the law of the Fundamentals of Legislation of the Russian Federation on the protection of the health of citizens.

Thus, Article 38 of the Fundamentals defines: “Primary health care is the basic, accessible and free type of medical care for every citizen and includes: treatment of the most common diseases, as well as injuries, poisoning and other emergency conditions; medical prevention of major diseases; sanitary hygienic education; carrying out other activities related to the provision of health care to citizens at their place of residence.

Primary health care is provided by institutions of the municipal health care system. Institutions of public and private health care systems may also participate in the provision of primary health care on the basis of agreements with insurance medical organizations.

The scope and procedure for the provision of primary health care is established by legislation in the field of protecting the health of citizens.

Financial support for activities to provide primary health care in outpatient clinics, inpatient clinics and hospitals, medical care for women during pregnancy, during and after childbirth in accordance with these Fundamentals, is an expenditure obligation of the municipality.

The provision of primary health care can also be financed from compulsory health insurance and other sources in accordance with the legislation of the Russian Federation."

In Article 13 of the Fundamentals “Municipal Health Care System,” the legislator once again establishes the sources of financing for primary health care.

Financial support for the activities of organizations of the municipal healthcare system is an expenditure obligation of the municipality.

The provision of medical care in organizations of the municipal healthcare system can also be financed from funds from compulsory health insurance and other sources in accordance with the legislation of the Russian Federation."

From these norms it follows that the main source of financing for the activities of organizations of the municipal health care system that provide primary health care, emergency medical care, as well as medical care for women during pregnancy, childbirth and after childbirth, should be the municipal budget, and compulsory medical insurance is an optional source of financing and can, “just” like other sources, be used by decision of local governments. Such consolidation of funding sources is absolutely contrary to the basic principles of compulsory health insurance and the legislation regulating it. It is primary health care that should be financed from compulsory health insurance, since it is the main, accessible, free type of medical care. The main source of its financing is compulsory health insurance, based on the joint financial responsibility of the healthy in favor of the sick, the young in favor of the old, the rich in favor of the poor.

In addition, the legislator, for the sake of delineating financial powers between levels of government, excluded from the concept of health care its most important components such as sanitary, hygienic and anti-epidemic measures. It is difficult to agree with such changes. The exclusion of sanitary and hygienic and anti-epidemic measures from primary health care may lead to the fact that medical institutions will not carry out such important measures as vaccination, measures to isolate infectious patients and establish quarantine, and sanitary and hygienic treatment within the framework of this form of organization of medical care. in foci of infections, etc. There will be no proper coordination of actions in carrying out these measures between municipal medical institutions and institutions and bodies of the sanitary and epidemiological service, which fall under the competence of the federal center. This will lead to a deterioration in the implementation of preventive measures.

As amended by the 1993 Fundamentals, primary health care included measures to protect the family, motherhood, paternity and childhood, which were excluded by Federal Law No. 122-FZ. Complete exclusion of these measures is unjustified. Primary health care should include measures to protect family, maternal, paternal and childhood health. And this must be enshrined in law.

It should be noted that when amending this law in the summer of 2004, it was necessary to replace the concept of “medical care,” the legal and organizational meaning of which is unclear, with the constitutional concept of medical care.

In addition, it should be noted that the definition of specialized health care specifies diagnostic and treatment technologies, while primary health care only specifies technologies of prevention and treatment.

Previously, the Fundamentals established the establishment of the volume of primary health care by local administrations in accordance with the territorial compulsory health insurance program.

The procedure for provision was entrusted to be established by the governing bodies of the municipal healthcare system on the basis of regulations of the federal and regional executive authorities in the field of healthcare. Federal Law No. 122-FZ excluded these norms; the establishment of the scope and procedure for the provision of primary health care was defined in the law in a fairly general form - “in accordance with the law.”

The procedure for organizing the provision of primary health care is determined by Order of the Ministry of Health and Social Development of Russia dated July 29, 2005 N 487. This procedure regulates issues related to the organization of the provision of this type of medical care. Institutions providing primary health care must carry out their activities in accordance with the established procedure. According to the Order, primary health care includes, among other things, medical care for women during pregnancy, during and after childbirth. Primary health care is provided by institutions of the municipal health care system mainly at the place of residence, namely outpatient clinics, which are specifically listed in the Order: outpatient clinic, general medical (family) practice center, district (including central), city clinic, children's city clinic, antenatal clinic.

The order duplicates the norm of the law on participation in the provision of primary health care by institutions of public and private health care systems on the basis of contracts with insurance medical organizations.

It should be noted that the Order (paragraphs 8 and 9) defines in detail the structure of outpatient and inpatient care, and in relation to inpatient care it is specified that it is provided to the population of municipalities in hospital and inpatient clinics without specifying their types, defined by the 2005 Nomenclature .

Thus, only the Order of the Ministry of Health and Social Development of Russia dated October 13, 2005 N 633 defines a list of institutions providing primary health care in hospital institutions - district, district and central district hospitals, nursing homes and hospices, centers, medical units, city hospitals, orphanages, maternity hospitals, emergency hospitals, perinatal centers. However, there is no reference to the previous Order.

The order (clause 7) clarifies that the responsibility of institutions to provide primary health care is performed by medical workers of these institutions: local therapists, local pediatricians, general practitioners (family) obstetricians-gynecologists, other medical specialists, as well as specialists with secondary medical and higher education, in accordance with the established procedure.

From this definition it follows that medical specialists provide primary health care in accordance with their specialty and position. Specialists of the same specialties also provide specialized medical care in 31 specialties. That is, in 31 specialties medical care can be specialized and primary health care, and only in 16 specialties medical care is specialized. For example, cardiovascular surgery provided by the emergency hospital of a city district is classified as primary health care, and cardiovascular surgery organized in healthcare institutions of the constituent entities of the Russian Federation - hospital, center, regional, republican, district hospital , is a specialized cardiovascular surgery.

