1. Organization 1. Organization of emergency of emergency

and acute careand acute carePrepared by:Prepared by:

C.m.s., assistant professor of outpatient C.m.s., assistant professor of outpatient therapy and emergency medical therapy and emergency medical

emergency KSMUemergency KSMUAA..R. AlpyssovaR. Alpyssova

The purpose of the lectureThe purpose of the lecture

After completing the lecture, students should be After completing the lecture, students should be guided in the organization of emergency and guided in the organization of emergency and urgent careurgent care

The cThe conceptsoncepts of of LUTS LUTS

Medical emergency – it is suddenly Medical emergency – it is suddenly emerged pathological change in the emerged pathological change in the functions of the human body, functions of the human body, threatening to his life, health or threatening to his life, health or those around him.those around him.

Urgent states are classified as follows:Urgent states are classified as follows:

Life-threatening conditions - a pathological Life-threatening conditions - a pathological condition characterized by impaired vital main condition characterized by impaired vital main functions (blood circulation and respiration).functions (blood circulation and respiration).State, threatening the health - this pathological State, threatening the health - this pathological condition with a high risk of disorders of vital condition with a high risk of disorders of vital functions or can cause persistent health functions or can cause persistent health problems that may occur in the absence of problems that may occur in the absence of medical care in the near future.medical care in the near future.Conditions requiring urgent medical intervention Conditions requiring urgent medical intervention in the interests of others persons in connection in the interests of others persons in connection with the behavior of the patient.with the behavior of the patient.A special type of emergency conditions A special type of emergency conditions considered labor. In fact, the birth - a considered labor. In fact, the birth - a physiological act, they can be resolved without physiological act, they can be resolved without emergency medical intervention. However, due emergency medical intervention. However, due to certain risk of complications, including life-to certain risk of complications, including life-threatening, you must include the delivery of threatening, you must include the delivery of medical emergencies, and to include within the medical emergencies, and to include within the scope of the provision of UMC.scope of the provision of UMC.

The main reasons for urgent The main reasons for urgent conditionsconditions

acute diseasesacute diseases Exacerbation of chronic diseasesExacerbation of chronic diseases InjuriesInjuries poisoningpoisoning

The concept of UMCThe concept of UMC UMC (syn. emergency medical care),UMC (syn. emergency medical care), as a form as a form

of care - a set of implemented without delay of care - a set of implemented without delay treatment and diagnostic and tactical measures treatment and diagnostic and tactical measures aimed at elimination of sudden pathological aimed at elimination of sudden pathological condition that threatens human life and health condition that threatens human life and health (medical emergency), or surrounding persons at all (medical emergency), or surrounding persons at all stages of treatment .stages of treatment .

UMC, as a systemUMC, as a system - a set of standards, structures - a set of standards, structures and mechanisms of interaction, to provide UMC, its and mechanisms of interaction, to provide UMC, its scientific and methodological support and training. scientific and methodological support and training. The term “UMC system" means also emergency The term “UMC system" means also emergency medical assistance at all stages, and scientific-medical assistance at all stages, and scientific-methodological support and training, respectively, methodological support and training, respectively, includes, along with the services of UMC (stations, includes, along with the services of UMC (stations, offices) and hospitals UMC, specialized research offices) and hospitals UMC, specialized research institutes and centers UMC training centers and institutes and centers UMC training centers and disaster medicine.disaster medicine.

Hospital UMCHospital UMC - health care setting of a - health care setting of a stationary type, having a branch in the stationary type, having a branch in the structure of the UMC.structure of the UMC.The service UMC interacts with the The service UMC interacts with the hospitals of various types, providing hospitals of various types, providing emergency medical care. Patients can be emergency medical care. Patients can be delivered to teams of UMC in municipal, delivered to teams of UMC in municipal, district, regional (territorial, republican) district, regional (territorial, republican) hospitals, institutions, ambulances and hospitals, institutions, ambulances and specialized scientific-practical specialized scientific-practical institution.institution.

The Prehospital stage of UMCThe Prehospital stage of UMC - - emergency medical care outside of emergency medical care outside of hospitals.hospitals.

Basic principles for UMCBasic principles for UMC The urgency of providing UMC, due to a The urgency of providing UMC, due to a

violation of the vital functions of the patient violation of the vital functions of the patient (victim) or a high risk of development due to (victim) or a high risk of development due to the rapid progression of the pathological the rapid progression of the pathological state in state in the absence of adequate medical the absence of adequate medical benefits.benefits.

Trouble-free nature of the UMC provision in Trouble-free nature of the UMC provision in urgent situations.urgent situations.

Every citizen regardless of social, ethnic, Every citizen regardless of social, ethnic, cultural-religious and other features by cultural-religious and other features by contacting UMC and in need of urgent medical contacting UMC and in need of urgent medical intervention is entitled to receive free intervention is entitled to receive free emergency medical care in accordance with emergency medical care in accordance with the standards of care.the standards of care.

Free nature of the assistance patients (victims) Free nature of the assistance patients (victims) in urgent situations.in urgent situations.

State regulation requires executive agencies State regulation requires executive agencies responsible for organizing the uninterrupted responsible for organizing the uninterrupted provision of UMC.provision of UMC.

The volume of UMCThe volume of UMC - a set of urgent medical- - a set of urgent medical-diagnostic measures to address urgent condition.diagnostic measures to address urgent condition.

Depending on the condition of the assistance due Depending on the condition of the assistance due

to stage of care, availability of special medical to stage of care, availability of special medical equipment and training, assistance can be equipment and training, assistance can be provided in the following amounts:provided in the following amounts:

First aid for the sick and injuredFirst aid for the sick and injured before doctor carebefore doctor care First medical aidFirst medical aid Skilled careSkilled care Specialized medical careSpecialized medical care

The list of minimum required diagnostic-treatment The list of minimum required diagnostic-treatment activities regulated by the relevant standards activities regulated by the relevant standards (protocols).(protocols).

Algorithm of emergency medical careAlgorithm of emergency medical care - a - a sequence of necessary diagnostic-treatment sequence of necessary diagnostic-treatment activities in a typical clinical situations, the activities in a typical clinical situations, the appropriate phase and the volume of supporting appropriate phase and the volume of supporting emergency medical care.emergency medical care.

The tactics of emergency medical servicesThe tactics of emergency medical services - - tools and methods used to ensure timely and tools and methods used to ensure timely and effective emergency medical care at all stages.effective emergency medical care at all stages.

The tactics of the UMC should include a The tactics of the UMC should include a preventive component - a warning of possible preventive component - a warning of possible life-threatening conditions and other life-threatening conditions and other emergencies, to provide security for both the emergencies, to provide security for both the patient and for the surrounding people and patient and for the surrounding people and medical staff.medical staff.

The service UMC is operates:The service UMC is operates:

daily workdaily work- Emergency- Emergency

Two interrelated stages of organization and delivery of Two interrelated stages of organization and delivery of the UMC:the UMC:

prehospital (station UMC);prehospital (station UMC); hospital (hospitals at various levels)hospital (hospitals at various levels)

3 levels in the organization of the UMC:3 levels in the organization of the UMC: One-level (paramedic) in rural areas.One-level (paramedic) in rural areas. 2-level (mixed) in medium-sized cities (medical crew and 2-level (mixed) in medium-sized cities (medical crew and

paramedic team).paramedic team). 3-level (mixed) in the major cities (medical team, a 3-level (mixed) in the major cities (medical team, a

specialized medical team paramedic and team).specialized medical team paramedic and team).

2 principles of the separation of functions 2 principles of the separation of functions between the stations of the UMC and clinics:between the stations of the UMC and clinics:

On the basis of determining the severity of a On the basis of determining the severity of a reason to call (a life-threatening, unlife-reason to call (a life-threatening, unlife-threatening disease).threatening disease).

On the basing of determining of place of crime On the basing of determining of place of crime scene. (street, apartment).scene. (street, apartment).

Taking into account the principle of determining Taking into account the principle of determining the severity of the organization of medical care the severity of the organization of medical care for patients with acute and chronic, but unlife-for patients with acute and chronic, but unlife-threatening disease are the responsibility of the threatening disease are the responsibility of the clinic.clinic.

