The field of emergency medical care is perhaps the most responsible branch of medicine. It is important for an ambulance doctor not only to correctly diagnose a condition that is dangerous for the patient’s life, but also to respond very quickly, select the necessary resuscitation measures or emergency therapy to remove the acute threat to life, and all this so that the affected person can survive or survive the transport process to medical institution - because the ambulance team works on the road, in the absence of the necessary set of drugs and medical devices. The patient’s life directly depends on how fast and correct treatment measures the doctor takes.

Paramedic and ambulance doctor - what's the difference

Many inhabitants, without going into the subtleties of differences in medical professions, believe that paramedics work in the ambulance, and it is they who provide medical assistance to the victims. In fact, the paramedic can work in an ambulance, but this is not the only possible place of work for him.

An ambulance doctor is a doctor with a special higher education who provides precisely qualified medical care and consultations, has the right to decide on emergency resuscitation measures.

The paramedic, like the emergency doctor, can diagnose the patient, determine the diagnosis and prescribe treatment. However, unlike a doctor, a paramedic has a secondary specialized education - it may be a diploma from a medical college or technical school. Most often, he provides first aid.

This specialist can work not only in the ambulance brigade, but also in military units, at the ambulance substation, at the river or sea vessel, at the medical station at the railway station or at the airport terminal, as well as in villages and villages in the feldsher-obstetric center.

In places where it is difficult for the population to access qualified medical care, the skills and knowledge of the medical assistant should be enough to perform the functions of a doctor. For example, he participates in the medical examination of patients, in the absence of an obstetrician, he observes pregnant women and participates in childbirth, watches children under 2 years old, conducts physiotherapy according to the doctor’s testimony, and monitors the timeliness of vaccinations and vaccinations.

If there is only one doctor in the ambulance team, it is called linear. A specialized team is one that specializes in working with a specific pathology, for example, cardiological or psychiatric. The team, where the doctor is not provided for by the staffing, is called the paramedic.

In the absence of a doctor, the paramedic can, if necessary, conduct:

• heart defibrillation;
• tracheotomy;
• cardiopulmonary resuscitation;
• acceptance of childbirth.

Thus, the difference between a paramedic and an ambulance doctor is mainly in the level of qualification.

What does an ambulance doctor do?

The doctor's sphere of competence includes the provision of emergency qualified medical assistance to victims who need it urgently.

The first task this specialist is faced with is the diagnosis, the correct definition of a disease or condition that requires medical attention. At the same time, it is necessary to take into account, firstly, the limited time, and secondly, the lack of many necessary devices and devices at hand, which are in a stationary medical facility.

It depends on the ambulance brigade whether the victim will reach the hospital, whether he will live to see the intensive care unit, and whether the doctors will be able to provide him with full assistance. Therefore, to say that ambulance doctors are engaged in the treatment of diseases will not be entirely correct. Provided that the patient has a condition where his life is in danger, the emergency doctor must take all measures aimed at reducing or completely eliminating it, so in this case we are talking more about the treatment of dangerous symptoms and manifestations.

Doctors of this specialty are the first to encounter victims of accidents and road accidents; they come to calls if a person’s condition does not leave him the opportunity to go to a medical institution on his own.

In addition, the doctor provides symptomatic therapy, for example, helping cancer patients who suffer from severe pain attacks (special painkillers), patients with blood pressure disorders, they are called to children in the presence of signs of fever, acute infectious lesions.

The duties of an emergency doctor are:

• providing qualified medical care to patients;
• transportation of victims to an inpatient medical facility;
• assessment of the general condition of the patient and the choice of the most suitable method of transportation and transfer of the affected;
• if the patient refuses hospitalization, if necessary, take all possible measures in relation to the patient and his relatives in order to convince him;
• when traveling, in the event of an accident or accident, inform the dispatcher and proceed to provide assistance to the victims.

The doctor must have good physical and mental health, medical logic, observation, speed of reaction and the ability to make decisions quickly, knowledge of the main pathological conditions and the skills of providing prehospital care when they occur, and the skills and experience of a specialist diagnostician.