Hematological, dermatovenerological, diabetological, coloproctological, neonatological, oncological for adults and children, specialized medical care for infectious diseases, psychiatric, psychiatric-narcological, dental, urological-andrological, phthisiatric, medical-genetic medical care (16 in total) are specialized.

The question arises about the difference between these two types of medical care provided within the same specialty. Is it possible to differentiate based on diseases, standards of medical care, technologies used, level of training of specialists, and other criteria. Theoretically, anything can be justified. In practice this is impossible. The distinction established by this Order is artificial and does not at all resolve the issues of delimitation of powers in the field of healthcare and securing sources of funding by levels of government.

At the same time, it should be noted that this Order completely deprives the population of municipalities of accessible TB medical care, since it can only be provided in a specialized dispensary and a specialized hospital. The population of rural areas will have to go to these specialized institutions. The logic of the Order does not allow having a TB specialist and a TB department on staff at the central district hospital. This management decision was immediately translated into stagnation of tuberculosis incidence rates and an increase in mortality rates.

A similar situation arises with the availability of other types of medical care.

Separately, we should dwell on the availability of dental care, which by Order is classified only as specialized medical care provided in healthcare institutions of a constituent entity of the Russian Federation: regional, regional, republican hospital, dispensary, specialized hospital, hospital (from which it follows that it is a specialized medical institution, together however, in the 2005 Nomenclature it is not classified as such), in a center without indicating specialized or other types, and most importantly, in a clinic (without indicating its profile), which does not belong to specialized healthcare institutions.

The result of such an artificial division of medical care may be the destruction of appropriate medical care services, a decrease in accessibility and deterioration in its quality, a decrease in morbidity rates and an increase in mortality rates. Most importantly, this does not comply with the legislation on the division of powers.

The order also clarifies that citizens have the right to free medical care in the state and municipal health care system in accordance with the legislation of the Russian Federation, the legislation of the constituent entities of the Russian Federation and regulations of local governments.

A guaranteed volume of free medical care is provided to citizens in accordance with the Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation. From these standards it follows that primary health care is included in the state guarantee program.

At the same time, the legislator admitted that public and private health care organizations can provide primary health care under contracts with insurance medical organizations, without specifying what type of insurance they will provide - compulsory or voluntary health insurance. Thus, this definition lacks clarity in the delimitation of powers to implement financing.

This duality in the definition of types of medical care leads to different understandings when determining measures to restructure medical care. Another question arises. What is primary health care?

According to N 131-FZ and Fundamentals as amended. N 122-FZ is the entire volume of medical care provided by medical organizations of municipalities - municipal districts and urban districts, which provide both outpatient and inpatient medical care. At the same time, among many specialists in the field of organizing domestic healthcare, the opinion is firmly established that primary health care is exclusively outpatient medical care provided at the place of residence by local doctors. The latter interpretation is associated with drawing parallels with foreign analogues when defining this type of medical care. Indeed, in the health care systems of foreign countries, with a developed system of general medical (family) practice, a general practitioner provides a fairly wide range of medical services and refers the patient for outpatient consultation to a hospital specialist or for hospitalization. It is quite rare for hospital specialists to consult patients with a general (family) practitioner or in a group practice.

I believe it is advisable to consolidate in the federal law the concept of primary health care, taking into account the recommendations of the Alma-Ata Conference, legislation on the division of powers and historically developed features of the domestic health care system in the following wording:

"Primary health care is a guaranteed for every citizen, accessible and free type of medical care provided to a citizen by medical organizations of a municipal district or city district, as well as to certain categories of citizens in medical organizations of the constituent entities of the Russian Federation or the Russian Federation, licensed to provide medical care Primary health care includes:

primary medical care provided using simple medical technologies on an outpatient basis by doctors with a medical specialty: local doctor, general practitioner (family doctor) in medical organizations of municipalities;

specialized medical care of the first and second level, provided by doctors from outpatient and hospital healthcare organizations of municipalities;

primary medical care and specialized first-level medical care provided to certain categories of citizens in accordance with the law in outpatient organizations of the constituent entity of the Russian Federation and the Russian Federation.

Primary health care is provided in accordance with the standards of medical care and includes prevention, diagnosis, treatment and rehabilitation of the most common diseases (conditions), as well as injuries, poisoning, sanitary and hygienic education; carrying out measures to protect family health, motherhood, paternity and childhood, and other activities related to the provision of health care to citizens, including sanitary, hygienic and anti-epidemic measures."

Specialized medical care is the services that a citizen of our country in need of medical care can count on if he has been diagnosed with a disease from a certain list. Assistance is expected to be high-tech, using the most modern means and approaches, equipment and drugs. You can count on her to diagnose and treat pathologies using medical technologies that require significant investments and resources. The citizens of our country also have access to unique technologies.

Appearances and passwords

Specialized medical care is a service for which specialists in specific medical fields are responsible. This applies only to doctors working in a strictly defined number of institutions providing thematic services to the population. These are not only medical organizations, but also involved in the prevention of various pathologies.

Specialized medical care is the services of medical institutions that all citizens of our country can count on. The system also includes some other organizations responsible for health protection, including the municipal level. There are several private institutions - all of them have previously received a license in the prescribed form and can legally provide medical services to the population from the specialized class. Such activities require a special permit.