Service UMC can be organized on the Service UMC can be organized on the

following principles:following principles:

By geography signBy geography sign By the principle of relationships with hospitals By the principle of relationships with hospitals

and the type of administration (and funding)and the type of administration (and funding) By the principle of giving first aid "on the scene" By the principle of giving first aid "on the scene"

with the organization of parallel emergency with the organization of parallel emergency medical services at clinics: Street - UMC, medical services at clinics: Street - UMC, apartment - a medical emergency.apartment - a medical emergency.

By the principle of giving first aid to "the severity By the principle of giving first aid to "the severity of reason“, independently of the scene (without of reason“, independently of the scene (without the creation of emergency medical services) with the creation of emergency medical services) with forces and means only the UMC.forces and means only the UMC.

By the principle of affiliation and funding, and By the principle of affiliation and funding, and (or) by dividing by the state and non-(or) by dividing by the state and non-governmental services of the UMC.governmental services of the UMC.

Station UMCStation UMC - state or municipal health care - state or municipal health care facility that is designed to assist UMC in the facility that is designed to assist UMC in the prehospital outreach and has the necessary prehospital outreach and has the necessary forces and means it.forces and means it.      As part of the station should be provided for       As part of the station should be provided for UMC: operational department (office) (for UMC: operational department (office) (for receiving calls), the department of receiving calls), the department of communication (for the interaction between the communication (for the interaction between the station and outreach UMC), Department of station and outreach UMC), Department of Medical Statistics from the archive office for Medical Statistics from the archive office for receiving out-patient room for storage of medical receiving out-patient room for storage of medical equipment UMC and teams prepare for the work equipment UMC and teams prepare for the work of medical pilings, storage space for stock drugs, of medical pilings, storage space for stock drugs, equipped with fire and burglar alarm, rest rooms equipped with fire and burglar alarm, rest rooms for the doctors, the averagefor the doctors, the average

medical personnel, ambulances drivers, room for medical personnel, ambulances drivers, room for meal duty personnel, administrative and other meal duty personnel, administrative and other buildings, garages, covered parking boxes, buildings, garages, covered parking boxes, enclosed area with a paved parking lot, enclosed area with a paved parking lot, corresponding to the size of the maximum corresponding to the size of the maximum number of vehicles operating simultaneously.number of vehicles operating simultaneously.             Operations Division (office) station UMC      Operations Division (office) station UMC provides non-stop centralized receiving calls provides non-stop centralized receiving calls (calls) of the population, timely referral outreach (calls) of the population, timely referral outreach MSP, operational management and control over MSP, operational management and control over their work, the organization of the UMC, their work, the organization of the UMC, depending on the current operational situation.depending on the current operational situation.

The main functions of the operative The main functions of the operative department:department:

Receiving calls from the public.Receiving calls from the public. Transferring calls for execution.Transferring calls for execution. Operative management of outreach.Operative management of outreach. Sharing information with substations on Sharing information with substations on

operational work.operational work. Interaction with the duty of the city services Interaction with the duty of the city services

(rural area), the police, traffic police, fire (rural area), the police, traffic police, fire protection, emergency, etc.protection, emergency, etc.

Emergency information management station of Emergency information management station of emergency and conflict situations.emergency and conflict situations.

Information on emergency instances, certain Information on emergency instances, certain public health authorities.public health authorities.

Issuance of the population reference information.Issuance of the population reference information.

Basic stepsBasic steps of a call manager when of a call manager when receiving phone call:receiving phone call:

Listen to the citizen who applied for the "03".Listen to the citizen who applied for the "03". Address the issue of receiving a call in Address the issue of receiving a call in

accordance with the instructions.accordance with the instructions. When the complexity of the decision - to switch When the complexity of the decision - to switch

the telephone line to a senior doctor.the telephone line to a senior doctor. If a decision on receiving a call, record data:If a decision on receiving a call, record data: address and telephone number;address and telephone number; surname, first name, age of the patientsurname, first name, age of the patient name and phone calling, relationship to the name and phone calling, relationship to the

patient;patient; What happened?What happened? Based on the response to formulate a reason to Based on the response to formulate a reason to

call (when working by hand). When operating an call (when working by hand). When operating an automated call processing system cause the call automated call processing system cause the call is formed by a computer program.is formed by a computer program.

Depending on the capabilities of UMC processing Depending on the capabilities of UMC processing station calls can be conducted manually or station calls can be conducted manually or through an automated system.through an automated system.

All jobs in the operations department (dispatch) All jobs in the operations department (dispatch) must be computerized, equipped to record must be computerized, equipped to record conversations and Automatic Number conversations and Automatic Number Identification telephone.Identification telephone.

In the operations department (dispatch) should In the operations department (dispatch) should be form a single personalized database of be form a single personalized database of patients who applied for the provision of UMC.patients who applied for the provision of UMC.

Receiving calls and sending their outreach Receiving calls and sending their outreach carried out by nurse (the nurse) to receive and carried out by nurse (the nurse) to receive and transfer calls to the operations department transfer calls to the operations department (dispatch) station of the UMC.(dispatch) station of the UMC.

Away team UMC - UMC staff service Away team UMC - UMC staff service workers, providing emergency medical care workers, providing emergency medical care for the sick and injured to the point of call for the sick and injured to the point of call and in the ambulances in the way to and in the ambulances in the way to following in health care setting.following in health care setting.

Depending on the composition, equipment Depending on the composition, equipment and tasks are the following types of outreach:and tasks are the following types of outreach:

Away linear (medical) team UMC - UMC Away linear (medical) team UMC - UMC visiting team, led by a physician with a visiting team, led by a physician with a special "emergency ambulance service." special "emergency ambulance service." Medical outreach UMC includes in its Medical outreach UMC includes in its membership a doctor, two paramedics, membership a doctor, two paramedics, paramedic and the driver and provides paramedic and the driver and provides medical care in accordance with the medical care in accordance with the standards of the UMC and is working on standards of the UMC and is working on schedule. In his spare time, call staff on-site schedule. In his spare time, call staff on-site team UMC must be present at the station team UMC must be present at the station (substation), office of the UMC.(substation), office of the UMC.

Away specialized team of UMCAway specialized team of UMC - outreach - outreach activities designed to provide emergency medical activities designed to provide emergency medical assistance in the amount of pre-hospital assistance in the amount of pre-hospital specialist care, which has as part of a doctor who specialist care, which has as part of a doctor who owns a specialty basic "ambulance" and owns a specialty basic "ambulance" and additional specialty (specialties) along the profile additional specialty (specialties) along the profile of a specialized team and has the necessary of a specialized team and has the necessary specialist equipment.specialist equipment.

The main types of specialized The main types of specialized brigade:brigade:

Reanimation anesthetic (resuscitative-surgical, Reanimation anesthetic (resuscitative-surgical, cardiac, neurological, multidisciplinary intensive cardiac, neurological, multidisciplinary intensive care, intensive care) brigade.care, intensive care) brigade.

Mental health brigade.Mental health brigade. Pediatric and other brigade.Pediatric and other brigade.

Away paramedic brigade of UMC –Away paramedic brigade of UMC – brigade of UMC, led by a medical assistant, brigade of UMC, led by a medical assistant, designed to assist UMC in the amount of pre-designed to assist UMC in the amount of pre-hospital with the elements of skilled care.hospital with the elements of skilled care.

Away paramedic team UMC includes in Away paramedic team UMC includes in its membership two paramedics, paramedic its membership two paramedics, paramedic and the driver and provides medical care in and the driver and provides medical care in accordance with the functional accordance with the functional responsibilities of assistant:responsibilities of assistant:

-at transport of patients (when the nurse works -at transport of patients (when the nurse works as an independent unit in accordance with as an independent unit in accordance with established medical diagnosis and assistance established medical diagnosis and assistance to women in childbirth);to women in childbirth);

-help the doctor in the team, as the acting -help the doctor in the team, as the acting physician.physician.     Paramedics can be used as a doctor      Paramedics can be used as a doctor acting in desperate situations [when not acting in desperate situations [when not enough or not physicians (rural area)].enough or not physicians (rural area)].

