DISASTER MEDICINE No. 2•2017 Download the journal
ORGANIZATION AND TACTICS OF DISASTER MEDICINE SERVICE
1. Chubayko V.G., Grebenyuk B.V., Kryukov V.I., Prosin V.I., Shilkin I.P., Belova A.B., Yuvakaev I.S. Activity of All Russian Service for Disaster Medicine Headquarters in 2016
The Federal State Budgetary Institution «All-Russian Centre for Disaster Medicine «Zaschita» of Health Ministry of the Russian Federation, Moscow, Russian Federation
The main directions of All Russian Service for Disaster Medicine headquarters activity in 2016 are discussed: enforcing the preparedness for timely and efficient response to emergency situations and for liquidation of their medical and sanitary consequences; coordination of cooperation of management bodies, formations and institutions of the Service for Disaster Medicine of Health Ministry of Russia, of civil defense on the federal, interregional, territorial, and municipal levels; technical support and operation of telecommunications information and analysis components; realization of civil defense and mobilization preparation measures.
The data are presented on the number of emergency situations with medical and sanitary consequences in 2016 and on the number of mobile medical teams that took part in medical care provision to the victims of the emergency situations.
The authors present as well information on: the activity of All Russian Service for Disaster Medicine headquarters in enhancing of preparedness of 11 regions for medical support organization of 2017 Confederation Cup and 2018 World Cup matches; the participation of the headquarters specialists in the elaboration of the suggestions for the priority project on securing of timely emergency medical care provision to people living in hard-to-reach areas of the Russian Federation.
It is stressed that the key task of the headquarters of the Service and of the Service as a whole for the nearest future is still the perfection of preparedness of health service management bodies, medical formations and institutions for liquidation of medical and sanitary consequences of emergency situations and for medical support of the 2017 Confederations Cup and the 2018 World Cup matches.
Key words: 2017 Confederations Cup, 2018 World Cup, All Russian Center for Disaster Medicine “Zaschita”, All Russian Service for Disaster Medicine headquarters, civil defense, command-staff exercises, emergency situation, road traffic accident, sanitary aviation, Service for Disaster Medicine of Health Ministry of Russia, special tactical training exercises, staff training, territorial center for disaster medicine
2. Goncharov S.F.1,2, Rozinov V.M.3, Shilkin V.I.1, Shilkin I.P.1 Potential Capacity of Telemedical Technologies in Reduction of Mortality of Population of Russia from External Causes
1 The Federal State Budgetary Institution «All-Russian Centre for Disaster Medicine «Zaschita» of Health Ministry of the Russian Federation, Moscow
2 Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Postgraduate Education» of the Ministry of Healthcare of the Russian Federation, Moscow
3 Moscow Scientific Research Institute of Pediatrics and Child Surgery of Ministry of Health of Russia, Moscow, Russian Federation
The potential capacity of telemedical technologies in reduction of mortality of population of Russia from external causes is analyzed.
Research Objective is determination of scope of requirement for telemedical consultations of emergency situations victims; assessment of personnel resources of federal state budgeted institutions of Health Ministry of Russia in provision of the service and of their technical, organizational and methodological preparedness in the field.
Research Materials and Methods. Departmental statistical reports of the Service for Disaster Medicine of a subject of the Russian Federation for 2006-2015 and statistical data of Interior Ministry of Russia on road traffic accidents in 2006-2015 are used as source materials. The research is based on the assumption that a share of those hospitalized in critical and extremely critical condition in the total number of road traffic accident victims does not depend on the scope of the event.
Research Results and their Analysis. The following conclusions were made based on the research results:
– to meet the demand for emergency telemedic consultations on cases of those hospitalized in critical and extremely critical condition in the territory of the Russian Federation telemedic system of the Health Ministry of Russia on the federal level must provide the possibility of simultaneous consultations of up to three experts in resuscitation, up to two neurosurgeons and one specialist in every other branch of medicine on a round-the-clock basis;
– it is found that the present Health Ministry medical facilities capabilities do not meet the estimated demand for emergency consultative telemedical care.
The possible ways of solving the problem are defined.
Key words: emergency situation, federal state budgeted institutions of Health Ministry of Russia, Russian population mortality from external causes, telemedical system of Health Ministry of Russia, telemedical technologies
REFERENCES
1. Zdravoohranenie v Rossii. Statisticheskij sbornik. [Health care in Russia. Statistics digest]. Moscow, Rosstat Publ., 2015. (In Rus.)
2. On the fundamental principles of the public health protection in the Russian Federation: Federal Law dated November 21, 2011 No 323-FZ. (In Rus.)
3. Dyachenko V.G., Kostakova Т.А., Pchelina I.V. Medical personnel in the Far East. Round of Crisis. Khabarovsk, GBOU VPO DVGMU Publ., 2012, 421 p. (In Rus.)
4. Message of the President of the Russian Federation to the Federal Assembly in 2016. URL: http://kremlin.ru/events/president/news/53379 (In Rus.)
5. URL: http://www.gibdd.ru/stat/archive/ (In Rus.)
6. On approval of the emergencies information criteria: order of EMERCOM of Russia dated July 8, 2004 No 329. (In Rus.)
7. Porfir’ev B.N. Risk of natural and human-induced disasters in the world and in Russia. Russia in the world around: Analitical annual. Executive editor Marfenin N.N.; endorsed by Marfenin N.N., Stepanov S.А. Moscow, ModusK–Eterna Publ., 2005, 320 p. (In Rus.)
8. Suvorov S.G., Lekmanov А.U., Rosinov V.М. Epidemiology of the road accidents involving children in Russia. Neotlozhnaya meditsina. [Emergency Medicine]. 2010; 4: 5–11. (In Rus.)