Who should

Specialized medical care is a complex that a person can count on if it is necessary to finally formulate a diagnosis, but it is clear that the course of the disease is atypical, and the currently practiced therapeutic program does not produce results. Also, such services can be provided if repeated courses of treatment also do not show a good result, but doctors rightfully assert that the use of more modern approaches will provide a positive effect. This applies to surgical interventions and the provision of medical services using the most modern and sophisticated technology.

You can contact a specialized medical care center if surgical intervention is necessary, but its implementation is associated with an increased risk of complications provoked not only by the main pathology, but also by additional ones identified in a particular patient. Patients in need of readmission to hospital can count on assistance under such a program if it is recommended by a federal government agency.

When else?

Current laws establish that the provision of specialized medical care should be provided if the case is considered difficult to diagnose and additional measures are required to complete the work to formulate the specifics of the situation. Similar conditions apply to complex preparation for surgical intervention if the patient’s condition is complicated by additional factors and associated pathologies.

If it is assumed that the only effective therapy in a particular case is surgical intervention using particularly modern and precise technology, then the organization of specialized medical care to identify all aspects and features of the condition of a particular patient acts as a preliminary preparatory stage.

How can I find out more details?

In our country, an order on specialized medical care was issued that applied to all subjects and regions. It follows from it that in government institutions included in the list of those responsible for this type of medical services, the staff undertakes to promptly provide information about the service to all citizens who apply. The data must be transmitted immediately during the application of the applicant or the person representing him.

The financial aspect is no less important. As determined by law, all information about healthcare and specialized medical care must be transferred to interested parties completely free of charge; taking money for this is prohibited by law. Not only citizens of our country, but also persons who have citizenship of another power or do not have any at all, can count on this.

How to get a?

Currently, specialized medical care is provided to children and adults only if the person concerned complies with the letter of the law. In particular, it is necessary to provide a complete list of the documentation specified in the regulations, otherwise the medical institution simply does not have the right to include the applicant in the list of those to whom the service will be provided.

It is mandatory to present a copy of the referral letter issued by the doctor for special care. In this paper, doctors indicate information about the person’s health status, mention what diagnostic measures were carried out, what therapeutic methods were used and what results this brought. The pathology profile is also mentioned. In some cases there is no profile information. There is a possibility that the applicant does not even have a referral. If there is none, but the service is required, you must contact the responsible institution to clarify the details of participation in the program.

What can I add?

Normally, all types of specialized medical care established by current legislation are provided to applicants with or without a referral, but the need for timely assistance is obvious. At the same time, the tendency of many institutions in the country to be bureaucratic encourages applicants to collect additional documentation to attract attention to their case: the more pieces of paper, the more serious the situation.

Additional documentation support in accordance with current standards of specialized medical care may include:

compulsory medical insurance policy;
SNILS;
documentation from which the authority of the representative of the person in need of the service follows;
documentation confirming the identity of the representative.

Regulatory acts

The procedure and rules for the provision of specific medical services are stipulated in the order of the Ministry of Health issued seven years ago. The document was released in April under number 243n. It also reveals aspects of financing institutions that provide this type of medical service.

It is officially stated that in some cases, in the territory of a particular subject, there may be a lack of funding opportunities for medical institutions capable of providing special services to the population. In such a situation, citizens in need of therapeutic, diagnostic, and surgical care can contact institutions located in other regions, as well as other federal health care and various medical organizations that have the appropriate capabilities, technical capacity and qualified personnel.

When to pay, when not to?

The order of the Ministry of Health states that special assistance can not only be free, but also provided with money from private individuals or any interested organizations. The option, which does not require payment, must satisfy the requirements of the federal program, which considers aspects of state guarantees to individual citizens of the state in relation to medical care. In this case, financing is organized from specific thematic budgets collected under the compulsory insurance fund program.

High technologies to help people

High-tech is a special assistance service that involves the use of the most complex techniques, often unique approaches. The methods used in such research are resource-intensive. An important condition for including a technology in the list of high-tech ones is the proven effectiveness of its application, which should be confirmed not only by clinical trials, but also by scientific calculations.

One of the important areas of high-tech special assistance is cellular development. No less significant is another thing that has been promoted recently - robotic technology. The latest information technologies, genetic modification and engineering approaches available to the scientific community are actively used. In a word, more or less developed methods created within the framework of medical science and related industries are used.

Some specific documents

In some cases, the provision of special assistance is possible if the applicant has a referral within the framework of which he must undergo planned hospitalization. Such a paper can be signed by the attending doctor, who is assigned the area of residence of the sick person. In some cases, the paper is issued by other doctors who have the right to do so in accordance with their job responsibilities if the patient contacts them directly.

If the consultation is carried out in absentia, then you can receive special services at a medical institution if there is a special protocol confirming that the commission selected this particular candidate from the entire proposed list of patients. If a citizen with a disability applies for medical care, it is necessary to attach an ITU certificate to the general package of documents.

Additional official papers

In most modern medical institutions, the applicant will be asked to provide a copy of the passport pages confirming registration information, as well as personal data (including a photograph). If a representative of a minor patient who is under 14 years of age and for this reason does not yet have a passport asks for help, it is worth providing a birth certificate to make a copy of it, and the parent will need to present an identification document where the child is registered. When applying for a guardian, you must have with you a certificate confirming guardianship, as well as personal identification documentation (passport).

It will not be superfluous to attend to the preparation of an extract from the medical record so that no additional questions arise. It is worth remembering that the indications for hospitalization in accordance with the plan are primarily the responsibility of the doctor assigned to the area where the patient is registered.

What to expect?

On the territory of each federal subject, documents are annually adopted that set out the funding framework for special programs. Accordingly, you can expect that compulsory health insurance will cover those treatment costs that meet the standards specified in such documentation. If you exceed this limit, you will probably have to pay extra from your own funds or ask some organization for help. In addition to the current standards for the current year, planning documents are also regularly adopted. This allows patients to navigate their options for receiving free treatment in the near future.