Organs, organ systems and mental phenomena with which an ambulance doctor works

The doctor on duty, working in the ambulance team, is obliged to understand such branches of medicine as gynecology, pediatrics, surgery, obstetrics, neurology, general therapy, rheumatology, resuscitation, traumatology, ophthalmology, otolaryngology. In the process of his medical activity, an ambulance doctor is faced with violations in work:

• heart, blood vessels;
• brain;
• organs of the gastrointestinal tract;
• genitourinary system;
• eye;
• nervous system;
• spine, joints, bones;
• body parts: head, trunk, limbs;
• ENT organs.

A specialized team of psychiatric ambulance is called if:

• psychotic or acute psychomotor agitation (hallucinations, delirium, pathological impulsivity);
• depressive state, which is accompanied by suicidal behavior;
• socially dangerous behavior of the mentally ill (aggression, threat of murder);
• manic states with gross violation of public order and socially dangerous behavior;
• acute affective reactions, accompanied by aggression, agitation;
• acute alcoholic psychoses;
• suicide attempts in people who have not previously been on psychiatric records.

Diseases and injuries treated by emergency doctors

This specialist helps patients in any difficult situations that threaten life and health.

By the nature of diseases, and, accordingly, medical measures that may be provided by ambulance crews, they are all divided into:

• resuscitation (work, most often, with victims of road accidents and disasters, specializing in the most severe cases of damage to the human body);
• pediatric (it employs specialists with a specialized education in the field of pediatrics who are engaged in providing emergency care to the smallest patients, for example, in acute febrile conditions, pain attacks, burn injuries);
• cardiology (these doctors are sent to save people with dangerous conditions such as attacks of acute heart failure or heart attack);
• traumatological (specializing in providing assistance and transporting victims with injuries and polytrauma of any nature);
• psychiatric (they are involved in emergency treatment and transporting patients with acute mental disorders, people who, due to their illness, can threaten their behavior to themselves and others, with appropriate medical institutions);
• general qualification brigades (brigades working with various injuries, burns, diseases, feverish conditions).

When you need to see emergency doctors

The reason for calling an ambulance is a condition of the patient in which he needs urgent medical care, otherwise his life and health are in serious danger. There are a number of so-called threatening conditions in which you need to contact emergency teams:

• electric shock, significant burns, poisoning by poisons;
• Accidents and disasters in which victims suffered fractures, tears, bleeding and other life-threatening injuries;
• difficulty breathing (regardless of etiology, this condition can lead to suffocation and death);
• symptoms of acute fever: intense fever, which antipyretics do not relieve, cramps, suffocation, headaches;
• acute pains in the abdominal cavity, which literally deprive a person of the ability to move (these may be signs of peritonitis, appendicitis, acute pancreatitis, ulcerative lesions of the stomach and intestines);
• sharp pains in the chest, which can give to the shoulder, back, neck, jaw, arm;
• in the presence of signs of stroke and heart attack (numbness of the limbs, dizziness, loss of consciousness, temporary loss of vision, numbness of half of the face, nausea and vomiting, severe pain in the chest, lack of air, weakness, a sharp causeless increase in temperature).

There are cases when calling an ambulance is not necessary. The ambulance does not deal with calls for prescribing a doctor (injections, droppers, dressings), for issuing sick leave and certificates, for providing dental care, for assisting in the exacerbation of chronic diseases, if the patient’s condition does not require emergency medical intervention, and to transport the dead to the morgue.

Today, you can get emergency medical care both from ambulance teams from state hospitals and from private clinics.

Screening and treatment methods used by emergency doctors

The specifics of the work of this doctor is that he is very limited in time and in the means of diagnosis. The main methods that he uses to determine the causes of the patient’s damage are external examination, palpation of the abdomen (palpation and pressure in the abdominal cavity), listening to the heart and lungs using a stethoscope, measuring blood pressure and body temperature, conducting electrocardiography. If the patient is conscious, the doctor will interview him.