3. Lobanov A.I. Nonorganic Medical Formations of Civil Defense in System of Medical Support of Population in Military Conflicts
Federal State Budgetary Educational Institution of Higher Professional Education «Academy of Civil Protection of EMERCOM of Russia», Khimki Town, Moscow Region, Russian Federation
A risk-oriented approach to setting up of nonorganic medical formations of civil defense and problems of their legal status are presented. Their role and importance in the system of medical support of population in war time are shown. The results are discussed of a system analysis of a normative legal basis of building a system for medical support of population in war time. The problems identified are highlighted and scientifically substantiated suggestions for their solution are made.
Key words: civil defense, Military doctrine of the Russian Federation, nonorganic medical formations, normative legal basis, personnel resources of health service, risk-oriented approach, system of medical support of population in war time
REFERENCES
1. Voennaja doktrina Rossijskoj Federacii [Military doctrine of the Russian Federation], 2015. (In Rus.)
2. Fundamental principles of the state policy of the Russian Federation in the field of civil defence for the period through to 2030: Adopted by the Decree of the President of the Russian Federation dated December 20, 2016 No 696. (In Rus.)
3. On amending the Procedure for establishing supernumerary emergency rescue teams approved by the Order of the Russian Emergency Ministry dated December 23.12.2005 No 999: Order of the Russian Emergency Ministry dated June 30, 2014 No 331. (In Rus.)
4. On approval of the Standard Procedure for establishing supernumerary teams for enforcement of civil defense measures: Order of the Russian Emergency Ministry dated December 18, 2014 No 701. (In Rus.)
5. Guidelines on establishing, training and equipping supernumerary teams on civil defence activities in the organizations subordinate to the Ministry of Health of Russia. Approved on August 9, 2016. (In Rus.)
6. On the fundamental principles of the public health protection in the Russian Federation: Federal Law dated November 21, 2011 No 323-FZ. (In Rus.)
7. On approval of Regulation on organization and maintaining civil defence in municipalities and organizations: Order of the Russian Emergency Ministry dated November 14, 2008 No 687. (In Rus.)
4. Parkhomchuk D.S. Experience of Organization of Televideoconsultative Medical Care Delivery to Population of Lugansk People’s Republic
State Institution Lugansk National Emergency Medicine and Disaster Medicine Center of Lugansk People’s Republic
The first results of the activity are presented of telemedical consultative aid ward which is a new structural unit of the Lugansk Republican Center for emergency medical care and disaster medicine. It is shown that the main task of the ward is the organization of emergency consultative medical care delivery to the population of the self-proclaimed republic by leading specialists of facilities with use of telemedical technologies, as well as of carrying out of teleconferences and of distance education. It is noted that 44 adults and 81 children from the Lugansk People’s Republic were provided with highly qualified consultations and corresponding treatment.
Key words: Center for emergency medical care and disaster medicine, distance education, emergency consultative medical care, Lugansk People’s Republic, population, medical specialists, teleconferences, telemedical technologies
REFERENCES
1. Goncharov S.F., Lobanov A.I., Sakhno I.I. et al. All-Russian Service for Disaster Medicine: establishing, objectives, governance, operating principles: Medical study guide. Moscow, VCMK ”Zaschita” Publ., 2000, 71 p. (In Rus.)
2. Alekseeva О.P., Levanov V.М., Mironov N.N., Krishtopenko S.V. Gastroenterological Center of the Volga Federal District of the Russian Federation (organizational, diagnostic and treatment and telemedicine aspects of activity): Study guide. Nizhny Novgorod, 2008, 181 p. (In Rus.)
3. Goryunova V.V., Goryunova Т.I., Zhilyaev P.S. Principles of the implementation of regional telemedicine centers. Fundamental’nye issledovanija [Fundamental research]. 2014; 11. (In Rus.)
4. Korotkov Scientific Conference: «21st century is a century of high-technology medicine!» Conference materials, Nizhny Novgorod, 26.02.2014. Editorial board: Tsibusov S.N., Monich V.А., Kirilov А.А. Nizhny Novgorod, Nizhny Novgorod State Medical Academy Publ., 2014, 104 p. (In Rus.)
5. Lavlinskaya О.Y., Gubkin А.V., Kryavkin P.S. Advanced technologies of medical information systems implementation. Modelirovanie, optimizacija i informacionnye tehnologii [Modeling, optimization and information technologies]. 2014; 4: 1. (In Rus.)
CLINICAL ASPECTS OF DISASTER MEDICINE
5. Shabanov V.Eh., Umerov A.Kh., Demenko V.V. Activity of Field Multipurpose Hospital Unit of All-Russian Center for Disaster Medicine “Zaschita” in 2016
The Federal State Budgetary Institution «All-Russian Centre for Disaster Medicine «Zaschita» of Health Ministry of the Russian Federation, Moscow, Russian Federation
The activity is analyzed of field multipurpose hospital unit of All-Russian Center for Disaster Medicine “Zaschita” in 2016. The following directions of activity are discussed:
– participation in liquidation of medical and sanitary consequences of emergency situations in the territory of the Russian Federation and abroad;
– organization and realization of medical evacuation of sick and victims of emergency situations;
– medical support of mass events;
realization of emergency telemedical consultations of emergency situations victims;
– participation in exercises and upgrading of professional skills;
– organizational activity;
– scientific activity;
– educational activity;
– International cooperation.
Prospects for the development of the hospital are presented.
Key words: All-Russian Center for Disaster Medicine “Zaschita”, educational activity, emergency situation, emergency telemedical consultation, exercises, field multipurpose hospital, International cooperation, medical and sanitary consequences, medical evacuation, medical support of mass events, organizational activity, upgrading of professional skills
REFERENCES
1. On the fundamental principles of the public health protection in the Russian Federation: Federal Law dated November 21, 2011 No 323-FZ. (In Rus.)
2. On approval of the Procedure for delivery of the first-aid and specialized medical care: order of the Ministry of Health of Russia dated June 20, 2013 No 388n. (In Rus.)