Healthcare. Definition. History of the development of the state healthcare system

Zo development indicators. Calculation method. Current levels in the Republic of Belarus (all data for 2012!!!)

State Zoo System (Beveridge, Semashko)

Private and insurance medicine, organizational principles.

Medical ethics and medical deontology

Contribution to the development of medicine by scientists of the Ancient World and scientists of the early and developed Middle Ages

Organization of public health protection on the territory of Belarus as part of the incl., rp, Russian Empire

Section II Medical statistics, sections, tasks. The role of the statistical method in studying population health and the performance of the health care system

Statistical population, definition, types. Sample population, requirements for it. Sampling methods.

Organization of medical research, stages. Characteristics of the medical research plan and program

Statistical observation. Methods for collecting statistical information. Stat tables, types, requirements for compilation

Features of medical research

Main mistakes when conducting medical research

Relative values, calculation method, use in zoo.

Graphic representation in statistics. Types of diagrams, construction rules

Variation series, its elements, types, rules of construction

Average values, types, calculation methods. Use in medicine.

Characteristics of the diversity of the studied trait in the sample population. Mean square deviation, calculation method, use in the work of a doctor.

Assessing the reliability of the difference between relative and average values. "t" test.

Correlation, its characteristics, types. Correlation coefficient, definition, properties, calculation methods. Pearson series correlation method. Spearman's rank correlation method.

The concept of nonparametric research methods. Correspondence criterion (χ-square), calculation stages, meaning. The concept of the null hypothesis.

Time series, types, alignment methods. Dynamic series indicators, calculation methods.

Section III Public health, its determining factors. Indicators used to assess population health.

Demography as a science, definition, content. The most important population problems. The importance of demographic data for health care.

Law of the Republic of Belarus “on demographic security”.

National program of demographic security of the Republic of Belarus for 2011-2015. Goal, tasks. Expected results of implementation.

Population statics, study methods. Population censuses. Types of age structures of the population. The size and composition of the population of the Republic of Belarus.

Mechanical movement of the population. Characteristics of migration processes, significance for health authorities.

Natural movement of the population, factors influencing it. Indicators, calculation methods. Basic patterns of natural population movement in the Republic of Belarus.

Fertility as a medical and social problem. Current state, trends in the Republic of Belarus.

General and special fertility indicators. Calculation method, level assessment. Types of population reproduction. The nature of reproduction in the Republic of Belarus.

Mortality of the population as a medical and social problem. Current state, trends in the Republic of Belarus.

General and special mortality rates. Calculation method, level assessment.

Infant mortality, factors determining its level. Calculation methods, level assessment. Main causes of infant mortality in the Republic of Belarus. Directions of prevention.

Maternal mortality, factors determining its level. Calculation method. Main causes of maternal mortality in the Republic of Belarus. Directions of prevention.

International statistical classification of diseases and related health problems, tenth revision, its role in the statistical study of morbidity and mortality of the population.

Population morbidity as a medical and social problem. Importance of morbidity data for healthcare. Current state of morbidity in the Republic of Belarus.

Methods for studying population morbidity, characteristics.

Method for studying morbidity by referral to treatment and prevention organizations, characteristics.

Primary and general morbidity. Accounting and reporting documents. Indicators. Levels and structure in the Republic of Belarus.

Study of morbidity with temporary disability. Accounting and reporting documents. Indicators.

7) Proportion of people who were often and long-term ill:

Study of acute infectious morbidity. Accounting and reporting documents. Indicators.

Infectious diseases (per 100 thousand population)

Study of the incidence of the population with the most important non-epidemic diseases. Accounting and reporting documents. Indicators.

Study of hospitalized morbidity. Accounting and reporting documents. Indicators.

A method for studying population morbidity based on the results of preventive medical examinations. Types of inspections. Health groups. Accounting and reporting documents. Indicators.

2) Momentary defeat

3) Distribution of those examined by health group:

A method for studying morbidity using data on causes of death. Accounting documents, filling rules. Indicators.

1) Mortality

2) Mortality

Section IV Primary health care for the population (PHC). Tasks. Functions. Directions for the development of primary health care in the Republic of Belarus. Types of medical care.

Organization of medical care for the population in outpatient clinics, main directions of development. Nomenclature of outpatient clinics.

City clinic, structure, tasks. Principles of organizing the work of a city clinic. Types of sites, population standards.

Clinic registry, structure, tasks. Organizing patient appointments with doctors. Rules for storing medical records.

Preventive work of the city clinic. Prevention department, tasks. Organization of medical examinations of the population. Types of inspections. Indicators of preventive work.

Sections of the work of a local general practitioner, their characteristics. Accounting documentation in the work of a local therapist. Performance indicators.

Medical examination of the population. Definition, tasks. Organization and content of clinical examination stages. Accounting documents. Indicators for assessing the volume, quality and efficiency of dispensary work.

Office of medical statistics of the clinic, main sections of work. The role of statistical information in clinic management. Basic reporting forms. Performance indicators of the clinic.

General practitioner (GP): definition, types of activities. Contents of the work of a general practitioner.

The role and place of the GP in the primary health care system. General practice outpatient clinic, staffing standards, work organization.

Organization of medical care for the population in a hospital setting, main directions for improvement. Nomenclature of hospital organizations.

City hospital, structure, tasks, management, organization of work, accounting and reporting documentation.

Organization of the work of the hospital reception department, tasks, admission procedure. Documentation.

Types of hospital regimes, their characteristics, objectives, main activities.