Obstetric brigade.Obstetric brigade.

Ambulance service - Ambulance service - a special vehicle equipped a special vehicle equipped with medical stretchers and medical equipment and with medical stretchers and medical equipment and designed to provide emergency medical care and designed to provide emergency medical care and transportation of the patient. The main types of transportation of the patient. The main types of ambulance - road, air and water.ambulance - road, air and water.

Selecting a profile brigades depends on the Selecting a profile brigades depends on the following circumstances:following circumstances:

living conditions and the magnitude of the living conditions and the magnitude of the population (rural, small towns, medium and large population (rural, small towns, medium and large cities;cities;

availability of appropriate patient population availability of appropriate patient population (uptake and structure of the calls).(uptake and structure of the calls).

It is necessary to take into account the It is necessary to take into account the fundamental aspects:fundamental aspects:

Medical care on the quality is higher from medical Medical care on the quality is higher from medical assistant.assistant.

If the medical team makes calls that do not require If the medical team makes calls that do not require medical attention, it quickly leads to loss of medical attention, it quickly leads to loss of qualification.qualification.

Paramedical teams work in any circumstances, Paramedical teams work in any circumstances, require medical supervision.require medical supervision.

Away brigade of UMC undertaking the Away brigade of UMC undertaking the following activities:following activities:

Immediate departure and arrival to the Immediate departure and arrival to the patient (the scene) within the time limits set patient (the scene) within the time limits set for the administrative area.for the administrative area.

The diagnosis, implement activities that The diagnosis, implement activities that promote stabilization or improvement of the promote stabilization or improvement of the patient, and, in the presence of medical patient, and, in the presence of medical indications , transporting it to the clinicindications , transporting it to the clinic

Transfer of patients to appropriate medical Transfer of patients to appropriate medical documentation to the duty doctor (the documentation to the duty doctor (the assistant), a hospital health-care setting.assistant), a hospital health-care setting.

Conduct triage (the victims) and the Conduct triage (the victims) and the sequencing of health care for those diseases, sequencing of health care for those diseases, poisoning, injuries and other emergencies.poisoning, injuries and other emergencies.

Software and holding the necessary hygienic Software and holding the necessary hygienic and anti-epidemic measures in due course.and anti-epidemic measures in due course.

Basic requirements for exit brigades of Basic requirements for exit brigades of ambulance to work ambulance to work

Efficiency of work exit brigades.Efficiency of work exit brigades. After receiving the call, the brigade going After receiving the call, the brigade going

out in during 4 minutes.out in during 4 minutes. Brigade UMC arrives to the place of call Brigade UMC arrives to the place of call

on the optimal route and report about on the optimal route and report about arrival in the operational department.arrival in the operational department.

Brigade UMC spends the minimum time Brigade UMC spends the minimum time for quality assistance in full (the volume for quality assistance in full (the volume of medical care may be reduced only in an of medical care may be reduced only in an emergency).emergency).

The brigade UMC immediately report The brigade UMC immediately report about execution of call. about execution of call.

The quality of medical care controls these The quality of medical care controls these persons:persons:

Head of sub-stations (departments) of medical Head of sub-stations (departments) of medical documents (call card, returnable coupons documents (call card, returnable coupons accompanying sheet) andaccompanying sheet) and in the control exits.in the control exits.

Senior doctors of operative department (tactical Senior doctors of operative department (tactical decisions of exit brigades).decisions of exit brigades).

Doctors of bureau hospitalization (tactical Doctors of bureau hospitalization (tactical decisions of exit brigade).decisions of exit brigade).

Senior doctors-specialists of station (by medical Senior doctors-specialists of station (by medical documents).documents).

Assistant of Chief doctor of medical field (of Assistant of Chief doctor of medical field (of medical documents).medical documents).

Medical-control commission of the station Medical-control commission of the station assigned to the order of the chief physician.assigned to the order of the chief physician.

Quality of registration of medical Quality of registration of medical documents checked below listed documents checked below listed individuals and committees:individuals and committees:

Heads of sub-stations (departments).Heads of sub-stations (departments). Doctors of bureau hospital (accompanying Doctors of bureau hospital (accompanying

sheet).sheet). Assistant of chief physician at the medical Assistant of chief physician at the medical

field (selective).field (selective). Commission on the audit of the departments Commission on the audit of the departments

appointed by the Chief.appointed by the Chief.

Ensuring health care quality in the service Ensuring health care quality in the service NSRNSR

Quality of care (ILC) - a set of features Quality of care (ILC) - a set of features satisfying the needs of citizens in the satisfying the needs of citizens in the effective prevention and treatment of effective prevention and treatment of diseases, improving the quality of life and diseases, improving the quality of life and increase its duration.increase its duration.

Health Care Quality Assurance is aimed at Health Care Quality Assurance is aimed at obtaining the maximum possible given the obtaining the maximum possible given the current level of knowledge of the results for current level of knowledge of the results for the improvement of public health with a the improvement of public health with a minimum (optimal) expenditure of funds.minimum (optimal) expenditure of funds.

Commission's evaluation criteria are:Commission's evaluation criteria are: accessibility;accessibility; adequacy;adequacy; continuity;continuity; effectiveness;effectiveness; efficiency;efficiency; focus on the patient;focus on the patient; security;security; timeliness.timeliness.

Indicators of quality of care -Indicators of quality of care -

—— A numerical indicators used to assess medical A numerical indicators used to assess medical care, indirectly reflect the quality of its basic care, indirectly reflect the quality of its basic components: the structure, processes and components: the structure, processes and outcomes. The value of quality indicators outcomes. The value of quality indicators expressed as a percentage of the threshold expressed as a percentage of the threshold (target or acceptable) values. Development and (target or acceptable) values. Development and implementation of quality indicators is a implementation of quality indicators is a methodologically complicated process, but their methodologically complicated process, but their use can identify problems and irregularities of use can identify problems and irregularities of technology at different levels in the activities of technology at different levels in the activities of physicians, institutions and industry in general. physicians, institutions and industry in general. Analysis of these indicators can help you develop Analysis of these indicators can help you develop ways to improve the quality of care.ways to improve the quality of care.

We are currently performing the development of We are currently performing the development of quality indicators for service SMEs and explores quality indicators for service SMEs and explores the possibility of their implementation.the possibility of their implementation.

Clinical practice guidelines of professional Clinical practice guidelines of professional societies, standards and plans for patient societies, standards and plans for patient management as the basis of the medical management as the basis of the medical

processprocess Clinical guidelines - a systematically Clinical guidelines - a systematically

developed a document containing developed a document containing information on prevention, diagnosis, information on prevention, diagnosis, treatment of specific diseases and syndromes treatment of specific diseases and syndromes and helps your doctor make good clinical and helps your doctor make good clinical decisions.decisions.

Clinical guidelines developed by Clinical guidelines developed by professional international and national healthprofessional international and national health NGOsNGOs..

Standards of care Standards of care applicable to the RK and applicable to the RK and approved by health authorities, determine the approved by health authorities, determine the recommended minimum amount of care and recommended minimum amount of care and treatment time. These documents are used for treatment time. These documents are used for economic calculations, but not as guidelines for economic calculations, but not as guidelines for the management of patients.the management of patients.

Based on Based on CDCD and in accordance with its human and in accordance with its human

and material capacity of health institutions at and material capacity of health institutions at various levels can make plans (protocols) of various levels can make plans (protocols) of patients with established disease. Their patients with established disease. Their implementation allows to reduce the cost of implementation allows to reduce the cost of treatment due to cost optimization, improve treatment due to cost optimization, improve patient safety, reduce the incidence of patient safety, reduce the incidence of complications and reduce treatment time.complications and reduce treatment time.

The regulation of service SMEsThe regulation of service SMEs State regulation of relations arising in the State regulation of relations arising in the

provision of UMC, by authority of executive provision of UMC, by authority of executive power, with responsibility for implementing the power, with responsibility for implementing the licensing service UMC, state control of quality of licensing service UMC, state control of quality of care.care.

