DISASTER MEDICINE No.2 •2023
Simultaneous Mass Admission of Emergency Victims to Medical Treatment Organizations: Organizational Problems and Possible Ways to Solve them
Maslyakov V.V. 1, Sidelnikov S.A. 1, Barachevskiy Y.E. 2, Kurkin K.G. 3, Pimenova A.A. 1, Polidanov M.A. 1, Polikarpov D.A. 1, Barulina M.A. 4
1 Saratov State Medical University named after V.I. Razumovskiy of the Ministry of Health of the Russian Federation, Saratov, Russian Federation
2 Northern State Medical University of the Ministry of Health of the Russian Federation, Arkhangelsk, Russian Federation
3 Main Military Clinical Hospital named after acad. N.N. Burdenko of the Ministry of Defense of Russia, Moscow, Russian Federation
4 Institute of Precision Mechanics and Control Problems of the Russian Academy of Sciences, Saratov, Russian Federation
Summary. The aim of the study is to identify problems in the organization of medical triage and medical care in trauma centers of different levels at mass simultaneous admission of victims in emergency situations and to determine possible ways to solve them.
Study materials and methods. We analyzed the results of treatment of 136 emergency patients in Saratov and Saratov region trauma centers in 2010-2021. All patients were delivered by emergency medical teams (EMTs). Road traffic accidents (RTA) were the most frequent cause (76.0%) of traumatization of the patients, in the remaining cases (24.0%) carbon monoxide poisoning and burns caused by fires were the most common. The mean age of the victims was (39±7) years, of whom 71 (52.2%) were men, and 65 (47.8%) were women.
The study was a total retrospective study, using patient medical histories as primary documentation. Patients older than 18 years were included in the study. Victims, who were delivered to trauma centers in addition to ambulance teams, were excluded from the study.
Results of the study and their analysis. The results of the study show that of 136 accident victims delivered to trauma centers in Saratov and Saratov region, 76 cases (55.9%) proved to have errors in the organization of medical triage and medical care to the victims.
Most of the errors can be conditionally divided into 2 large groups. The first group included 52 observations (38.2%) related to the organization of the admission of injured persons who arrived from the emergency area.
The second group included cases of underestimation of the patient’s condition severity, wrong diagnosis, incompletely performed antishock or infusion therapy. The authors designated these errors as therapeutic — they occurred less frequently and were noted only in 9 cases (6.6%) — all these errors were made only in Level III trauma centers.
Analysis of the study results showed that the main problem encountered by the management of trauma centers in Saratov region during mass simultaneous admission of victims in emergencies was the incorrect involvement of medical specialists in medical triage, which led to an increase in the timing of its implementation and in the timing of medical care — for example, the involvement of therapeutic specialists in the medical triage of surgical patients.
To solve this problem, the authors propose to reverse the involvement of anesthesiology, surgery, and neurology medical specialists in the emergency departments of medical treatment organizations with their subsequent return to their departments as the workload in the emergency departments decreases.
Keywords: emergencies, medical treatment organizations, simultaneous mass admission of victims, organizational problems, trauma centers,
Conflict of interest. The authors declare no conflict of interest
For citation: Maslyakov V.V., Sidelnikov S.A., Barachevskiy Y.E., Kurkin K.G., Pimenova A.A., Polidanov M.A., Polikarpov D.A., Barulina M.A. Simultaneous Mass Admission of Emergency Victims to Medical Treatment Organizations: Organizational Problems and Possible Ways to Solve them. Meditsina Katastrof = Disaster Medicine. 2023;2:51-55 (In Russ.). https://doi.org/10.33266/2070-1004-2023-2-51-55
- Kuzovlev O.P., Shablovskiy O.R., Laptev V.A., et al. Experience in Providing Specialized Medical Care to Victims in Emergency Situations. Meditsina Ekstremalnykh Situatsiy = Extreme Medicine. 2011;4:5-13 (In Russ.).
- Aleksanin S.S., Gudz Yu.V. Concept (Principles, Model, Directions) of Organizing the Provision of Emergency Trauma Care to Victims in Emergency Situations. Mediko-Biologicheskiye i Sotsialno-Psikhologicheskiye Problemy Bezopasnosti v Chrezvychaynykh Situatsiyakh = Medicо-Biological and Socio-Psychological Problems of Safety in Emergency Situations. 2016;4:21-32. DOI:10.25016/2541-7487-2016-0-4-21-32 (In Russ.).