Indicators of inpatient medical care, calculation methods, levels in the Republic of Belarus.

Hospital performance indicators, calculation methods, evaluation. Hospital

Women's consultation, tasks, structure, organization of work. Accounting documentation. Indicators of work on servicing pregnant women.

Maternity hospital, tasks, structure, organization of work. Accounting documentation. Performance indicators of the maternity hospital.

Organization of medical care for children. Nomenclature of organizations. Leading medical and social problems of children's health.

Children's clinic, tasks, structure. Features of the organization of medical care for children. Performance indicators of a children's clinic.

2. Services for children at home:

3. Preventive work:

4. Observation of newborns and children of the first years of life:

5. Clinical examination indicators:

Preventive work of a children's clinic. Patronage of newborns. The office of a healthy child, the contents of his work.

Anti-epidemic work of a children's clinic. Vaccination room, its tasks, organization of work. Accounting documentation. Communication in work with the Center for Hygiene and Epidemiology.

Children's hospital, tasks, structure, organization of work, features of patient reception. Accounting and reporting documentation. Performance indicators.

1. Characteristics of hospital care provided to the population

Rural medical station (VSU). Medical organizations svu. Rural district hospital. Organization and maintenance of treatment, preventive and anti-epidemic work.

Central district hospital, structure, functions. Role in organizing medical care for people living in rural areas. Performance indicators.

Regional hospital, structure, functions. Role in organizing medical care for people living in rural areas. Performance indicators.

Organization of specialized medical care for the population. Specialized medical care centers, types, tasks, structure.

Dispensaries. Types, tasks, structure. The role of dispensaries in improving the quality of specialized medical care for the population. Relationship in work with the clinic.

Organization of emergency (emergency) medical care for the population. Tasks of the emergency (emergency) medical care station. Emergency hospital: tasks, structure.

Medical Consultative Commission (MCC), composition, functions. Sections of work of VKK. The procedure for referring patients to the VKK, issuing a certificate of incapacity for work through the VKK.

Medical and social examination, definition, content, basic concepts.

Organization of medical and social examination (examination of patients’ vital functions). Documents regulating the procedure for conducting a medical and social examination.

Medical and rehabilitation expert commissions (MREC). Types, composition and functions of mrek. The procedure for referring and examining patients to MREK, documentation, rules for its preparation.

Classification of special medical care : 1) general types of special medical care: therapy, surgery, obstetrics and gynecology, dentistry, pediatrics; 2) main types of specialization: psychiatry, oncology, ophthalmology, gastroenterology, dermatovenerology, otorhinolaryngol, phthisiopulmonology; 3) narrow specialization: allergology, maxillofacial surgery, neurosurgery, vascular surgery, medical genetics; 4) ultra-narrow specialization: neuro-oncology, transplantology. Center -organization of healthcare facilities, ensuring the concentration of high medical technologies, provision of specialized medical care, medical rehabilitation, organization of methodological functions, hygienic, anti-epidemic (preventive) functions. RNPC 17 pcs. : Cardiology, Neurology and neurosurgery, Pediatric oncology and hematology, Oncology and medical radiology named after Alexandrov, Traumatology and orthopedics, Mother and child, Radiation medicine and human ecology, Pathology of hearing, voice, speech, Pulmonology and phthisiology, Hygiene, Mental health, Epidemiology and microbiology, Medical examination and rehabilitation, Organ and tissue transplantation, Clinical Center for Plastic Surgery and Medical Cosmetology, Center for Medical Technologies. The principle of multi-level provision of emergency medical services. 1st level – ambulance medical care (40% - specialized teams). 2nd level – outpatient clinic assistance is provided by clinic doctors. 3rd level – consultative and diagnostic clinics and specialized dispensaries – clarify or establish an accurate diagnosis; provide consultations, diagnostic studies, issue opinions on the state of health and give recommendations, carry out clinical examination of patients. Types of EMS centers : interdistrict, regional, republican.Tasks of the EMS center: 1) scientific, methodological and organizational leadership and provision of highly qualified emergency medical services in this narrow specialization; 2) systematic development and implementation of modern medical technologies and scientific achievements in the field of patient treatment; 3) carrying out specialization and improvement of personnel in this narrow specialty; 4) analysis of public health and development of a set of preventive measures. Headed by the centers – professors and associate professors, doctors with extensive experience. The center consists of : medical-prof. institutions; departments of improvement; scientific departments.

Dispensaries. Types, tasks, structure. The role of dispensaries in improving the quality of specialized medical care for the population. Relationship in work with the clinic.

Dispensary- a special treatment and preventive medical institution that provides specialized medical care to patients of a certain profile and carries out systematic monitoring of their health status. Classification : 1) by administrative territory: republic, city, regional, interdistrict; 2) by profile: anti-TB (24), skin-vein (21), psychoneurological (14), oncology (11), narcology (12), endocrinology (5-6), cardiology (5-6). Tasks : provision of specialized medical, diagnostic and advisory assistance to specialized patients; patient registration and register creation; organizational and methodological management of the profile specialized service of medical organizations; introduction of new scientific methods and technologies; Hygienic education and promotion of healthy lifestyle. Structure : management (chief physician, deputies), organizational method department, outpatient department, hospital, laboratory diagnostic department, department of auxiliary treatment methods, administrative and economic service.