After checking the basic vital signs of the body, analyzing the information received, the physician decides on the need for urgent resuscitation measures or urgent transportation of the victim to a medical facility. If the doctor ascertains respiratory arrest and cardiac function, he proceeds to conduct defibrillation of the heart, the implementation of artificial respiration and pumping activity of the heart.

If the injured person is diagnosed with injuries (fractures, tears, dislocations), the physician takes measures to immobilize him and deliver him to the hospital.

The doctor uses medical methods of care (injections, droppers, sprays, tablets), in some cases, he can perform surgical intervention, for example, tracheotomy.

The doctor of the medical care team should be a qualified specialist with lightning fast grip, the ability to respond quickly and make decisions. His competence includes assisting patients with an immediate threat to life. It is this specialist who is the first to arrive at the scene of an accident, catastrophe, electric shock, poisoning. All of these threatening conditions in the absence of a quick and adequate medical intervention can cause disability or death, so a huge responsibility rests on the shoulders of emergency doctors.

Requirements for the packaging of medicines and medical devices for laying and kits for emergency medical care are established by Order of the Ministry of Health of the Russian Federation dated 08/07/2013 No. 549n “On approval of the requirements for the packaging of medicines and medical devices for laying and kits for emergency medical care”.
  Stations for emergency medical care are to be completed with medicines registered in the established manner on the territory of the Russian Federation in secondary (consumer) packaging without withdrawing instructions for the use of the drug.
  Stacks and kits for emergency medical care are to be completed with medical devices registered in the established manner on the territory of the Russian Federation.
  Medicines and medical products that are used for laying and kits for emergency medical care are not subject to replacement with medicines and other medical devices.
  The ambulance kit is placed in a case (bag) with strong locks (latches), handles and a manipulation table. The cover should have retroreflective elements on the case and the Red Cross emblem. The design of the cover should ensure that it cannot be opened when carried with unlocked locks. The material and design of the cover should provide multiple disinfection.
  After the expiration dates of medicines, medical devices and other means provided for by these requirements, or in case of their use, styling and kits for emergency medical care must be replenished.
  It is not allowed to use, including repeated, medicines, medical devices and other means provided for by these requirements, contaminated with blood and (or) other biological fluids.

The quality of medical care.

The quality of emergency medical care is determined by many factors.
  In accordance with Article 2 of the Fundamentals, the quality of medical care is a combination of characteristics that reflect the timeliness of medical care, the correct choice of treatment methods for the provision of medical care, the degree of achievement of the planned result.
Qualified to determine whether the quality of emergency medical care is provided, only an examination can, but you yourself can assess the quality of this assistance to understand if there are grounds for complaint and examination.
  Signs of quality medical care: quick arrival of the team, compliance with its profile of the severity of the patient’s condition, staffing with all necessary specialists, the availability of the necessary equipment and medications. In addition, health workers must be competent, polite and perform all the actions required for the provision of medical care, anesthesia, carrying, making a diagnosis, making a decision on referral to a medical organization. Their decisions should be motivated and explained to those present. If necessary, the ambulance team should call a specialized brigade.
  Ambulance personnel must have a good reaction and the ability to quickly concentrate in any conditions. Ambulance doctors must correctly assess the symptoms and syndromes, the clinical picture of the disease, which is extremely important in the diagnosis. They must have deep knowledge in many medical disciplines.
  Each health worker must be fluent in the rules for transferring the patient, transferring from one stretcher to another, and also know the reasons leading to complications during transportation (shaking, impaired immobilization, hypothermia, etc.).
  The ambulance station must have enough  machines with a full set of medicines and medical equipment to achieve their goals. Ambulances should be equipped with an artificial respiration apparatus, a set of medicines needed in emergency cases, dressings, medical instruments (tweezers, syringes, etc.), a set of tires and a stretcher, etc. Urgent events are held on the way to the hospital or at the scene. Ambulance staff conduct artificial respiration and closed heart massage, stop bleeding, transfuse blood. They also make a number of diagnostic procedures: they determine the prothrombin index, the duration of bleeding, take an ECG, etc. In this regard, the ambulance service transport has the necessary medical and resuscitation and diagnostic equipment.