3. On amendments being made to delivery of the first-aid and specialized medical care approved by order of the Ministry of Health of Russia dated June 20, 2013 No 388n: order of the Ministry of Health of Russia dated January 22, 2016 No 33-N. (In Rus.)
4. On approval of the requirements to kitting of emergency medical care cases and kits with pharmaceuticals and medical products: order of the Ministry of Health of Russia dated January 22, 2016 No 36-N. (In Rus.)
6. Kostyuchenko A.I.1, Chaplyuk A.L.2, Bulavin V.V.4, Kal’manov A.S.4, Medvedev V.R.3 Characteristics of Disseminated Intravascular Coagulation Syndrome in Servicemen with Traumatic Disease Wounded in Counterterrorist Operation
1 Regional Centre of New Medical Technologies, Rostov-on-Don, Russian Federation
2 Federal State Public Institution “Head Centre for Military Medical Examination” of the Ministry of Defense of the Russian Federation, Moscow, Russian Federation
3 Federal State Budgetary Institution State Scientific Research Test Institute of Military Medicine, St. Petersburg, Russian Federation
4 Federal State Budgetary Institution “Central State Scientific Research Institute of Air Forces” of the Ministry of Defence of the Russian Federation, Schelkovo town, Moscow Region, Russian Federation
The issues of timely preventive care and diagnostics of DIC syndrome development at all stages of medical evacuation of wounded with a traumatic disease are discussed. A conclusion is drawn that prevention and treatment of DIC syndrome need an early and complex etiotropic and pathogenetically justified therapy at every stage of development of the complicated disorder of blood coagulation system.
Key words: disseminated intravascular coagulation, traumatic disease, wounded
REFERENCES
1. Barkagan Z.S., Makarov V.A., Lychev V.G. et al. New methods of laboratory diagnostics of disseminated intravascular coagulation (DIC-syndrome): Guidelines. Moscow, 1989, 28 p. (In Rus.)
2. Bokarev I.I., Schepotin N.A. Intravascular coagulation. Kiev, Zdorov’e Publ., 1989, 184 p. (In Rus.)
3. Lychev V.G. Diagnostics and treatment of disseminated intravascular coagulation. Moscow, Medicina Publ., 1993, 72 p. (In Rus.)
4. Bryusov P.G. Modern aspects of concomitant injuries treatment. Voenno-medicinskij zhurnal. [Military Medical Journal]. 1994; 5: 73. (In Rus.)
5. Efimenko N.A. Combat gunshot wound by experience of armed conflicts of the recent years. Sovremennaja ognestrel’naja travma. [Modern gunshot injury]: Materials of scientific conference, St. Petersburg, 2001, pp. 16–18. (In Rus.)
6. Zerbino D.D., Lukasevich L.L. Disseminated intravascular coagulation: facts and concepts. Moscow, Medicina Publ., 1989, 256 p. (In Rus.)
7. Chursin V.V. Disseminated intravascular coagulation. Onkologija i radiologija Kazahstana. [Kazakhstan oncology and radiology]. 2011; 4: 24–26. (In Rus.)
8. Levi M., de Jonge E., van der Poll N. New treatment strategies for disseminated intravascular coagulation based on current understanding of the pathophysiology. Ann. Med. 2004; 36-1: 41–49.
9. Baluda V.P., Deyanov I.I., Baluda M.V. Thromboprophylaxis. Saratov, 1992, 47 p. (In Rus.)
10. Mc. Kay D.G. Disseminatet intravascular coaqulation. An intermediary mechanism of disease. New York, 2010, 211 p.
7. Lakhin R.E., Emel’yanov A.A., Shchyogolev A.V., Zhirnova E.A., Grachyov I.N. Sensitivity and Specifics of Roentgenographic and Ultrasound Signs in Detection of Lung Damage Character in Severe Pneumonia Cases
Federal state budgetary military institution of the higher education «Medical Military academy of S.M.Kirov» of Ministry of Defense of the Russian Federation, St. Petersburg, Russian Federation
Ultrasound investigation of lungs is an evolving method in critical care medicine used at prehospital and hospital stages. Ultrasound makes it possible to verify the scope and character of lung tissue damage.
Research Objective is a comparative assessment of sensitivity and specifics of roentgenographic and ultrasound methods of lung involvement character identification.
Research Materials and Methods. Simultaneous roentgenographic and ultrasound as well as computer tomography examinations of 12 patients with severe pneumonia were carried out.
Research Results and their Analysis. The data received have shown that the efficiency of ultrasound examination was higher in defining such specific signs as infiltration and consolidation of lungs. Besides the predictive value of ultrasound model was higher than that of x-ray. Thus ultrasound examination in diagnostics of severe pneumonia and the assessment of the character of lung tissue damage proved to be more sensitive with higher specificity compared to x-ray examination.
Key words: consolidation, damage character, diagnostics, infiltration, lungs, roentgenographic examination, sensitivity, severe pneumonia, specificity, ultrasound examination
REFERENCES
1. Killu K., Dalchevsky S., Koba V. Ultrasonography in intensive care unit. Translated from English; edited by Lakhin R.Е. Moscow, GEOTAR-Media Publ., 2016, 280 p. (In Rus.)
2. Lakhin R.Е., Antipin E.E., Bautin А.Е. et al. Clinical recommendations for catheterization of vessels under control of ultrasound. Anesthesiology-intensive care. Edited by Zabolotskikh I.B., Shifman Е.М. Moscow, GEOTAR-Media Publ., 2016, pp. 280. (In Rus.)
3. Holm J.H., Frederiksen C.A., Juhl-Olsen P., Sloth E. Perioperative use of focus assessed transthoracic echocardiography (FATE). Anesth. Analg. 2012; 115(5): 1029–1032.
4. Seif D., Perera P., Mailhot T. et al. Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol. Critical care research and practice. 2012. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485910 (accessed date: 04.12.2016).