Organizational-methodical management of the Organizational-methodical management of the service provided by the Ministry of Health and service provided by the Ministry of Health and Social Development of the RK, health authorities.Social Development of the RK, health authorities.

In order to improve UaEMC (Urgent and In order to improve UaEMC (Urgent and emergency medical care) and improve the quality emergency medical care) and improve the quality of services to the population of the RK, of services to the population of the RK, strengthening its regulatory framework, strengthening its regulatory framework, published by Order № 756 of 16.08.2001 "On published by Order № 756 of 16.08.2001 "On measures to improve emergency medical care to measures to improve emergency medical care to the population of the RK" Agency for Health the population of the RK" Agency for Health Affairs, which approved the Rules of station Affairs, which approved the Rules of station (department(department

NSR, Rules of call an ambulance, Regulations NSR, Rules of call an ambulance, Regulations and Instructions.and Instructions.

SMP station operates its activity according to the SMP station operates its activity according to the Order № 511 of Ministry of Health ot17.08.2007 Order № 511 of Ministry of Health ot17.08.2007 "The activities of organizations that provide "The activities of organizations that provide emergency medical care to the population of the emergency medical care to the population of the RK."RK."

Annex to the Order № 511 - "Regulations on Annex to the Order № 511 - "Regulations on the activities of health care organizations that the activities of health care organizations that provide emergency medical care."provide emergency medical care."

The most important regulatory documents of The most important regulatory documents of stations are include:stations are include:

The job descriptions of employees stations The job descriptions of employees stations (offices)(offices)

The position of station units, approved by the The position of station units, approved by the director (chief physician)director (chief physician)

Orders, regulations governing the forms of plantOrders, regulations governing the forms of plant House rulesHouse rules The collective agreement between management The collective agreement between management

and trade union committee of the station on the and trade union committee of the station on the main directions of socio-economic protection of main directions of socio-economic protection of workersworkers

Documentation of Ambulance ServiceDocumentation of Ambulance Service Map of the call - № 220u, approved by Order № 332 Map of the call - № 220u, approved by Order № 332

from 2005.from 2005. Accompanying sheet - № 110uAccompanying sheet - № 110u Signal list Signal list №№110 1 / y110 1 / y Journal of incoming calls - № 109 / eJournal of incoming calls - № 109 / e Notice - approved ATS Notice - approved ATS №№193 / y193 / y The report of the deathThe report of the death Journal of the senior doctor on dutyJournal of the senior doctor on duty journal of emergencyjournal of emergency Journal of the comments on the cards callsJournal of the comments on the cards calls Register of infectious diseases № 13-10Register of infectious diseases № 13-10 Record Book of narcotic and psychotropic Record Book of narcotic and psychotropic

substancessubstances Journal of "hot line"Journal of "hot line" The log of complaints and suggestionsThe log of complaints and suggestions

RULES RULES of station (department) of station (department) emergency medical careemergency medical care

Station emergency medical care is a medical Station emergency medical care is a medical organization providing free round the clock organization providing free round the clock ambulance and emergency medical assistance to ambulance and emergency medical assistance to adults and children with life-threatening adults and children with life-threatening conditions, accidents, acute serious diseases, like conditions, accidents, acute serious diseases, like at the scene and in route.at the scene and in route.

The main principles are:The main principles are: full availability to the public;full availability to the public; efficiency in work and timeliness of care;efficiency in work and timeliness of care; completeness of the volume and the high completeness of the volume and the high

qualification;qualification; ensuring smooth admission to the appropriate ensuring smooth admission to the appropriate

medical organizations.medical organizations.

The concept of "emergency" medical care The concept of "emergency" medical care includes emergency removal of all pathological includes emergency removal of all pathological conditions of emergency arising unexpectedly conditions of emergency arising unexpectedly due to external and internal factors that are due to external and internal factors that are independent of severity of the condition independent of severity of the condition requiring immediate diagnosis and treatment requiring immediate diagnosis and treatment activities.activities.

The concept of "emergency state" The concept of "emergency state" shall shall establish the pathological changes in the human establish the pathological changes in the human body that lead to a sharp deterioration in health body that lead to a sharp deterioration in health and can be life threatening. At their treatment is and can be life threatening. At their treatment is required an aggregate of emergency medical required an aggregate of emergency medical interventions that can not be postponed.interventions that can not be postponed.

Schedule time out teams:Schedule time out teams: by ambulance, to 4 minutes;by ambulance, to 4 minutes; for emergency traffic - up to 30 minutes;for emergency traffic - up to 30 minutes; on the planned traffic - in during 90 minutes.on the planned traffic - in during 90 minutes.

Station emergency medical care is organized in Station emergency medical care is organized in cities, district centers with populations over 30 cities, district centers with populations over 30 thousand people.thousand people.

In cities with smaller populations organized In cities with smaller populations organized emergency department and urgent medical care emergency department and urgent medical care in urban and central district and other hospitals.in urban and central district and other hospitals.

In big cities and district centers in the In big cities and district centers in the emergency stations and emergency care are emergency stations and emergency care are organized substation with a 15-minute organized substation with a 15-minute calculation of accessibility.calculation of accessibility.

In the cities and district centers with populations In the cities and district centers with populations of more than 70 thousand inhabitants should be of more than 70 thousand inhabitants should be allocated a team to provide medical care for allocated a team to provide medical care for children's population, over 100 thousand - the children's population, over 100 thousand - the brigade is organized to provide emergency care brigade is organized to provide emergency care to patients with severe mental disorders.to patients with severe mental disorders.

Station (Department) emergency medical Station (Department) emergency medical assistance should be provided by local assistance should be provided by local telephone connection from the input rate of 2 telephone connection from the input rate of 2 per 100 thousand people, but not less than 2 per 100 thousand people, but not less than 2 inputs, with radio and direct outreach - from inputs, with radio and direct outreach - from medical institutions, agencies of the Ministry medical institutions, agencies of the Ministry of Interior, divisions Agency for Emergency of Interior, divisions Agency for Emergency Situations.Situations.

The residence time of emergency teams and The residence time of emergency teams and emergency care in a hospital emergency emergency care in a hospital emergency room less than 10 minutes (time to transfer a room less than 10 minutes (time to transfer a sick or injured on duty doctor-patient).sick or injured on duty doctor-patient).

For the station (office) emergency medical For the station (office) emergency medical assistance is allocated an ambulance with a assistance is allocated an ambulance with a stretcher for every 10,000 people.stretcher for every 10,000 people.

RULESRULESof call emergency medical careof call emergency medical care

Brigade Station (Branch) emergency medical Brigade Station (Branch) emergency medical aid is sent aid is sent for emergency treatment:for emergency treatment:

accidents;accidents; Sudden life-threatening diseases.Sudden life-threatening diseases.

Assists and makes transportation Assists and makes transportation to to specialized health care organizations:specialized health care organizations:

childbirth and complications of pregnancy;childbirth and complications of pregnancy; children under 1 year;children under 1 year; acute exacerbation and various chronic diseases acute exacerbation and various chronic diseases

associated with rapidly deteriorating health;associated with rapidly deteriorating health; patients, on call doctors, in need of medical care patients, on call doctors, in need of medical care

in transit and transport stretcher, at health in transit and transport stretcher, at health issues, needing to transport medical issues, needing to transport medical transportation.transportation.

Ambulance does not accept the call Ambulance does not accept the call and not leave in the following cases:and not leave in the following cases:

to patients at home, not in need of emergency to patients at home, not in need of emergency medical aid in time of polyclinics and family medical aid in time of polyclinics and family doctors' clinics;doctors' clinics;

for the examination and making the act of death;for the examination and making the act of death; for doctors and prescriptions of the planned for doctors and prescriptions of the planned

treatment;treatment; of providing advisory services to healthcare of providing advisory services to healthcare

organizations;organizations; for the delivery of patients home from hospitals.for the delivery of patients home from hospitals.

InformationInformation on hospitalization of on hospitalization of patients affected and provides round the clock patients affected and provides round the clock help desk station.help desk station.