Medical evacuation

When providing emergency medical care, if necessary, medical evacuation is carried out.
Medical evacuation is carried out by emergency ambulance crews and includes sanitary and aviation evacuation, and sanitary evacuation carried out by land, water and other means of transport.
  Medical evacuation may be carried out   from the scene  or the location of the patient (outside the medical organization), as well as from a medical organization in which there is no possibility of providing the necessary medical care in life-threatening conditions, including the evacuation of women during pregnancy, childbirth, the postpartum period and newborns, people affected by emergency situations and natural disasters.

The choice of a medical organization for patient delivery during medical evacuation is based on the severity of the patient's condition, the minimum transport accessibility of the medical organization where the patient will be delivered and its profile.

The decision on the need for medical evacuation takes:
   from the scene of the incident or the location of the patient - a medical worker of the visiting ambulance brigade appointed by the senior of the indicated brigade;
   from a medical organization in which there is no opportunity to provide the necessary medical care - the head (deputy head of medical work)
  During the medical evacuation, medical workers of the emergency ambulance team monitor the state of the patient's body functions and provide the latter with the necessary medical care.

Perhaps the profession of an ambulance doctor can be called one of the most difficult and responsible among all medical specialties. After all, he should know well not only the theory, but also perfectly master many practical skills. Often there are situations when an ambulance doctor has only a few minutes to make a diagnosis and at the same time he does not have the opportunity to use laboratory or instrumental methods of diagnosis, to consult with his colleagues. Therefore, he must perfectly know such medical specialties as therapy, neurology, surgery, gynecology and obstetrics, resuscitation, be familiar with the pathology of ENT organs and the organ of vision.

What qualities should an ambulance doctor have?

Based on the characteristics of the work, the following qualities should be inherent in any ambulance and emergency doctor:

• Good physical and mental health;
• Excellent medical observation and logic;
• Speed \u200b\u200bof reaction and ability to keep calm in any situation;
• Knowledge of basic emergency conditions, the ability to diagnose and treat them at the prehospital stage;
• The ability to find contact, both with the patient himself and with his relatives. Indeed, in some cases, they may require an emergency medical consultation;
• Modesty, discipline, decency, cleanliness;
• The ability to maintain their authority among all employees of the team.

Responsibilities of an emergency doctor

Before starting duty, an ambulance doctor must personally accept the necessary medical equipment, laying with medicines.

The duties of an ambulance doctor include monitoring the condition of all team members. If, during the duty, the doctor notices any of them have signs of alcohol intoxication or ill health, he is obliged to immediately remove them from work and inform the manager and dispatcher about this.

After receiving the call, the ambulance doctor must check with the dispatcher the name of the patient, his age and address. Departure is carried out within one minute from the moment of its receipt. It is forbidden to disconnect radio communications during the entire departure period.

In case of impossibility of timely departure to a call, an ambulance doctor must immediately inform the dispatcher about this, which allows you to timely transfer the call to another team.

The duties of an emergency doctor include:

• Conducting and providing competent and free medical care to patients;
• Transportation of injured and sick people to a hospital;
• The ability to correctly assess the general condition of the patient and choose for him the most optimal way to carry and transport. Carrying the patient on a stretcher is one of the types of medical care and, accordingly, is another responsibility of the emergency doctor;
• If you refuse hospitalization, take all measures in order to convince her of the need for both the patient and his relatives. If this cannot be done, then provide the necessary assistance, make a note on the refusal of hospitalization in the call card and inform the dispatcher about this to transfer the active call to the local doctor of the clinic;
• Being on the way and in the event of an accident, the ambulance doctor must stop the car, inform the dispatcher about this and proceed to provide assistance;
• When providing medical care, he must act decisively and quickly, rendering it in full. If necessary, an ambulance doctor has the right to call a specialized team to the patient;
• An emergency medical consultation can only be provided orally. He has no right to issue any certificates or conclusions in the hands of the sick, their relatives or any officials.