5. Theerawit P., Morasert T., Sutherasan Y. Inferior vena cava diameter variation compared with pulse pressure variation as predictors of fluid responsiveness in patients with sepsis. J. Crit. Care. 2016; 36: 246–251.
6. Aksoy Y., Eyi Y.E. The Bedside Ultrasound: A Rapid Way of Measuring Optic Nerve Sheath Diameter in Emergency. J. Emerg. Med. 2016; 51(2): 25–26.
7. Via G., Storti E., Gulati G. Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva anestesiologica. 2012; 11(78): 1282–1296.
8. Caltabeloti F.P., Rouby J.-J. Lung ultrasound: a useful tool in the weaning process? Revista Brasileira de terapia intensiva. 2016; 1(28): 5–7.
9. Lichtenstein D., Mеziеre G., Biderman P. et al. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. American journal of respiratory and critical care medicine. 1997; 5(156): 1640–1646.
10. Picano E., Frassi F., Agricola E. et al. Ultrasound lung comets: a clinically useful sign of extravascular lung water. Am. Soc. Echocardiogr. 2006; 19: 356–363.
11. Zaytsev А.А., Shchegolev А.V. Diagnosis and treatment of severe lung lesions with influenza A (H1N1-09): Practical recommendations. Voenno-medicinskij zhurnal. [Military Medical Journal]. 2016; 3(337): 39–46, 63. (In Rus.)
12. Reissig A. Lung Ultrasound in the Diagnosis and Follow-up of Community-Acquired Pneumonia. CHEST Journal. 2012; 4(142): 965.
13. Reissig A., Copetti R. Lung Ultrasound in Community-Acquired Pneumonia and in Interstitial Lung Diseases. Respiration. 2014; 3(87): 179–189.
14. Chavez M.A., Shams N., Ellington L.E. et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respiratory research. 2014; 15. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005846/pdf/1465-9921-15-50.pdf (accessed date: 04.12.2016).
15. Berlet T. Thoracic ultrasound for the diagnosis of pneumonia in adults: a meta-analysis. Respiratory research. 2015. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531799/ (accessed date: 04.12.2016).
16. Zabolotskikh I.B., Gelfand B.R., Kozlov R.S., Lakhin R.Е. et al. Diagnosis of nosocomial pneumonia. Nosocomial pneumonia in adults: Russian national guidelines. Edited by Gelfand B.R., Protsenko D.N., Belotserkovsky B.Z. Moscow, Mediinskoe informatsionnoe agentstvo Publ., 2016; 72–105. (In Rus.)
17. Volpicelli G., Elbarbary M., Blaivas M. et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive care medicine. 2012; 4(38): 577–591.
18. Bourcier J.-E., Braga S., Garnier D. Lung Ultrasound Will Soon Replace Chest Radiography in the Diagnosis of Acute Community-Acquired Pneumonia. Current infectious disease reports. URL: http://link.springer.com/article/10.1007/s11908-016-0550-9 (accessed date: 04.12.2016).
19. Nazerian P., Volpicelli G., Vanni S. et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. The American journal of emergency medicine. 2015; 33: 620–625.
20. Ye X., Xiao H., Chen B., Zhang S. Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community-Acquired Pneumonia: Review of the Literature and Meta-Analysis. PLoS One. URL: http://journals.plos.org/plosone/article?id =10.1371/journal.pone.0130066 (accessed date: 04.12.2016).
8. Ehrgashev O.N., Makhnovsky A.I., Davydenko V.V., Zabivalova N.M., Brazhnikova E.N., Anfyorova M.S., Garibyan N.Eh. Experience of Use of Chitosan-Based Topical Hemostatic Agent for Temporary External Hemorrhage Control in First Aid Delivery
1 Pavlov First Saint Petersburg State Medical University of the Health Ministry of Russia, St. Petersburg, Russian Federation
2 Leningrad Region Public Health Committee, St. Petersburg, Russian Federation
3 «Inmed» Limited Liability Company, St. Petersburg, Russian Federation
The results are presented of use of chitosan-based topical hemostatic agent “Hemoflex” Combat (LLC “Inmed”, Russia) for traumatic external hemorrhage control in first aid and emergency medical care delivery.
Research Objective is to estimate the efficiency of chitosan-based topical hemostatic agent “Hemoflex” Combat for temporary external hemorrhage control in emergency medical care delivery.
Research Materials and Methods. The research was carried out at the chair of hospital surgery #2 named after Academician F.G.Uglov of the First St. Petersburg State Medical University named after Academician I.P.Pavlov using materials of Health Service Committee of Leningrad Oblast.
The main group consisted of 88 patients. The temporary arrest of external hemorrhage was realized with use of topical hemostatic agent “Hemoflex” Combat. In the control group of 279 patients the temporary bleeding arrest was carried out by traditional way without the agent named.
In all the cases the technique of temporary arrest of external hemorrhage envisaged tamponing of wound with the agent or with cotton gauze pad with applied direct pressure for 3 minutes and the imposition of a pressure bandage followed.
The absence of continued soaking of bandage and lack of need of tourniquet application was the proof of the procedure efficiency.
Research Results and their Analysis. The positive result was evidenced in 85 cases (97%) in the main group and in 207 cases in the control one (74%) p<0,05.
The use of the chitosan-based topical hemostatic agent “Hemoflex” Combat reliably enhanced the efficiency of a pressure bandage in controlling of arterial and venous hemorrhage.
Z-folded bandage with topical hemostatic agent is more handy at prehospital stage compared to a powder-form one.
Key words: chitosan-based topical hemostatic agent, emergency medical care, first aid, temporary arrest of external hemorrhage
REFERENCES
1. Rossija v cifrah. 2016: Krat. stat. sb. Moscow, Rosstat Publ., 2016. 543 p. (In Rus.)
2. Shljafer S.I. Analysis of emergency medical care in the Russian Federation. Jelektronnyj nauchnyj zhurnal «Social’nye aspekty zdorov’ja naselenija». 2012; 24; 2: 4. (In Rus.)