Clinic doctor when identifying diseases - tuberculosis, syphilis, gonorrhea, trichophytosis, microsporia, favus, scabies, trachoma, leprosy, malignant neoplasms, mental illness, alcoholism and drug addiction - refers patients to the appropriate territorial specialized dispensaries (anti-tuberculosis, dermatovenerological, oncological, psychoneurological, narcological) to clarify the diagnosis. For identified patients, the corresponding notifications are filled out: “Notification about a patient with a first-time diagnosis of active tuberculosis, venereal disease, trichophytosis, microsporia, favus, scabies, trachoma, mental illness” (f. 089/u), “...cancer or other malignant neoplasm" (f. 090/u), "...drug addiction" (f. 091/u). For patients with microsporia, trichophytosis, favus, scabies with a diagnosis established for the first time in their life, an “Emergency Notification” (f. 058/u) is also filled out, which is sent to the territorial Center for Hygiene and Epidemiology.

In connection with the possible use of weapons of mass destruction, completely new contingents of injured and sick people may appear in need of specialized medical care.

4.1.6 Providing medical care to women during pregnancy and childbirth in state and municipal health care institutions

General principles of emergency medical care for poisoning

5. Providing first aid for various poisonings

toxic poisoning diagnostics help In case of poisoning with medicines, alcohol and its surrogates, various technical liquids, insecticides, mushrooms, poisons of plant and animal origin, first of all...

Providing first aid for burns

2 Providing first aid for burns

First aid is the simplest urgent measures necessary to save the life and health of a victim in case of damage, accidents...

Providing first aid for various injuries

2 Providing first aid for a sprain

A dislocation is a displacement of the articular ends of bones. When the articular surfaces do not touch, they speak of a complete dislocation, and when they at least partially touch, they speak of an incomplete dislocation. When a dislocation occurs, the joint capsule and joint capsule rupture...

1.
Organization of specialized medical care

Providing emergency assistance

In large-scale wars with massive sanitary losses, the defining moment in the organization of anesthesiological and resuscitation care is the discrepancy between the capabilities of the medical service and the volume of work assigned to them...

Organization of assistance during the initial period of a large-scale war

2. Providing local assistance

At subsequent stages, the volume of resuscitation care increases. At the battalion medical center, the paramedic has the opportunity to administer oxygen therapy using the KI-4 apparatus...

Basic concepts of healthcare in Russia and the world

2.1 System of organizing medical care to the population

From the first half of the twentieth century to the present, a two-level principle of building a system of medical care for the population has been implemented in Russia...

Peculiarities of behavior with dying patients

3. Providing assistance in terminal conditions

The main resuscitation measures in case of clinical death are indirect (closed) cardiac massage and artificial respiration, which must be carried out simultaneously...

Sports injuries

2. Providing first aid

First aid for fractured limbs consists of immobilizing the damaged segment using improvised means (planks, sticks and other similar objects), which are secured with a bandage, scarf, scarf, piece of fabric, etc...

Tactics of a paramedic of a mobile ambulance team in case of emergency conditions due to injuries, long-term compartment syndrome

1.1 Organization of emergency medical care for the population of Buguruslan State Budgetary Healthcare Institution BGB “SNMP”

An emergency medical service station is a medical and preventive institution designed to provide round-the-clock emergency medical care to adults and children, as at the scene of an accident...

Injuries in sports

3. First aid

The quality and special conditions of first aid, its timeliness taking into account the specifics of the injury are reflected in the effectiveness of further treatment...

1.2 Ensuring the quality of medical care to the population within the framework of the concept of the regional Program for modernization of the healthcare system of the Trans-Baikal Territory for 2011-2012

The basis for the development of the Healthcare Modernization Program for the Trans-Baikal Territory for 2011-2012 is the Draft Federal Law (dated May 25, 2010) “On Compulsory Health Insurance”...

Formation of a quality assurance system using the example of a rehabilitation hospital in the context of healthcare modernization

2.
SYSTEM OF QUALITY CONTROL OF PROVIDING MEDICAL CARE TO THE POPULATION OF THE TRANSBAIKAL REGION

Formation of a quality assurance system using the example of a rehabilitation hospital in the context of healthcare modernization

2.1 Principles of organizing a quality control system for the provision of medical care to the population in the Trans-Baikal Territory

In order to ensure the efficient functioning of the healthcare system of the Trans-Baikal Territory, one of the priority areas of its development should be increasing the availability and quality of medical care for the population...

Function of a medical position, calculation method. The significance of this indicator when planning the need for medical personnel

1.6 Volumes of medical care provided to the population by city health care facilities participating in the implementation of the Program of State Guarantees for Providing Citizens of the Russian Federation with Free Medical Care

Table 5 Name of types of assistance Standards of the state guarantee program Provided for 2007 Total, including at the expense of compulsory medical insurance Budget 1. Outpatient care 1.1…

Article 34. Specialized, including high-tech, medical care

1. Specialized medical care is provided by medical specialists and includes the prevention, diagnosis and treatment of diseases and conditions (including during pregnancy, childbirth and the postpartum period) requiring the use of special methods and complex medical technologies, as well as medical rehabilitation.

2. Specialized medical care is provided in an inpatient setting and in a day hospital.

3. High-tech medical care, which is part of specialized medical care, includes the use of new complex and (or) unique treatment methods, as well as resource-intensive treatment methods with scientifically proven effectiveness, including cellular technologies, robotic technology, information technologies and genetic methods engineering, developed on the basis of the achievements of medical science and related branches of science and technology.

(as amended by Federal Law dated November 25, 2013 N 317-FZ)

Specialized assistance

text in previous)

(see text in previous)

5 - 7. Lost force on January 1, 2017. — Part 8.1 of Article 101 of this Federal Law (as amended on December 14, 2015).

(see text in previous)

7.1. The procedure for compiling a list of types of high-tech medical care established by the authorized federal executive body includes, among other things, deadlines after which types of high-tech medical care are included in the basic compulsory health insurance program.