POSITION POSITION ofof performance of the stations performance of the stations ((offices) offices)

ofof emergency medical care emergency medical care

To improve accounting and reporting forms and To improve accounting and reporting forms and simplify them without reducing the information simplify them without reducing the information content introduced key performance indicators content introduced key performance indicators for for single stations (department), urgent single stations (department), urgent and emergency care in the Republic of and emergency care in the Republic of Kazakhstan:Kazakhstan:

Total hits:Total hits: the absolute number -the absolute number - per 1000 population – from them to children per 1000 population – from them to children

under 14 years:under 14 years: the absolute number -the absolute number - per 1000 population -per 1000 population -

Unsuccessful (in%);Unsuccessful (in%); rejected as ungrounded - (in%):rejected as ungrounded - (in%):

Rendered medical assistance, including in Rendered medical assistance, including in connection with:connection with:

In accidents:In accidents: the absolute number -the absolute number - Percentage -Percentage - 1,000 calls –1,000 calls – Sudden illness:Sudden illness: the absolute number -the absolute number - Percentage –Percentage – 1,000 calls –1,000 calls – Emergency transportation:Emergency transportation: the absolute number -the absolute number - Percentage –Percentage – 1,000 calls –1,000 calls – Childbirth and disorders of pregnancy:Childbirth and disorders of pregnancy: the absolute number -the absolute number - Percentage -Percentage - 1,000 calls –1,000 calls –

Served an outpatient basis:Served an outpatient basis: the absolute number -the absolute number - in% of patients who were assisted.in% of patients who were assisted. The number of calls which performed The number of calls which performed

late: late: the absolute number -the absolute number - inin % % 1,000 calls –1,000 calls –Of these, "first aid":Of these, "first aid": absolute number-absolute number- percentagepercentage 1,000 calls1,000 calls Referral to hospital:Referral to hospital: the absolute number -the absolute number - in% of patients who were assisted.in% of patients who were assisted. 1,000 calls1,000 calls Hospitalized:Hospitalized: the absolute number -the absolute number - in% of the number delivered in a hospitalin% of the number delivered in a hospital 11,,000000 calls calls Coincidence with diagnoses stations:Coincidence with diagnoses stations: inin % % 11,,000 000 callscalls

To day mortality in a hospital:To day mortality in a hospital: the absolute number ofthe absolute number of in% of total admissionsin% of total admissions 1000 Call1000 CallRepeated calls because of fault of Repeated calls because of fault of

medical staff:medical staff: the absolute number ofthe absolute number of inin % % 1000 1000 callcallChallenges in working hours of health Challenges in working hours of health

clinics:clinics: the absolute numberthe absolute number 100 100 callcall

Qualifying feature Qualifying feature specialist physician of emergency medical specialist physician of emergency medical

carecare

General knowledge:General knowledge: basic legislation on public health and policy basic legislation on public health and policy

documents defining the activities and health documents defining the activities and health care;care;

basis for the organization of emergency basis for the organization of emergency assistance, the basic documents governing its assistance, the basic documents governing its work, the rights and duties of staff Brigade of work, the rights and duties of staff Brigade of First Aid Station, the structure of morbidity in First Aid Station, the structure of morbidity in the ambulance service, basics of labor rights and the ambulance service, basics of labor rights and health;health;

basis resuscitation: basic techniques for basis resuscitation: basic techniques for resuscitation at sudden cardiac arrest, acute resuscitation at sudden cardiac arrest, acute respiratory failure, allergic, comatose states, respiratory failure, allergic, comatose states, with hanging, drowning, electric shock, with hanging, drowning, electric shock, especially intensive care in children and infants;especially intensive care in children and infants;

basis of general anesthesia, used for pre-basis of general anesthesia, used for pre-hospital;hospital;

basics of diagnosis and emergency care in urgent basics of diagnosis and emergency care in urgent situations in the clinic of Internal Medicine (for situations in the clinic of Internal Medicine (for cardiovascular diseases, diseases of the cardiovascular diseases, diseases of the respiratory tract, diseases of abdominal organs, respiratory tract, diseases of abdominal organs, endocrine diseases, blood diseases, allergic endocrine diseases, blood diseases, allergic diseases);diseases);

basics of diagnosis and emergency care for acute basics of diagnosis and emergency care for acute diseases and injuries of the abdominal cavity;diseases and injuries of the abdominal cavity;

basics of diagnosis and emergency care for basics of diagnosis and emergency care for injuries of the musculoskeletal system;injuries of the musculoskeletal system;

basisbasis of emergency at acute diseases and injuries of emergency at acute diseases and injuries of ear, nose and throat;of ear, nose and throat;

basis of emergency at acute injuries and diseases basis of emergency at acute injuries and diseases of the nervous system;of the nervous system;

Basis of emergency at acute eye diseases and Basis of emergency at acute eye diseases and injuries;injuries;

general principles of emergency care for general principles of emergency care for obstetric and gynecological pathology;obstetric and gynecological pathology;

general principles of emergency care for mental general principles of emergency care for mental illnesses;illnesses;

basis of emergency for acute exogenous basis of emergency for acute exogenous poisoning;poisoning;

basis of emergency under the thermal lesions;basis of emergency under the thermal lesions; basis of emergency with infectious diseases;basis of emergency with infectious diseases; basis of emergency for acute diseases and basis of emergency for acute diseases and

injuries in urology;injuries in urology;

General Skills:General Skills: obtain information about the disease;obtain information about the disease; to apply objective methods of examination of the to apply objective methods of examination of the

patient, to identify common and specific patient, to identify common and specific symptoms of the disease;symptoms of the disease;

assess the severity of the patient, the cause of assess the severity of the patient, the cause of this condition;this condition;

define the scope and sequence of resuscitation, define the scope and sequence of resuscitation, provide necessary medical care;provide necessary medical care;

determine the needing of application of special determine the needing of application of special methods of investigation (electrocardiography), methods of investigation (electrocardiography), to perform and to interpret;to perform and to interpret;

justify the serial diagnosis, plan and tactics of justify the serial diagnosis, plan and tactics of the patient, evidence of hospitalizations, provide the patient, evidence of hospitalizations, provide transportation to the hospital;transportation to the hospital;

arrange medical documentation provided by the arrange medical documentation provided by the legislation on health care.legislation on health care.

Special skills:Special skills:     In the intensive care ambulance, surgeon      In the intensive care ambulance, surgeon

should know and be able to:should know and be able to: clinical and pharmacological study of the use of clinical and pharmacological study of the use of

the mediator (M-and H-cholinomimetics and the mediator (M-and H-cholinomimetics and holinilitics, alpha and beta - agonists and holinilitics, alpha and beta - agonists and blockers), antiarrhythmics, narcotic analgesics, blockers), antiarrhythmics, narcotic analgesics, devices used for infusion therapy;devices used for infusion therapy;

indications and methods of resuscitation, the indications and methods of resuscitation, the conditions out of it, features of resuscitation in conditions out of it, features of resuscitation in children and infants;children and infants;

reasons for the development, classification and reasons for the development, classification and treatment of allergic and comatose states;treatment of allergic and comatose states;

features of reanimation and intensive care units features of reanimation and intensive care units in drowning, hanging in;in drowning, hanging in;

major components of general anesthesia, used in major components of general anesthesia, used in the prehospital phase, the mechanism of action the prehospital phase, the mechanism of action and methods of use of nitrous oxide, Trillo, and methods of use of nitrous oxide, Trillo, ftorotana, barbiturates, hydroxybutyrate, sodium, ftorotana, barbiturates, hydroxybutyrate, sodium, ketamine, drugsketamine, drugs

neyroleptoanalgesia, pharmacodynamics, and ways neyroleptoanalgesia, pharmacodynamics, and ways to use local anesthetics;to use local anesthetics;

Inhalation of anesthesia equipment and its Inhalation of anesthesia equipment and its characteristics and operation;characteristics and operation;

equipment for ventilation, its characteristics and equipment for ventilation, its characteristics and operation.operation.