3. Barsukova I.M., Miroshnichenko A.G., Kisel’gof O.G., Bumaj O.A. Skoraja medicinskaja pomoshh’. 2014; 2: 4–12. (In Rus.)
4. Anisimov A.Ju. Vestnik NC BZhD. 2009; 2: 39–46. (In Rus.)
5. Dezhurnyj L.I., Neudahin G.V., Jurasova E.D., Migliorini L., Shmitkova T.I. Jelektronnyj nauchnyj zhurnal «Social’nye aspekty zdorov’ja naselenija». 2015; 2 (42): 1–14. (In Rus.)
6. Davis J.S., Satahoo S.S., Butler F.K., Dermer H., Naranjo D., Julien K., Van Haren R.M., Namias N., Blackbourne L.H., Schulman C.I. An analysis of prehospital deaths: Who can we save? J. Trauma Acute Care Surg. 2014; 77; 2: 213–218.
7. Zietlow J.M., Morris D.S., Berns K.S., Jenkins D.H. Journal of Special Operations Medicine. 2015; 15: 48–53. (In Rus.)
8. Samohvalov I.M., Reva V.A., Pronchenko A.A., Judin A.B., Denisov A.V. Politravma. 2013; 1: 80–86. (In Rus.)
9. Chepur S.V., Judin A.B., Shperling I.A., Dezhurnyj L.I., Mahnovskij A.I. Blinda I.V. Voenno-medicinskij zhurnal. [Military Medical Journal]. 2016; 7: 25–33. (In Rus.)
10. Khoshmohabat H., Paydar S., Kazemi H.M., Dalfardi B. Trauma Mon. 2016; 21 (1): 1–6.
11. Smith A.H., Laird C., Porter K., Bloch M. Emerg Med. 2013; 30: 784–789.
12. Buklov T.B., Dmitrienko I.A., Ermakov M.A., Zemljanskaja T.F., Ivanov O.I., Kireev A.N., Belozerskaja G.G., Zhidkov E.A. Neotlozhnaja terapija. 2005; 1: 24. (In Rus.)
13. Petlah V.I. Results of Use of Local Hemostatics in Disaster Medicine. Medicina katastrof. [Disaster medicine]. 2014; 4: 21–24. (In Rus.)
14. Kireev A.N. Farmakologicheskaja aktivnost’ mestnyh gemostaticheskih sredstv v jeksperimente i u pacientov s naruzhnymi travmaticheskimi krovotechenijami na dogospital’nom jetape. Avtoref. diss. … kand. med. nauk. [Pharmacological activity of local haemostatic agents in the experiment and in patients with external traumatic bleeding at the prehospital stage. Abstract Cand. med. sci. diss.]. Moscow, 2005, 24 p. (In Rus.)
15. Bojarincev V.V., Dezhurnyj L.I., Trofimenko A.V., Fil’kov G.I., Zhuravlev S.V. Kremlevskaja medicina. Klinicheskij vestnik. 2015; 2: 26–29. (In Rus.)
16. Samohvalov I.M., Reva V.A., Denisov A.V., Telickij S.Ju., Adamenko V.N., Churkin A.A., Judin A.B., Jablokov I.P. Voenno-medicinskij zhurnal. [Military Medical Journal]. 2017; 2: 18–24. (In Rus.)
17. Blackbourne L.H., Baer D.G., Eastridge B.J., Kheirabadi B., Kragh J.F., Cap A.P., Dubick M.A., Morrison J.J., Midwinter M.J., Butler F.K., Kotwal R.S., Holcomb J.B. J. Trauma Acute Care Surg. 2012; 73; 6: 372–377.
18. Galante J.M., Smith C.A., Sena M.J., Scherer L.A., Tharratt R.S. Military Medicine. 2013; 178: 1227–1230.
19. Brown M.A., Daya M.R., Worley J.A. J. Emerg. Med. 2009; 31; 1: 1–7.
20. Grotenhuis R., Grunsven P.M., Heutz W.M., Tan E.C. Injury. 2016; 47; 5: 1007–1011.
9. Solomennikov A.V.1, Umerov A.Kh.2, Trunin E.M.3, Kurdyaev I.G.2, Demenko V.V.2 Diagnostics of Complex Haemogram Structure Changes against Background of Growing Hemoglobulin as Express-Method of Water-Electrolyte Metabolism Disorder Determination in Critically Ill Patients
1 State budget-funded educational institution of high professional education «Saint Petersburg state chemical and pharmaceutical Academy», St. Petersburg, Russian Federation
2 The Federal State Budgetary Institution «All-Russian Centre for Disaster Medicine «Zaschita» of Health Ministry of the Russian Federation, Moscow, Russian Federation
3 State budget institution of higher education «North-Western State Medical University named after I.I Mechnikov» under the Ministry of Public Health of the Russian Federation, St. Petersburg, Russian Federation
The results of examination of 189 patients with various pathology including critically ill patients are analyzed. The parameters of haemogram, water-electrolyte status, blood protein composition, coagulation hemostasis were determined. The analysis with use of an original methodics has identified the patients with differing statistically significant complex correlations of the haemogram changes against the background of hemoglobulin growth with specifics of water-electrolyte metabolism changes. The elaborated algorithm of data processing in the opinion of the authors can be used as differential express diagnostics of hemoglobulin-associated disorders of water-electrolyte metabolism in intensive care profile patients with limited laboratory facilities at hand. This is especially important in emergency situation environment.
Key words: complex haemogram structure changes, critically ill patients, diagnostics, emergency situation, express-method, hematocrit, hemoglobulin, water-electrolyte metabolism disorders
REFERENCES
1. Methods of clinical laboratory research: Handbook. Vol. 1. Hematologic studies. Coagulation testing. Chemico-microscopic studies. Edited by Men’shikov V.V. Moscow, Labora Publ., 2008, 448 p. (In Rus.)