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Comments on material (30):

1 2

I quote Hope:

Hello! How can I thank the ambulance crew? The ambulance doctor, the only one out of 5 doctors, made the correct diagnosis for the child, which was later confirmed by a blood test. Unfortunately, I did not ask the doctor’s name, I only know the date and time when they came to us. (had a temperature of 39 and a rash)

Hello, Hope.
You can call an ambulance and convey gratitude by describing the time and place of arrival of the brigade. You can write a letter of thanks to the address of the ambulance station from where the brigade came to you.

Hope doctor / Feb 27, 2018 11:47 p.m.

I quote Elena:

02/25/2018 I called emergency aid to my husband (born 1952). ...
What kind of team came, what was the result, what measures were taken by it, what recommendations? Is it not natural to know. As it turned out, it’s natural not to know! It seems that such an order allows the help to nullify.

An emergency team is called for in life-threatening conditions.
Regarding pressure, the doctor told you correctly, the upper number 140 (systolic pressure) is still the norm. Even if this is increased pressure for your husband compared to his worker, then it is not critical.

I quote Galina:

The son lost consciousness and vomit partially fell into the respiratory tract. Ambulance doctors saved him of course. And they decided that he used something, therefore poisoning. Since his son was beaten three months ago, he had an open fool, we asked to pay attention to his head. The doctor did not listen, said that it was later. Delivered to toxicology. After 10 hours, an operation was performed. After three days of coma, the son died. 31 years. Why do the ambulances do not want to hear relatives. Is there their fault that they delivered to the wrong department? Time is lost. The diagnosis is acute non-traumatic subdural hemorrhage. If the operation is done after 4-6 hours, then 80% for survival.

Hello.
No, there is no fault of the ambulance doctor, because he cannot and should not make an accurate diagnosis, he does not have the opportunity to do so. An ambulance doctor can suggest a diagnosis, but already in the hospital he confirms or refutes, there are different diagnostic possibilities.

I quote SERGEY:

Good day! Please tell me, if I learned to be a paramedic, can I become a therapist or an ambulance doctor?

Good day, Sergey.
If you have learned to be a paramedic, you can work as a paramedic. To work as a doctor, you need to study as a doctor.

1 2

Do you know that:

The human stomach does a good job with foreign objects and without medical intervention. Gastric juice is known to dissolve even coins.

The rarest disease is Kuru’s disease. Only representatives of the Fore tribe in New Guinea are ill with her. The patient dies of laughter. It is believed that the cause of the disease is eating the human brain.

When lovers kiss, each of them loses 6.4 kcal per minute, but at the same time they exchange almost 300 kinds of different bacteria.

If your liver stopped working, death would occur within a day.

The first vibrator was invented in the 19th century. He worked on a steam engine and was intended to treat female hysteria.

American scientists conducted experiments on mice and concluded that watermelon juice prevents the development of atherosclerosis of blood vessels. One group of mice drank plain water, and the second a watermelon juice. As a result, the vessels of the second group were free of cholesterol plaques.

It used to be that yawning enriches the body with oxygen. However, this view was disproved. Scientists have proved that yawning, a person cools the brain and improves its performance.

The liver is the heaviest organ in our body. Her average weight is 1.5 kg.

During sneezing, our body completely stops working. Even the heart stops.

Each person has not only unique fingerprints, but also language.

According to studies, women who drink several glasses of beer or wine a week have an increased risk of getting breast cancer.

According to statistics, on Mondays, the risk of back injuries increases by 25%, and the risk of a heart attack - by 33%. Be careful.

Scientists from Oxford University conducted a series of studies, during which they came to the conclusion that vegetarianism can be harmful to the human brain, as it leads to a decrease in its mass. Therefore, scientists recommend not to completely exclude fish and meat from their diet.

People who are used to having regular breakfast are much less likely to be obese.

74-year-old Australian resident James Harrison became a blood donor about 1,000 times. He has a rare blood type, the antibodies of which help newborns with severe anemia survive. Thus, the Australian saved about two million children.