(Part 7.1 introduced by Federal Law dated July 3, 2016 N 286-FZ)

8. The organization of the provision of high-tech medical care is carried out using a unified state information system in the field of healthcare in the manner established by the authorized federal executive body.

(Part 8 as amended by Federal Law dated July 29, 2017 N 242-FZ)

(see text in previous)

SPECIALIZED TREATMENT OF DAMAGES TO THE MAXILLOFACIAL LOCALIZATION IN VICTIMS WITH COMBINED TRAUMA

The time, volume and nature of specialized treatment is determined by the severity of the injury, the severity of the individual reaction of the victim and the prognosis of the course of shock. In this case, one should use an objective methodology for predicting the outcomes of traumatic shock, developed by the St. Petersburg Research Institute of Emergency Medicine named after. I. I. Dzhanelidze*. This technique makes it possible to predict the outcome of the injury at the time of delivery of the victim to a medical facility, as well as to determine the duration of shock with a favorable outcome and life expectancy with an unfavorable outcome (Tsibin Yu. N. Multifactorial assessment of the severity of traumatic shock in the clinic//Western surgeon.,

* Carried out by a resuscitator or anesthesiologist.

1980, no. 9, p. 62-67). In addition, the methodological recommendations of the Poltava Medical Dental Institute should be used (V.F. Chistyakova et al., 1979); in particular - a recommendation on the use nicotine test And electrodermal(adrenaline or dionine) samples for diagnosing concussion, which is often not diagnosed in victims who are intoxicated. According to this institute, with traumatic brain injury there are deviations in indicators hydrophilic test the skin of the victim’s forearms, the mineral composition of the blood, its protein indicators, vitamins C, B, etc.

d. Therefore, only a complete comprehensive examination of craniomaxillofacial victims ensures the drawing up of a full comprehensive treatment plan with a favorable outcome

Specialized treatment of facial injuries with combined trauma can be carried out parallel or series with surgical treatment of injuries in other locations - primary surgical treatment of wounds, diagnostic or decompressive craniotomy, laparocentesis, laparotomy, amputation of limbs and extrafocal osteosynthesis of long tubular bones.

There are emergency, early and delayed specialized treatment of injuries of the maxillofacial localization.

The question of the peculiarities of the deontological foundations of the first meeting of a patient with any disease or damage to the maxillofacial area is quite fully covered by us in the monograph “The Doctor and the Patient in Dentistry” (Yu. I. Vernadsky, G. P. Bernadskaya, 1990). Here we will only dwell on the tactics of a maxillofacial surgeon working in the emergency room (department) of a maxillofacial hospital or at the emergency room there, at the clinic of the department of maxillofacial surgery of a medical university (faculty), since it is usually there Relatively young surgeons work.

We believe it is useful to recall that “the importance of the doctor’s mission is what distinguishes him from all others citizens." This point of view of the French writer A. Maurois can be considered absolutely indisputable, especially regarding doctors providing urgent help, which means saving people from severe suffering, saving them from death, disability, and facial disfigurement.

If the emergency room of a medical institution can be compared to the “front line of the defense line” in medicine, then the emergency surgical care center can be called a “peacetime medical battalion”, where doctors on duty

The most unexpected and severe cases await every minute: multiple fractures of both jaws; fracture of the zygomatic bone; dislocation of the lower jaw; peripharyngeal phlegmon; bleeding from the facial or carotid artery; acute purulent periostitis of the jaw; her acute osteomyelitis; phlegmon of the floor of the mouth; phlegmon of the tongue; odontogenic phlegmon of the neck, complicated by mediastinitis; phlegmon of the pterygopalatine fossa and orbital tissue; dislocation asphyxia due to a fracture of the lower jaw; combined severe injuries of the cerebral part of the skull, etc. Often patients with multiple injuries, able shock or collapse; they also need the help of a resuscitator-anesthesiologist, ophthalmologist, otorhinolaryngologist, general traumatologist, neurosurgeon, etc.

Due to the advanced age of the patient or the presence of concomitant somatic diseases, an urgent consultation with a gerontologist, neurologist, psychiatrist, etc. may be necessary.

Unfortunately, emergency rooms do not always have sufficiently qualified oral surgeons on duty. It is often necessary to organize so-called optional shifts for experienced surgeons (associate professors and assistant professors, residents), in some cases - to consult professors of different profiles (mainly maxillofacial surgery). That is why the emergency room attendant must have a good base of theoretical knowledge and practical skills, good health, self-control and tact, the ability to deeply sympathize be able to make a decision quickly and quickly realize(sometimes with advice and assistance from a related doctor - ophthalmologist, otorhinolaryngologist, neurosurgeon, resuscitator, etc.). When we talk about the ability to compassion, we mean “true compassion, which requires action, not sentiment; it knows what it wants and is determined, through suffering and compassion, to do everything humanly possible” (S. Zweig). All these qualities are especially necessary for a doctor in extreme situations. He must also take into account that crushing of the nose, lips, cheeks, crushing of teeth, fractures or separations of parts of the jaws, cheekbones, and the inability to verbally communicate with others causes the victim lightning-fast mental trauma, due to which deep depression, hippochondria, “up to mania of ugliness on relatively real grounds” may develop in the future (M. A. Napadov et al., 1984). Manifestations of violent excitement are also possible, up to traumatic psychoses, the desire to end the relationship

Yu I Vernadsky Traumatology and reconstructive surgery

fight (demands “Kill me! I don’t want to live!”) and even attempts implement suicide in the emergency room, since the aesthetic assessment of his body and face by others is of particular importance to a person.

In relation to a person who has lost his nose or lips, some people develop fear, unhealthy interest, and sometimes a desire to express out loud their impression of the appearance of a disfigured face (“Look, what a horror!”; “What a freak!”, etc. ). Disfigured people tend to become overly sensitive, touchy and suspicious. They avoid going out during the day and do not like meeting their friends and even relatives.