- Baranov A.V., Klyuchevskiy V.V., Barachevskiy Yu.E. Arrangement of Medical Aid for Victims of Road Traffic Accidents at Prehospital Stage of Medical Evacuation. Politravma = Polytrauma. 2016;1:12-17 (In Russ.).
- Baranova N.N. Medical Evacuation of Victims: Condition, Problems. Message 3. Meditsina Katastrof = Disaster Medicine. 2019;2:38-44 (In Russ.).
- Baranova N.N., Bobiy B.V., Goncharov S.F., et al. Medical Evacuation in the System of Elimination of the Health Consequences of Crisis Situations. Meditsina Katastrof = Disaster Medicine. 2018;1:5-14 (In Russ.).
- Agadzhanyan V.V., Kravtsov S.A., Pronskikh A.A., et al. On the Question of the Organization and Treatment of Mass. Politravma = Polytrauma. 2021;2:19-26. DOI: 10.24412/1819-1495-2021-2-19-26 (In Russ.).
- Maslyakov V.V., Chuprina A.P., Kurkin K.G. Improving the Provision of Surgical Care to Civilians with Gunshot Wounds of the Chest in Conditions of Local Armed Conflict. Skoraya Meditsinskaya Pomoshch = Emergency Medical Care. 2021;22;1:70-75. https://doi.org/10.24884/2072-6716-2021-22-1-70-75 (In Russ.).
- Bobiy B.V., Peshkun A.V. Organizational Aspects of Rendering of Emergency Medical Care of Trauma Cases at In-Patient Institutions. Meditsina Katastrof = Disaster Medicine. 2011;2:32 (In Russ.).
- Budantseva L.B., Kostomarova L.G., Fedotov S.A., et al. Factors Complicating the Registration of Accounting Parameters when Compiling Lists of Victims in the Process of Eliminating the Medical and Sanitary Consequences of Emergencies. Meditsina Katastrof = Disaster Medicine. 2013;1:10-13 (In Russ.).
- Goncharov S.F., Bystrov M.V., Tsinika G.V. Disaster Medicine and Emergency Medical Care: Organization of Emergency Medical Care in the Elimination of Medical and Sanitary Consequences of Emergency Situations. Meditsina Katastrof = Disaster Medicine. 2015;1:15-18 (In Russ.).
- Elfimov P.V., Kuznetsova N.L., Kuzmin Yu.F., et al. The System of Organization of Trauma Care in a Multidisciplinary Hospital. Obshchestvennoye Zdorovye i Zdravookhraneniye = Public Health and Health Care. 2008;3:71-73 (In Russ.).
- Kovalev V.A. Some Results of Monitoring the Condition of Medical Equipment Used in Providing Emergency Medical Care to Victims. Meditsina Katastrof = Disaster Medicine. 2009;2:56-57 (In Russ.).
- Matveev R.P., Gudkov S.A., Bragina S.V. Organizational Aspects of Providing Medical Assistance to Victims with Road Transport Polytrauma. Lit. Review. Meditsina Katastrof = Disaster Medicine. 2015;4:45-48 (In Russ.).
- Poroyskiy S.V., Donnika A.D., Eremina M.V. Assessment of a Medical Specialist’s Readiness for Professional Activity in Extreme Situations. Meditsina Katastrof = Disaster Medicine. 2014;2:53-54 (In Russ.).
- Rozinov V.M., Goncharov S.F., Makarov I.A., et al. The System of Organization and Provision of Specialized Medical Care to Children Injured in Road Accidents. Meditsina Katastrof = Disaster Medicine. 2010;2:58-61 (In Russ.).
- Maslyakov V.V., Barulina M.A., Pavlova O.N., et al. Programma Rascheta Neobkhodimogo Kolichestva Meditsinskogo Personala pri Massovom Postuplenii Postradavshikh = The Program for Calculating the Required Number of Medical Personnel for Mass Admission of Victims. Certificate of Registration of the Computer Program No. 2022681281, 2022 (In Russ.).
The material was received 12.05.23; the article after peer review procedure 26.05.23; the Editorial Board accepted the article for publication 23.06.23