Fish oil has been known for many decades, and during this time it has been proven that it helps to relieve inflammation, relieve joint pain, improves joint ...

More than a hundred years ago, emergency medical care was created in our country, which has no analogues in the world and works on the principle: "not a patient goes to the doctor, but the doctor goes to the patient."

Its main task is to provide qualified and specialized medical care to patients and victims as soon as possible from the onset of a pathological condition at the scene of the accident, during transportation, and to carry out the maximum possible amount of therapeutic measures aimed at restoring the functions of vital organs and systems. Foreign doctors call the domestic ambulance service “an object of Russian national pride” and envy our people, who have the opportunity at any time of the day or night to receive emergency medical care without leaving a warm bed and without incurring material costs.

Unfortunately, at present, this unique service, the main purpose of which is the salvation of human lives, is doomed to fulfill unusual functions and to solve numerous social problems.

In no country in the world would anyone think of calling an ambulance to change a diaper for a paralyzed grandmother. “But I cannot cope alone,” her daughter declares without a trace of embarrassment. And in the next entrance a bed patient fell out of bed. And again they call an ambulance, and when they see the women's team, they are outraged: “We asked to send men!”

A drunken neighbor who didn’t get to his floor collapsed on the stairs, and prevents the passage. Or a homeless person chose a place to sleep at your door. “We need to call an ambulance,” says one of the household members, “let him be taken to the hospital.”

Who wants to mess with a dirty lousy homeless person or with a drunk lying in a puddle? Where are the street children found in the basements and attics? Do not strain your brain gyrus to answer these questions when there is always an ambulance at hand. But what are the numerous social service officials doing to solve these problems at this time?

Only a very wealthy and wasteful owner will allow us to send specialized medical teams to search for and deliver the homeless to hospitals, and use clinical hospitals as a haven for them. Responsibility for the fate of these unfortunate and disadvantaged people should be held by state authorities, and not by healthcare institutions.

Using an ambulance as a free taxi deserves a special discussion. “Take us for a consultation with an ENT doctor (optometrist, dermatologist, allergist, etc.) I will call an ambulance until they take me wherever I want!” Says the mother and demands the phone number of the head doctor to immediately complain about the "bad" doctor who dared to object to her. Have to carry, where to go?

And in the reception department of the hospital again there is outrage: “How? Are you leaving already? And who will take us home? ”

In the hot summer of 2010, some individuals demanded that the ambulance crews immediately evacuate from the smoky Moscow or urgently hospitalize a healthy child "to a hospital with air conditioning." Would it not be more logical, guided by the slogan “Saving the drowning - the work of the drowning themselves”, take your family to a safe area or put an air conditioner in the apartment?

The child fell and broke his knee, but there is no green at home - they call an ambulance. The district nurse did not come to give an injection of an antibiotic (vitamin) - they call an ambulance. A patient with chronic gastritis calls an ambulance to find out if he can take a pill of analgin for a headache and if it will harm the stomach. Mom does not know how to put an enema on a child, make a compress on her ear, remove a splinter - they call an ambulance, etc. etc. This list goes on and on. Therefore, round the clock, and especially in winter at "rush hour", which occurs every evening from 8 p.m. to 2 a.m., calls are transferred to the teams with a significant delay, and patients are forced to wait hours for medical care.

The main advantages of the ambulance, which we once were proud of - free and affordable - now turned against our service. And that’s true: why respect her, this ambulance, is it possible to appreciate what is always at hand and not worth a dime?

Therefore, ambulance crews walk at night on dark craped porches in search of the right apartment, and none of the patient's relatives will take care to meet them. “Our hooligan is full in the courtyard, it’s scary to go out,” the young dad replies to the rebuke of the brigade that came to the baby and looked for the necessary entrance for a long time (numbers are not indicated) in the unlit courtyard. It would never occur to him that women, who mainly work in children's teams, in a strange courtyard and dark entrance are even worse.

They can answer the request to prepare a clean towel: wipe yourself with what is hanging.