In the emergency state in the internal medicine In the emergency state in the internal medicine

clinic, in emergency room physician needs to clinic, in emergency room physician needs to know:know: diagnosis and emergency care in coronary artery diagnosis and emergency care in coronary artery

disease, its modern classification, diagnosis of disease, its modern classification, diagnosis of angina, myocardial infarction and its angina, myocardial infarction and its complications, the principles of intensive complications, the principles of intensive therapy;therapy;

diagnosis and treatment of emergency conditions diagnosis and treatment of emergency conditions in the inflammatory, degenerative lesions, heart in the inflammatory, degenerative lesions, heart defects and cardiomyopathy;defects and cardiomyopathy;

diagnosis and emergency treatment for diagnosis and emergency treatment for arrhythmia and heart block;arrhythmia and heart block;

diagnosis and emergency treatment for arterial diagnosis and emergency treatment for arterial hypertension;hypertension;

methods of recording and transcript of the methods of recording and transcript of the electrocardiogram and its patterns of electrocardiogram and its patterns of myocardial infarction, rhythm disturbances myocardial infarction, rhythm disturbances and reducibility;and reducibility;

diagnosis and emergency treatment at diagnosis and emergency treatment at pneumonia, acute obstructive pneumonia, acute obstructive laryngotracheitis, pulmonary embolism, laryngotracheitis, pulmonary embolism, bronchial asthma and asthmaticus status;bronchial asthma and asthmaticus status;

diagnosis and emergency care with diagnosis and emergency care with spontaneous pneumothorax and pulmonary spontaneous pneumothorax and pulmonary hemorrhage;hemorrhage;

diagnosis and emergency care for peptic ulcer diagnosis and emergency care for peptic ulcer and its complications, diseases of the and its complications, diseases of the esophagus (hiatal hernia, changes in varicose esophagus (hiatal hernia, changes in varicose veins);veins);

epidemiology of hepatitis A and B, Approach to epidemiology of hepatitis A and B, Approach to the Patient with their diagnosis, acute care in the Patient with their diagnosis, acute care in hepatic coma;hepatic coma;

diagnosis and emergency care for gallstone diagnosis and emergency care for gallstone disease, acute pancreatitis, indications for disease, acute pancreatitis, indications for hospitalization;hospitalization;

diagnosis and emergency care for acute diagnosis and emergency care for acute pyelonephritis, urolithiasis, uremic coma;pyelonephritis, urolithiasis, uremic coma;

medical diagnosis and tactics in aneurysm of medical diagnosis and tactics in aneurysm of the abdominal aorta;the abdominal aorta;

diagnosis and emergency care for patients diagnosis and emergency care for patients with diabetes (hypoglycemic condition, with diabetes (hypoglycemic condition, diabetic acidosis);diabetic acidosis);

diagnosis and emergency care in diagnosis and emergency care in pheochromocytoma, adrenal insufficiency;pheochromocytoma, adrenal insufficiency;

diagnosis and emergency care in hypothyroid diagnosis and emergency care in hypothyroid coma, and thyrotoxicosis;coma, and thyrotoxicosis;

urgent status at hematocytoblastdoses and urgent status at hematocytoblastdoses and hemorrhagic diathesis.hemorrhagic diathesis.

IIn the field of emergency conditions in acute n the field of emergency conditions in acute diseases and injuries of abdominal and diseases and injuries of abdominal and thoracic, physician joint ventures must thoracic, physician joint ventures must know:know: diagnosis and tactics in acute appendicitis, diagnosis and tactics in acute appendicitis,

especially in pregnancy diagnosis, childhood especially in pregnancy diagnosis, childhood and old age;and old age;

diagnosis and tactics in strangulated hernia,diagnosis and tactics in strangulated hernia, the most common complications;the most common complications;

diagnosis and tactics in acute intestinal diagnosis and tactics in acute intestinal obstruction, disorders of homeostasis and obstruction, disorders of homeostasis and methods of their correction;methods of their correction;

diagnosis and tactics in damage to the diagnosis and tactics in damage to the stomach, hospital injuries of parenchymatous stomach, hospital injuries of parenchymatous and hollow organs, especially in the diagnosis and hollow organs, especially in the diagnosis of closed injuries of the abdomen;of closed injuries of the abdomen;

diagnosis and emergency care for injuries of diagnosis and emergency care for injuries of the chest, the mechanisms of ODN, the the chest, the mechanisms of ODN, the principles of treatment of various types of principles of treatment of various types of pneumothorax, hemothorax in tactics, pneumothorax, hemothorax in tactics, emergency on pre-hospital.emergency on pre-hospital.

In the field of traumatology emergency In the field of traumatology emergency doctor needs to know:doctor needs to know: structure damage due to injuries of the structure damage due to injuries of the

musculoskeletal system, the value of pain and musculoskeletal system, the value of pain and anti-shock;anti-shock;

diagnosis and emergency care for soft tissue diagnosis and emergency care for soft tissue injuries, fractures and dislocations;injuries, fractures and dislocations;

diagnosis and features of emergency care at diagnosis and features of emergency care at injuries of the pelvis and spine;injuries of the pelvis and spine;

classification of open lesions, classification of classification of open lesions, classification of wounds and their treatment methods and ways wounds and their treatment methods and ways of preventing;of preventing;

infection;infection; Features of diagnosis, principles of Features of diagnosis, principles of

travmatogenez with combined injuries, travmatogenez with combined injuries, medical events on pre-hospital;medical events on pre-hospital;

features of features of injuries of locomotor apparatus in injuries of locomotor apparatus in children.children.

In the field of emergency conditions in diseases In the field of emergency conditions in diseases and injuries of the ear, nose and throat, and injuries of the ear, nose and throat, physician of joint ventures must know:physician of joint ventures must know: principles of diagnosis and treatment of wounds principles of diagnosis and treatment of wounds

and foreign bodies;and foreign bodies; diagnosis and emergency care for fractures of diagnosis and emergency care for fractures of

the nasal bones, nasal bleeding, intracranial the nasal bones, nasal bleeding, intracranial complications of diseases of the nose and complications of diseases of the nose and paranasal sinuses (meningitis, brain abscess);paranasal sinuses (meningitis, brain abscess);

diagnosis and emergency care for injuries of the diagnosis and emergency care for injuries of the pharynx, larynx and esophagus, suppurative pharynx, larynx and esophagus, suppurative processes and foreign bodies.processes and foreign bodies.

In the field of emergency conditions in In the field of emergency conditions in injuries and diseases of the nervous system, injuries and diseases of the nervous system, physician joint ventures must know:physician joint ventures must know:

classification and diagnosis of traumatic brain classification and diagnosis of traumatic brain injury. The clinical course of different types of injury. The clinical course of different types of komotsionno-contusion syndrome, general komotsionno-contusion syndrome, general principles of treatment in pre-hospital ;principles of treatment in pre-hospital ;

classification and diagnosis of spinal cord injury, classification and diagnosis of spinal cord injury, treatment guidelines, particularly treatment guidelines, particularly transportation;transportation;

classification, diagnosis and treatment of classification, diagnosis and treatment of convulsive states, peculiarities of development convulsive states, peculiarities of development in children;in children;

classification, diagnosis and emergency care classification, diagnosis and emergency care in acute disorders of cerebral circulation;in acute disorders of cerebral circulation;

diagnosis and emergency care for acute diagnosis and emergency care for acute inflammatory diseases of the brain and spinal inflammatory diseases of the brain and spinal cord and its membranes.cord and its membranes.

In the field of emergency conditions in In the field of emergency conditions in

diseases and injuries of the eye, emergency diseases and injuries of the eye, emergency doctor needs to know:doctor needs to know: symptoms and emergency care in an acute symptoms and emergency care in an acute

attack of glaucoma;attack of glaucoma; characterization of wounds and burns of eyes, characterization of wounds and burns of eyes,

the principles of emergency care, indications the principles of emergency care, indications for hospitalization.for hospitalization.