2. Emanuel V.L. Laboratory diagnosis of kidney disease. St. Petersburg, Tver, Triada Publ., 2006, 248 p. (In Rus.)
3. Solomennikov A.V., Chernov A.V., Demenko V.V., Umerov A.Kh. Use of Peculiarities of Haematic Picture and of Hyperkalemia in Elaboration of Rapid Test Diagnostics Methods of Critical States and Possibility of their Use in Emergency Situations. Medicina katastrof. [Disaster medicine]. 2016; 4: 27–31. (In Rus.)
4. Zaytsev V.М., Liflyandskiy V.G., Marinkin V.V. Applied Medical Statistics: Study guide. St. Petersburg, Foliant Publ., 2006, 432 p. (In Rus.)
5. Dementieva I.I. Laboratory diagnostics and clinical evaluation of homeostatic disorders in critically ill patients with surgical interventions in the intensive care unit. 2007. Moscow, Rosh-Moskva Publ., 136 p. (In Rus.)
10. Budnikova L.N., Khabarova A.A., Vishnevskaya M.V., Prokhorova M.M. Use of Physiotherapeutic Technologies in Medical Rehabilitation Programs for Rescuers with Obesity Problem
The Federal State Budgetary Institution «All-Russian Centre for Disaster Medicine «Zaschita» of Health Ministry of the Russian Federation, Moscow, Russian Federation
Research Objective – is to determine the efficiency of use of physiotherapeutic technologies in rescuers suffering of obesity.
Research Materials and Methods. The rescuers aging from 25 to 58 with metabolism syndrome lasting from 2 to 5 years took part in the program. Every one of them had protracted treatment consisting of ten sessions. There were used electrostatic field in collar zone, pressure therapy for the waist zone, metered back bone stretching and deep muscular tissue heating on the device for many-factor back bone treatment model 07, psychological correction “Ehlka-N”, nebulizer aerosol therapy (with eucalyptus and mint), dry-air treatment sauna.
Research Results and their Analysis. The analysis of the research results has shown that the use of physiotherapeutic technologies led to body mass reduction and lower specific density of fatty tissue including visceral fat in 82.2% of cases. Besides there were noted positive dynamics in hemodynamic parameters, reduction of glucose level and body mass index. All this bear testimony to the efficiency of the technologies used.
Key words: metabolic syndrome, obesity, physiotherapeutic technologies, programs of medical rehabilitation, rescuers
REFERENCES
1. Goncharov S.F., Lyadov K.V., Ostapishin V.D., Preobrazhenskiy V.N. Rehabilitation medicine and medical rehabilitation of the persons engaged in dangerous occupations: Medical guidance. Vol. I. Maikop, OAO “Poligraf-Yug”, Publ., 2009. 464 p. (In Rus.)
2. Kalashnikova М.F. Effective pharmacotherapy. Endokrinologija. [Endocrinology]. 2013; 6 (55): 52–63. (In Rus.)
3. Lopatkina L.V. Optimizacija kompleksnyh nemedikamentoznyh programm s ispol’zovaniem innovacionnyh fizioterapevticheskih i psihokorrigirujushhih tehnologij pri metabolicheskom sindrome. Diss. dokt. med. nauk. [Optimization of comprehensive drug-free programs involving innovative physiotherapeutic and psycho-corrective technologies in the metabolic syndrome. Dr. med. sci. diss.]. Moscow, 2015, 251 p. (In Rus.)
4. Maksimov М.L., Sologova S.S., Dralova О.V. Obesity: Modern approaches to rational pharmacotherapy. Meditsinskij sovet. 2016; 3: 72–78. (In Rus.)
11. Zubarev A.F., Kleev V.V., Khabarova A.A. Health Status of Fire Fighters and Rescuers of Moscow Oblast. Periodical Medical Examinations in 2016
The Federal State Budgetary Institution «All-Russian Centre for Disaster Medicine «Zaschita» of Health Ministry of the Russian Federation, Moscow, Russian Federation
The analysis of the results of periodical medical examinations of fire fighters and rescuers in 2016 is presented.
Research Objective is the study of the health status and of morbidity patterns in personnel of fire fighting and life saving units and detachments of Moscow Oblast.
Research Materials and Methods. The research of health status and of morbidity patterns in the mentioned contingent was based on the results of periodical medical examinations carried out by Oblast fire-fighting service in 2016 with 3 528 people involved. The median age of those examined (40±11,1) years and median length of employment (6,0±4,2) years.
The medical panel of All-Russian Center for Disaster Medicine “Zaschita” summing up the results of laboratory, functional and instrumental examinations and medical specialists’ decisions handed down its opinion on the presence or absence of medical contraindications to continued employment in adverse work-related environment.
Research Results and their Analysis. The analysis of morbidity patterns has shown that endocrine, nutritional and metabolic disorders are predominant (class IV ICD-10) – 2094 employees (34.3%); the second place belongs to diseases of the digestive system (class XI ICD-10) – 1071 (17.6%), the third place – diseases of the circulatory system (class IX ICD-10) – 902 (14.8%), the fourth place – ocular diseases (class VII ICD-10) – 885 (14.5%), the fifth place – diseases of the respiratory system (class X ICD-10) – 625 employees (10.2%). The total share of the classes named in the whole morbidity structure is 91.4%.
After the periodical medical examinations 3462 employees were announced fit for job (98.4% of those examined). All people examined were given corresponding recommendations of organizational, diagnostical, treatment and/or reparative character.
Key words: All-Russian Center for Disaster Medicine “Zaschita”, firefighters, health status, morbidity structure, Moscow Oblast firefighting and rescue service, periodical medical examinations, rescuers
REFERENCES
1. Verzunov V.А. Gigienicheskaja ocenka uslovij truda i sostojanie zdorov’ja pozharnyh. Diss. kand. med. nauk. [Hygienic assessment of the fire guard labor conditions and health. Cand. Med. Sci. diss.]. Irkutsk, 2006, 131 p. (In Rus.)