To the remark that the dog must be cleaned before the brigade arrives, there should be a malicious reaction and a promise to set her on the doctors.

If it becomes necessary to carry the patient into a car on a stretcher, and the help of relatives is required, often there is indignation: where are your porters?

Opening the door to the brigade, they can, in an orderly manner, say: take off your shoes, otherwise you will stain the floor. This order alone already testifies to the groundlessness of the call. Tell me, will you worry about the cleanliness of the floor when the baby is in danger?

It does not fit in your head: how can you relate to people rushing to your aid at any time of the day, with such disrespect and even neglect? “They don’t bite an outstretched hand,” says popular wisdom, which is forgotten when it comes to ambulance. Doctors and paramedics working in the ambulance make up the golden fund of our medicine and deserve high respect, and sometimes admiration for the ability to provide the victim with the necessary help in a few incredible circumstances, often saving his life. Try to get into a vein and set up a dropper for a victim who is in a mangled car or crushed by the rubble of a collapsed building, conduct resuscitation in an ambulance rushing at full speed, take delivery on a market counter and convince a mentally ill patient to put aside a kitchen knife and “talk for life ".

Thanks to the poet Andrei Voznesensky for his kind words and sympathy for the ministers of this difficult profession:

  Among business scorpions,
   Nearby benefits
   Short-haired ambulance
   He lives near misfortunes.
Where are you taking off at midnight?
   Frost. She sat in warmth.
   Tormented emergency aid
   Who will only help you?

To provide emergency assistance to children, special pediatric teams have been created that endure all the children's suffering and try to alleviate and eliminate them as much as possible.

On the children's console of the Moscow Station of ambulance and emergency medical care all calls to the children arriving at "03" flow. From here, the call is transferred to the substation closest to the victim, and the children's team, consisting of a pediatrician and a paramedic, is in a hurry to help. Almost every substation has one pediatric team, sometimes two, and they never remain without work. Moreover, almost half of the calls to children are carried out by general practitioners of linear brigades who do not have experience in dealing with sick children.

After all, a child is not an adult in miniature. Each age has its own anatomical and physiological features that must be taken into account in treatment, and even more so when providing emergency care.

Only a pediatric doctor is able to deal with a tiny creature who cannot speak, and reports his ill health with a cry or lethargy and an indifferent state. An ambulance doctor, including a pediatrician, is limited in time and diagnostic capabilities, but a true professional is often helped by intuition, which helps to diagnose and provide emergency help in a matter of minutes. According to Napoleon’s definition, “intuition is a lightning fast calculation”. But such a calculation is possible only when there is knowledge and experience multiplied by careful observation of a sick child, his behavior, the ability to identify the most invisible symptoms and analyze them. That is why special pediatric ambulance teams were created that saved many children's lives.

“If among different things your child is sick,
   Don't pacify him with a pacifier or sugar
   One must not forget: there is a team number five
   With the best pediatrician on earth. ”

These words from the song of our colleague give a high professional mark to pediatric doctors working in ambulance, and in the vast majority of cases they (doctors) justify this assessment.

It is all the more annoying to realize that a significant part of the calls made by pediatric teams ends with just giving advice, that is, the child did not need emergency assistance or hospitalization. And this is good. But why was an ambulance needed? And aren't they paying too much for these tips that really need it?

Alas! Too many mothers argue like this: while you wait for a doctor from the clinic, while you go to the pharmacy for medicines, and the ambulance arrives and does everything right away.

Such parents give rise to alarming situations when a call comes in with a formidable excuse (“turns blue”, “dies”, “suffocates”, “gets poisoned”), and there is no children’s brigade at the nearest or neighboring substations.

A child’s call cannot wait, it is immediately transferred to any team, whether cardiological or traumatological. And “adult” doctors say: “It’s better to go to a complicated heart attack than to a child.” And almost always the baby is taken to the hospital, from where, after examining the pediatrician, he often returns home. A general practitioner can be understood: having no experience working with children, it is better to be safe than not to miss a serious illness.