In the field of urgent conditions in obstetric-In the field of urgent conditions in obstetric-gynecology, physician joint ventures must gynecology, physician joint ventures must know:know: etiology, pathogenesis and clinic abortion etiology, pathogenesis and clinic abortion

pregnant, emergency care for eclampsia;pregnant, emergency care for eclampsia; diagnosis and emergency care in abortion and diagnosis and emergency care in abortion and

premature delivery, the pathogenesis of premature delivery, the pathogenesis of hemorrhage in preterm labor;hemorrhage in preterm labor;

general principles of management of labor general principles of management of labor outside the hospital;outside the hospital;

diagnosis of bleeding in late pregnancy, diagnosis of bleeding in late pregnancy, childbirth and the postpartum period;childbirth and the postpartum period;

pathogenesis of hemorrhagic shock in obstetrics, pathogenesis of hemorrhagic shock in obstetrics, the principles of intensive therapy;the principles of intensive therapy;

clinical manifestations of septic disease clinical manifestations of septic disease (metroendometritis, peritonitis), and emergency (metroendometritis, peritonitis), and emergency care for them;care for them;

diagnosis and emergency care for an ectopic diagnosis and emergency care for an ectopic pregnancy, ovarian apoplexy and dysfunctional pregnancy, ovarian apoplexy and dysfunctional uterine bleeding;uterine bleeding;

diagnosis and tactics in acute inflammatory diagnosis and tactics in acute inflammatory diseases of female genital mutilation.diseases of female genital mutilation.

In the emergency conditions of mental In the emergency conditions of mental illness, JV doctor needs to know:illness, JV doctor needs to know: clinical psychiatric syndromes, their clinical psychiatric syndromes, their

classification, principles of emergency care;classification, principles of emergency care; clinical manifestations of schizophrenia and clinical manifestations of schizophrenia and

acute care in the prehospital phase in its acute care in the prehospital phase in its aggravations;aggravations;

diagnosis and emergency care for alcohol diagnosis and emergency care for alcohol psychosis, manic-depressive psychosis;psychosis, manic-depressive psychosis;

arreactive statesarreactive statesIn the field of toxicology physician joint In the field of toxicology physician joint

ventures must know:ventures must know: classification of poisons on toxicity, the main classification of poisons on toxicity, the main

factors determining the severity of poisoning;factors determining the severity of poisoning; classification of acute poisoning, pathological classification of acute poisoning, pathological

syndromes in acute poisoning, current syndromes in acute poisoning, current treatment guidelines;treatment guidelines;

Toxicology especially in childhood, clinical Toxicology especially in childhood, clinical features of acute poisoning in elderly and features of acute poisoning in elderly and senile age.senile age.

In the field of emergency at thermal lesions In the field of emergency at thermal lesions physician of SP needs to know:physician of SP needs to know: general information on burns, their general information on burns, their

classification, the periods of burn disease, classification, the periods of burn disease, pathogenesis and clinic of burn shock;pathogenesis and clinic of burn shock;

methods of intensive therapy;methods of intensive therapy; diagnosis and emergency care when the sun diagnosis and emergency care when the sun

and heat stroke, the general cooling and and heat stroke, the general cooling and frostbite.frostbite.

In the field of emergency conditions in In the field of emergency conditions in

infectious diseases physician joint ventures infectious diseases physician joint ventures must know:must know: etiology and epidemiology, diagnosis and etiology and epidemiology, diagnosis and

emergency care at tifoparatifoz diseases;emergency care at tifoparatifoz diseases; salmonellosis, nutritional diseases, botulism, salmonellosis, nutritional diseases, botulism,

influenza and its complications, and influenza and its complications, and diphtheria;diphtheria;

diagnosis and emergency care with diagnosis and emergency care with meningococcal infection, meningitis, meningococcal infection, meningitis, encephalitis, tetanus;encephalitis, tetanus;

medical tactics, self-protection measures in medical tactics, self-protection measures in particularly dangerous and quarantine particularly dangerous and quarantine infections (cholera,infections (cholera,

plague, anthrax, AIDS);plague, anthrax, AIDS); features of the course and first aid for infectious features of the course and first aid for infectious

diseases in newborns.diseases in newborns.

In the field of emergency conditions in acute In the field of emergency conditions in acute diseases and injuries in urology should know:diseases and injuries in urology should know: semiotics of urological diseases, urgent care, in semiotics of urological diseases, urgent care, in

acute urinary retention;acute urinary retention; basics of diagnosis and emergency care in basics of diagnosis and emergency care in

inflammatory diseases of genital organs in men;inflammatory diseases of genital organs in men; basics of diagnosis and emergency care for basics of diagnosis and emergency care for

injuries of urinary tract.injuries of urinary tract.

Manipulation:Manipulation: endotracheal intubation;endotracheal intubation; aspiration of fluid from the respiratory tract;aspiration of fluid from the respiratory tract; ventilation without devices and machines with ventilation without devices and machines with

a "Lada", "Pneumatic", AN-8, DN-10;a "Lada", "Pneumatic", AN-8, DN-10; closed cardiac massage;closed cardiac massage; puncture of peripheral veins;puncture of peripheral veins; venesection;venesection; inhalation of oxygen;inhalation of oxygen; nitrous oxide anesthesia, analgesia trilen;nitrous oxide anesthesia, analgesia trilen; gastric lavage;gastric lavage; tracheostomy and konikotomiya;tracheostomy and konikotomiya; technique of recordings and transcriptions of technique of recordings and transcriptions of

the electrocardiogram;the electrocardiogram; technology cardioversion (defibrillation of the technology cardioversion (defibrillation of the

heart) techniques to temporarily stop bleeding;heart) techniques to temporarily stop bleeding; puncture of pleural cavity with air-and puncture of pleural cavity with air-and

hemothorax;hemothorax;

Transport immobilization;Transport immobilization; implementation of closure: vagosimpatic, implementation of closure: vagosimpatic,

paravertebral, sakrospinal by Shkolnikov, paravertebral, sakrospinal by Shkolnikov, blockade of the femoral and sciatic nerve;blockade of the femoral and sciatic nerve;

execution of case anesthesia;execution of case anesthesia; imposition of bandage turbans, anterior and imposition of bandage turbans, anterior and

posterior tamponade in nasal posterior tamponade in nasal hemorrhages.hemorrhages.

INSTRUCTIONS INSTRUCTIONS equipping specialized mobile teams (teams of equipping specialized mobile teams (teams of

intensive care) station (office) NSRintensive care) station (office) NSR StretcherStretcher A set of transport busesA set of transport buses

Chance collar, hard headholderChance collar, hard headholder bus Dieterichsbus Dieterichs bus Cramerbus Cramer bus Yelanskayabus Yelanskaya Shield for patients with damage to the spine Shield for patients with damage to the spine

and pelvisand pelvis A set of sanitary equipment:A set of sanitary equipment:

pillowpillow pillowcasepillowcase sheetssheets sterile sheetssterile sheets

towelstowels blanketblanket scarves medicalscarves medical capacity to collect vomitcapacity to collect vomit probe for gastric lavageprobe for gastric lavage

Sterile generic package (set)Sterile generic package (set) including:including: Kocher's forcepsKocher's forceps scissorsscissors pupochnicspupochnics wipeswipes ligatureligature diaperdiaper pear rubberpear rubber portable electrocardiographportable electrocardiograph Electric current converterElectric current converter Apparatus for feeding anesthetic nitrous oxideApparatus for feeding anesthetic nitrous oxide Breathing apparatus manualBreathing apparatus manual pneumo-oxygenatorpneumo-oxygenatorSet for intubation:Set for intubation: laryngoscopelaryngoscope replacement Bladesreplacement Blades tracheal tubes of different sizestracheal tubes of different sizes adaptersadapters

conductors - mandrinconductors - mandrin gaggag glossotiltglossotilt ductsducts

Device for transferring liquids in the machineDevice for transferring liquids in the machine Apparatus for measuring blood pressureApparatus for measuring blood pressure Set for an ambulance in the box - installation:Set for an ambulance in the box - installation: medicinesmedicines