2. Mar’in М.I. Kompleks sredstv psihologicheskogo obespechenija dejatel’nosti pozharnyh. Diss. kand. psich. nauk. [Fireguard activity psychological support package. Cand. Psych. Sci. diss.]. Moscow, MGU Publ., 1992, 404 p. (In Rus.)
3. Mar’in М.I., Efanova I.N., Polyakov М.N. et al. Job specification of the core activity of officers of the State Fire Service of the Ministry of the Interior of Russia: Guide. Moscow, VNIIPO Publ., 1998. 114 p. (In Rus.)
4. On the approval of lists of harmful and (or) hazardous occupational factors and work, in the performance of which the mandatory preliminary and periodic medical examinations (surveys), and the procedure for mandatory preliminary and periodic medical examinations (surveys) of the employees engaged in heavy work and work with harmful and (or) hazardous labor conditions: order of the Ministry of Health and Social Development of Russia dated April 12, 2011, No 302n. (In Rus.)
5. Kreidich Y.V., Kleev V.V., Zhukov I.Y. et al. Health status of the Moscow Region fire guard and emergency response groups. The 20th Anniversary of the All-Russian Service for Disaster Medicine: Collection of research papers. Under the editorship of Goncharov S.F. Moscow, VCMK «Zashhita» Publ., 2013, pp. 163–167. (In Rus.)
6. Sannikov М.V., Andreev А.А. Characteristics of the health status of emergency response groups and specialists of the State Fire Service of the EMERCOM of Russia. Mediko-biologicheskie i social’no-psihologicheskie problemy bezopasnosti v chrezvychajnyh situacijah. [Biomedical and sociopsychological safety issues in emergencies]. 2007; 1: 19–26. (In Rus.)
7. Alexanin S.S. Results of the health status of emergency response groups of the EMERCOM of Russia. Vestnik psihoterapii. 2007; 21: 142–147. (In Rus.)
8. Alexanin S.S., Astafiev O.M., Sannikov M.V Perfection of System of Medical Examination of Rescuers and Firemen of Ministry of Emergency Situations of Russia. Medicina katastrof. [Disaster medicine]. 2010; 3: 7–11. (In Rus.)
9. Matyushin А.V., Poroshin А.А., Bobrinev Е.V. Investigation in the occupationally conditioned morbidity of firefighters. Pozharnaya bezopasnost. [Fire Safety]. 2005; 5: 85–86. (In Rus.)
ACTUAL PROBLEMS OF EMERGENCY CONSULTATIVE MEDICAL CARE PROVISION AND OF MEDICAL EVACUATION
12. Baranova N.N.1,2, Tychkova E.A.1, Kachanova N.A. 1 Activity of Center for Medical Evacuation of All-Russian Center for Disaster Medicine “Zaschita” in 2016
1 The Federal State Budgetary Institution «All-Russian Centre for Disaster Medicine «Zaschita» of Health Ministry of the Russian Federation, Moscow
2 Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Postgraduate Education» of the Ministry of Healthcare of the Russian Federation, Moscow
The activity is presented of the Center for medical evacuation of All-Russian Center for Disaster Medicine “Zaschita” in the areas of emergency medical care delivery to sick and wounded, of organization and realization of medical evacuation of patients in the territory of the Russian Federation and from abroad, of transportation of consultants and of medical goods and in other fields of activity in 2016.
It is noted that 3 teams of medical specialists were on alert at the Center day-and-night during the year.
A number of promising modes of activity for 2017 is suggested to enhance the preparedness of resources and capabilities for emergency situation response:
– perfection of a complex of measures on organization and realization of sanitary aviation evacuation by scheduled flights including those from abroad;
– organizing and manning of daily attendance in the territory of the Kremlin;
– participation of medical personnel of the Center in education activity, in specialist conferences, congresses, symposia and so on;
– elaboration of drafts of normative documentation and procedure of medical care delivery including medical evacuation, procedure of inter-agency cooperation on federal level on settlement of issues of medical evacuation by different transportation means including aviation;
– within the framework of developing extrabudgetary activity the procurement of aviation services on a competitive basis with agreement with carriers to be qualified for doing business with insurance companies, legal or physical persons for the sake of delivery of emergency care including specialized emergency care and of sanitary aviation medical evacuation on federal level;
– securing personnel preparedness for changes in training of medical specialists system caused by the switch from certification to accreditation and to continuing medical education.
Key words: All-Russian Center for Disaster Medicine “Zaschita”, Center for medical evacuation, emergency consultative medical care, emergency medical care, emergency situations, medical evacuation, patients, sanitary aviation evacuation, victims
13. Kurnyavka P.A., Sukhanov A.V., Katik A.A. Role of Sanitary Aviation in Emergency Consultative Medical Care Delivery and in Medical Evacuation in Khabarovsk Territory
Territorial State Budgetary Health Institution «Khabarovsk Territorial Center for Disaster Medicine», Khabarovsk, Russian Federation
The Role of sanitary aviation in emergency consultative medical care delivery and in medical evacuation in Khabarovsk Territory is presented. It is noted that aviation is used most actively in liquidation of medical and sanitary consequences of emergency situations and in everyday activity of emergency medical care delivery to population of rural areas, and hard-to-reach populated places with status of regions of the Extreme North. The role of Khabarovsk Territorial center for disaster medicine in general management and coordination of efforts of health service facilities on emergency medical care delivery with the use of sanitary aviation is analyzed. The main problems of sanitary aviation development in the Territory are defined. A detailed analysis is made of activity of sanitary aviation in delivery of emergency medical care to the victims of a major road traffic accident on the highway between Khabarovsk and Komsomolsk-on-Amur in 2015.