Particularly strong manifestations of mental trauma are observed in adolescent men and young women, who have their whole lives ahead of them. The doctor, nurse, and nurse at the emergency room or emergency room must understand this patient’s mood deeply, with all their hearts, and show special tact and vigilance to such a victim. After repositioning and fixing the fragments, cosmetic suturing of the soft tissues of the face should not be left out of sight of the victim who has had suicidal attempts. In a day or two, when the excitement subsides, he will be calmer about what happened.

Victims often arrive at emergency rooms while intoxicated. In such cases, the doctor is required, firstly, to have restraint and tact; secondly, proper planning of your actions in connection with the state of intoxication of the victim;

thirdly, the doctor must take into account that intoxication (even to a small degree) can mask the clinical picture of multiple trauma or extensive inflammation. In particular, a doctor may not recognize signs of damage to the abdominal organs, rib fractures, or skull base in a victim with damage to the maxillofacial area; against the background of alcohol intoxication, hyperglycemic or uremic coma, poisoning with technical alcohol solutions may go unrecognized. The doctor on duty must be extremely attentive to each victim, since the erroneous diagnosis of alcohol intoxication in severe comatose a patient with a facial injury is “doubly insulting and unfair” (Yu. D. Pavlov, P. M. Sapronenkov, 1984). The sudden death of such a victim can be classified as negligence in the work of a doctor, leading to serious consequences (punishable in court). Timely diagnosis of the degree of alcohol intoxication and immediate consultation with a therapist can prevent

reduce the fatal outcome in the event of a combination of facial trauma with coma, myocardial infarction and other acute diseases.

Unfortunately, maxillofacial patients are often brought to the emergency medical aid station (by ambulance or relatives) and non-specialized patients, for example, a victim with small damage to the soft tissues of the face in combination with an injury or fracture of the shoulder (thigh, lower leg, forearm), a patient with hemophilia with bleeding from the socket of an extracted tooth, a patient who has undergone surgery on blood vessels or the heart and is taking large amounts of anticoagulants, with signs of “hematoma” in the maxillofacial area against the background of total hemorrhages in the organs of the abdominal and thoracic cavities, on the upper and lower extremities (these persons, naturally, had to be admitted to the general traumatology or hematology department).

And then the medical discussion begins in the presence of the victim(the patient) and his accompanying relatives: “Where did you bring him!?”, “Why did you bring him to us?” etc. Long telephone conversations begin with a traumatologist, hematologist, neurologist, therapist, etc. An already suffering person hears all this.

You can sometimes hear from the maxillofacial surgeon on duty something like this: “What should I do with you? Where should I put you? After all, there is not a single free bed!” In some cases, there really are no free beds. But why and why should the patient know about this? If he was poorly treated at the clinic, why discuss this fact in the presence of the patient? Under any conditions The doctor on duty must find a place for a patient in need of hospitalization. And shortcomings in previous treatment are a topic for discussion not in the presence of the patient, but during the morning “five-minute meeting” and during a subsequent conversation with the outpatient doctor. In short, some duty officers have little understanding of their legal rights and responsibilities. They do not understand, What you can tell the patient, but What need to say tomorrow only to your administrator or colleague at the clinic. The doctor must know all this in order to protect patients and their relatives from additional suffering. We should not forget that the doctor’s above complaints about the lack of places can also be perceived by the patient and his relatives as a transparent hint about the need to bribe their “benefactor” in a white coat. Such a doctor deserves condemnation among medical workers, and if such deontological errors are repeated, expulsion from medicine (even in market conditions).

Chapter 7 Specialized medical care for victims with combined injuries

Concluding the question about the first meeting of the victim with the doctor of the hospital or hospital, let us recall the following: “Only he is a real surgeon worthy of imitation,” writes Academician F. G Uglov, - who treats every patient as a close and dear person, and will do for the patient everything that he would like to have done in relation to him, find yourself He in this situation, this is the basis of the relationship between the doctor and the patient, and for a surgeon this is many times more important.” This, in our opinion, should guide a doctor of any profile, primarily surgical, and in particular traumatology.

Emergency specialized treatment for facial injuries includes stop bleeding from the great vessels and normalization of external respiration

Early specialized treatment aimed at preventing inflammatory complications, reduction and reliable fastening of bone fragments. It is very important to use simple and reliable orthopedic and surgical methods for fastening bone fragments that do not interfere with the mobility of the lower jaw, resuscitation measures, sanitation of the tracheobronchial tree, facilitate the care of victims and not require frequent monitoring by a doctor

Early specialized treatment of facial injuries is carried out when stabilization hemodynamic parameters against the background of intensive antishock therapy.

In case of the first and second degrees of shock, a positive prognosis and the duration of the expected period of recovery of the patient from the state of shock is no more than 12 hours, treatment of facial injuries should be carried out in full If intensive therapy is effective, such treatment is possible 4-7 hours after injury.

In case of the second degree of shock, a positive prognosis and the duration of the expected period of recovery of the patient from shock is more than 12 hours, as well as in the third degree of shock with a positive prognosis, specialized treatment of facial injuries can be carried out in full, but postponing it until stable stabilization of hemodynamics.

For victims with a negative prognosis, only emergency surgical interventions are performed. Treatment of facial injuries in such cases is carried out after stable stabilization of the functions of life support systems.

Delayed specialized treatment injuries to the face in victims with concomitant trauma are carried out as injuries are identified, often 2-14 days after the injury. It provides for the fight against emerging complications.

burning complications, reduction and fastening of bone fragments in fractures.