strophanthin 0.05% to 1.0 ml in amp.strophanthin 0.05% to 1.0 ml in amp. Korglikon 0.06% to 1.0 ml in amp.Korglikon 0.06% to 1.0 ml in amp. adrenaline g / x 0.1% 1.0 lm in amp.adrenaline g / x 0.1% 1.0 lm in amp. norepinephrine 0.2% 1.0 ml in ampnorepinephrine 0.2% 1.0 ml in amp naloxone in 2.0 ml in amp.naloxone in 2.0 ml in amp. Lasix 20 mg 2.0 mlLasix 20 mg 2.0 ml atropine 0.1% 1.0 ml in amp.atropine 0.1% 1.0 ml in amp. dipiroksim 15% in 1.0 ml in amp.dipiroksim 15% in 1.0 ml in amp. pentamin 5% to 1.0 ml in amp.pentamin 5% to 1.0 ml in amp. benzogeksony 2.5% 1.0 ml in amp.benzogeksony 2.5% 1.0 ml in amp. chlorpromazine 2.5% 2.0 ml in amp.chlorpromazine 2.5% 2.0 ml in amp. vikasol 1% to 1.0 ml in amp.vikasol 1% to 1.0 ml in amp. diphenhydramine 1% 1.0 ml in ampdiphenhydramine 1% 1.0 ml in amp pipolfen 2.5% 2.0 ml in amppipolfen 2.5% 2.0 ml in amp

ascorbic acid 5% in 1.0 ml ampoulesascorbic acid 5% in 1.0 ml ampoulespromedol 2% 1.0 mlpromedol 2% 1.0 mlPanangin 10.0 ml in amp.Panangin 10.0 ml in amp.lidocaine 2% 2.0 ml in amp.lidocaine 2% 2.0 ml in amp.Mannitol 30.0 vialsMannitol 30.0 vialsfentanyl 0.005% to 2.0 ml in amp.fentanyl 0.005% to 2.0 ml in amp.Droperidol 25 mg of 10.0 ml vialDroperidol 25 mg of 10.0 ml vialRelanium (seduksen) 0.5% ml in amp.Relanium (seduksen) 0.5% ml in amp.sodium chloride 0.9% 5.0 ml in amp.sodium chloride 0.9% 5.0 ml in amp.Water for injection to 10.0 ml in amp.Water for injection to 10.0 ml in amp.Glucose 40% 10.0 amp.Glucose 40% 10.0 amp.

maprocaine 2% 5.0 ml in amp.maprocaine 2% 5.0 ml in amp.procaine 0.5% 5.0 ml in amp.procaine 0.5% 5.0 ml in amp.aminophylline 2.4% in 10 ml ampoules.aminophylline 2.4% in 10 ml ampoules.calcium chloride 10% 10.0 ml in amp.calcium chloride 10% 10.0 ml in amp.sodium gluconate 10% 10.0 ml in amp.sodium gluconate 10% 10.0 ml in amp.novokainamid 10% in 5.0 ml in amp.novokainamid 10% in 5.0 ml in amp.verapamil (fenoptin) in 2.0 ml ampoulesverapamil (fenoptin) in 2.0 ml ampoulesobzidan 0.1% PA5 ml in amp.obzidan 0.1% PA5 ml in amp.

unitiol 5% to 5.0 ml in amp.unitiol 5% to 5.0 ml in amp.bemegrit 0.5% 5 ml amp.bemegrit 0.5% 5 ml amp.penicillin 1 million vialspenicillin 1 million vialsheparin (5000 ed.v 1.0 ml) 5.0 ml vialsheparin (5000 ed.v 1.0 ml) 5.0 ml vialsprednisolone 30 ml in amp.prednisolone 30 ml in amp.chloramphenicol 0.5 vialschloramphenicol 0.5 vialsNitroglycerin 1% 10 ml vial 1Nitroglycerin 1% 10 ml vial 1glucose 5% 400.0 ml vialglucose 5% 400.0 ml vial"Disol" to 400.0 ml vial"Disol" to 400.0 ml vial"Atsesol" to 400.0 ml vial"Atsesol" to 400.0 ml vial

ethyl alcohol 33% 10.0 in the bottleethyl alcohol 33% 10.0 in the bottleethyl alcohol 96% 30.0 ml vialethyl alcohol 96% 30.0 ml vialethyl alcohol 70% 10.0 ml vialethyl alcohol 70% 10.0 ml vialHydrogen peroxide 3% 50.0 ml vialHydrogen peroxide 3% 50.0 ml vialiodine 5% alcoholic solution of 30.0 ml vialiodine 5% alcoholic solution of 30.0 ml vialammonia 10% solution of 30.0 ml in vialammonia 10% solution of 30.0 ml in vialpolyglukin to 400.0 ml vialpolyglukin to 400.0 ml vialsodium chloride 0.9% to 400.0 ml vialsodium chloride 0.9% to 400.0 ml vial

Rehydron to 28 grams. packagedRehydron to 28 grams. packagednifedipine 10 mg in the Table.nifedipine 10 mg in the Table.izoket (aerosol)izoket (aerosol)dopamine 0.5% 5.0 ml in amp.dopamine 0.5% 5.0 ml in amp.

bb) dressing) dressingBandage 14cm x 7mBandage 14cm x 7m5m x 10cm Bandage5m x 10cm BandageBandage 5m x 7 cmBandage 5m x 7 cmcotton-gauze padscotton-gauze padsBand-Aid 4cm x 5mBand-Aid 4cm x 5mAbsorbent cotton wool in the gr.Absorbent cotton wool in the gr.

c) tools, health products, etc.c) tools, health products, etc.- stethoscope- stethoscopesyringes for single use 20-gramsyringes for single use 20-gramsyringes for single use 10-gramsyringes for single use 10-gramDisposable syringes 5 gramDisposable syringes 5 gramsyringes for single use 2-gramsyringes for single use 2-gramscissorsscissorstweezerstweezers

clampclampprobe for tamponade of the noseprobe for tamponade of the nosestall metalstall metalmetal spatulametal spatulasilk surgical ampoulessilk surgical ampoulesmedical thermometermedical thermometerbeakerbeaker

rubber band for venipuncturerubber band for venipuncturepipettepipettesystem for blood transfusions and blood products system for blood transfusions and blood products (disposable)(disposable)medical rubber gloves (pair)medical rubber gloves (pair)g) sterile setsg) sterile sets

Tracheotomy set (in sterile packaging), Tracheotomy set (in sterile packaging), including:including:

ScalpelsScalpels hooks tracheotomyhooks tracheotomy surgical tweezerssurgical tweezers anatomic forcepsanatomic forceps needle holderneedle holder fluted tube surgeryfluted tube surgery medical scissors with sharp pointmedical scissors with sharp point medical scissors blunt curvedmedical scissors blunt curved tracheotomy tube number 2tracheotomy tube number 2 tracheotomy tube number 5tracheotomy tube number 5 dilator tracheotomydilator tracheotomy haemostatic clampshaemostatic clamps surgical silk number 3 (in amps).surgical silk number 3 (in amps).

Kit arteriovenosektsii in sterile packaging, Kit arteriovenosektsii in sterile packaging, including:including:scalpelscalpelsurgical tweezerssurgical tweezershaemostatic clampshaemostatic clampssurgical needlesurgical needleSurgical gloves (pair)Surgical gloves (pair)needle for intracardiac injection (in sterile needle for intracardiac injection (in sterile packaging)packaging)set of flexible catheters for childrenset of flexible catheters for children

A set of test strips to detect glucose in urineA set of test strips to detect glucose in urine

This equipment is recommended for visiting This equipment is recommended for visiting medical emergency teams and emergency medical emergency teams and emergency medical care is minimal.medical care is minimal.

At the discretion of management stations can be At the discretion of management stations can be replaced by types of anesthesia-respiratory and replaced by types of anesthesia-respiratory and electronic equipment, if necessary, extended electronic equipment, if necessary, extended range and increased the number of drugs, range and increased the number of drugs, dressings, etc.dressings, etc.

Interior design should provide for car seats and Interior design should provide for car seats and brackets for additional equipment in case of brackets for additional equipment in case of using the machine as a dedicated ambulance using the machine as a dedicated ambulance crews.crews.

Brigade to provide medical care for children Brigade to provide medical care for children equipped with a linear view of a set of tires, equipped with a linear view of a set of tires, tools, catheters, probes, anesthesia masks, etc., tools, catheters, probes, anesthesia masks, etc., designed for children age.designed for children age.

Thank you for Thank you for attention!!!attention!!!