Key words: aircraft, emergency consultative medical care, emergency medical care, emergency situation, Khabarovsk Territorial center for disaster medicine, medical evacuation, road traffic accident, sanitary aviation
14. Stepanov I.A., Kozyrenko E.M., Lukashova E.I., Fedorenko O.A. Experience of Activity of Tomsk Oblast Perinatal Center
Regional State Autonomous Health Institution «Regional Perinatal Center», Tomsk, Russian Federation
The three-tier system of obstetric and neonatal care in Tomsk Oblast is presented. The activity of teleconsultations center in Oblast Perinatal center set up in 2012 for coordination of the three-tier system is discussed. The detailed data are presented on the activity of obstetric and neonatal services of the teleconsultations center in 2012 and 2016. The efficiency of the measures carried out by the center is analyzed. The outstanding issues are shown and prospects of further development of three-tier system of obstetric and neonatal care delivery are defined.
Key words: criteria of activity efficiency, Oblast perinatal center, obstetric and neonatal care, teleconsultations center, three-tier system
EDUCATION AND TRAINING OF PERSONNEL
15. Goncharov S.F., Sakhno I.I. Disaster Medicine Issues in Higher and Further Vocational Education of Medical Cadres
The Federal State Budgetary Institution «All-Russian Centre for Disaster Medicine «Zaschita» of Health Ministry of the Russian Federation, Moscow, Russian Federation
Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Postgraduate Education» of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
The matters of qualification upgrading of health service organizers and of therapeutic specialists for medical care delivery in emergency situations are discussed. A list is suggested of training modules in disaster medicine discipline of professional education programs of higher education aimed at preparation of top-qualification cadres in residency training (postgraduate studies) and further professional programs of qualification upgrading of medical cadres of health service.
Key words: disaster medicine discipline, education programs, emergency situations, further professional education, higher education, professional competencies, qualification profile, training modules
REFERENCES
1. On education in the Russian Federation: Federal Law of the Russian Federation dated December 29, 2012, No 273-FZ. (In Rus.)
2. On the fundamental principles of the public health protection in the Russian Federation: Federal Law dated November 21, 2011 No 323-FZ. (In Rus.)
3. On special aspects of application of occupational standards as related to the requirements mandatory for the state extra-budgetary foundations of the Russian Federation, public or municipal institutions, public or municipal unitary enterprises, and government-owned corporations, government-owned companies and business entities the shares (participatory interest) of which in the authorized capital exceeding fifty percent are publicly owned: Decree of the Government of the Russian Federation dated June 27, 2016, No 584. (In Rus.)
4. Procedure of organization and delivering medical care in emergencies by the All-Russian Service for Disaster Medicine: Draft. Moscow, VCMK «Zashhita» Publ., 2015, 2504 p. (In Rus.)
INTERNATIONAL COOPERATION
16. Goncharov S.F.1,2, Kipor G.V.1, Bystrov M.V.1 «The Global Platform for Disaster Risk Reduction» Conference: Availability and Enhancing of Early Warning System in Emergency Situations, Cancun, Mexico 22–26 May, 2017
1 The Federal State Budgetary Institution «All-Russian Centre for Disaster Medicine «Zaschita» of Health Ministry of the Russian Federation, Moscow
2 Federal State Budgetary Educational Institution of Further Professional Education «Russian Medical Academy of Postgraduate Education» of the Ministry of Healthcare of the Russian Federation, Moscow
The results of the conference “The Global Platform for Disaster Risk Reduction” are presented as the matter for a debate of a kind on the realization of Sendai Framework for Disaster Risk Reduction 2015–2030. The focal point of the discussion is the use of different, including innovative, technologies in the system of information support of emergency situations management as a whole as well as in the system of early warning of all strata of population and of those taking part in liquidation of consequences of emergency situations in particular.
Key words: emergency situations management system, Global Platform 2017, Sendai Framework for Disaster Risk Reduction 2015–2030, system of early warning in emergency situations, system of information support of emergency situations
HUMAN PROTECTION IN EXTREME CONDITIONS
17. Sedov A.V., Tregub T.I. Ways and Means of Human Protection in Technogenic Accidents
The Federal State Budgetary Institution «All-Russian Centre for Disaster Medicine «Zaschita» of Health Ministry of the Russian Federation, Moscow
The three-level tactics of human protection in technogenic accidents is characterized. In is noted that drugs and individual technical protective means are used at the second level. And the means are presented with their classification and the factors dictating the choice of their type.
Key words: filtering individual lung protection means, individual technical protective means, insulating individual lung protection means, means of human protection, technogenic accidents, ways of human protection
REFERENCES
1. Korostin A.S., Il’ina S.L. Individual and pharmacological protection of the Disaster Medicine Service personnel in radiological accidents. Medicina katastrof [Disaster medicine]. 2005; 2: 50–52. (In Rus.)
2. Avetisov G.M., Goncharov S.F. et al. Organiza tion of hygienic and sanitary, and treatment and prophylactic measures in large-scale radiological accidents: Guidelines. Moscow, VCMK «Zashhita» Publ., 2000, 244 p. (In Rus.)
3. Sedov A.V., Goncharov S.F., Onishchenko G.G. et al. Human protection in emergencies. Moscow, OOO Firma «REINFOR» Publ., 2002, 502 p. (In Rus.)
4. Sedov A.V., Lukicheva T.A. Principles and methodological approaches to the organization of human protection from chemical, physical and biological adversities in emergencies. Medicina katastrof. [Disaster medicine]. 2005; 2: 52–55. (In Rus.)
5. Rubtsov V.I., Klochkov V.N., Surovtsev N.A. et al. Individual protective gear of the personnel of nuclear and power industry enterprises: Catalogue and guide. Moscow, FGBU GNC FMBC im. A.I.Burnazjana FMBA Rossii Publ., 2015, 255 p. (In Rus.)
6. Kochetkov O.A., Rubtsov V.I., Klochkov V.N., Surovtsev N.A. et al. Individual protective gear of the personnel of nuclear and power industry enterprises: Catalogue and guide. Moscow, 2007, 186 p. (In Rus.)