But how do you understand parents who stubbornly do not want to call a pediatrician from the clinic, do not know the phone of children's emergency care in their area, but just "wanted to consult if the child was taken to kindergarten if he vomited yesterday?"

Every mother should know the phone number where she can call a doctor at home, and the phone number of the round-the-clock medical care department (OKMP) for children in her area, so that if necessary she can go there any time of the day or night, on weekdays and holidays. And leave the Ambulance to those who really need it.

The ambulance does not prescribe treatment at home, does not inject antibiotics and vitamins, does not write out certificates and does not issue disability certificates. Otolaryngologists, ophthalmologists, surgeons, allergologists and other "narrow" specialists do not work on ambulance.

To make it easier to figure out whom to call in each case, be guided by the slogan: "Ambulance" does not heal, but saves. " Then, real professionals will come to the baby who needs urgent medical care, provide qualified assistance to him and, if necessary, hospitalize.

But even if your call is transferred to the pediatric team immediately, in many cases it does not arrive at the place as fast as we would like. And there are objective reasons for this.

In recent years, in Moscow, perhaps the most important difficulty in the work of ambulances has become traffic jams that occur at any time of the day or anywhere, making it difficult to move to the place of call or transport the patient to the hospital.

If there are car enthusiasts among readers, answer honestly to the question: “Do you always give way to a car with a red cross?” I'm afraid there will be few positive answers. Now imagine that this car is in a hurry to call your child.

Take a look at your house and the entrance through the eyes of an ambulance doctor: is the number written on the house, is there a numbering on the entrances, are the numbers of the apartments in them indicated. Quite often, leaving the elevator, the gaze of doctors stumbles on the door, for some unknown reason they are deprived of identification marks. Which one do you want to call? In the daytime, this does not cause problems: you can contact anyone, and the neighbors will indicate the right one. And what about the night? Do you like it if the call wakes you up late at night and someone else's voice outside the door takes an interest in your apartment number?

Many unlit porches and dark staircases poison the lives of ambulance workers. Try to enter the code of the front door in total darkness or find the desired button in the elevator. In the course are lighters, flashlights. It’s good if the numbers are indicated on them (on the buttons). And then our mischievous kids with perseverance worthy of the best use, love to have fun, erasing all the signs on the intercoms and floor signs in elevators.

Do you know that not only “two ninth cars” described by the comedian can exist on the train, but also the first two entrances in the same house? A check-in to the house located on one street, it is necessary to carry out completely from another? And on Krasny Zory Street, for example, right after house number 37 is house number 61? And where to look for the desired 55th? And on another no less mysterious street, house number 9 is for some reason located in the courtyard of the 17th. And in the area of \u200b\u200bKutuzovsky Prospekt there are also Kutuzovsky passage, and Kutuzovsky lane, and a little further street Kutuzova?

Therefore, when calling an ambulance, clearly and clearly state your address, tell me how it is best to drive to the house, and where the entrance to the entrance is located: from the street or from the yard. And do not consider it difficult to meet the brigade on the street, because it is your child who needs help.

Often doctors are reproached for callousness, heartlessness, they are used to supposedly someone else's pain. This is not true! You cannot get used to the pain and suffering of children, the grief of a mother who has lost a child. This is a kind of protective reaction, the so-called emotional immunity - and this is included in the category of professional qualities of ambulance workers. In critical situations, there is no time to gasp and shed tears. It is necessary to instantly navigate the situation, “get together” in order to save the patient’s life. In some cases, sometimes you have to shout at relatives, who interfere with emergency actions with their behavior.

Ambulance is a special world in which one constantly has to deal with negative, sometimes disgusting phenomena, the “wrong side” of life. Mothers throw their children at train stations, on trains, throw newborns in the trash. A drunken father, planning to take revenge on his ex-wife, kills two teenage sons with a kitchen knife. Killer, waiting for a businessman in the entrance, at the same time shoots at his preschool daughter. Sex maniac rapes and kills children in elevators and attics. And a twelve-year-old prostitute, unable to read, already has a bouquet of sexually transmitted and infectious diseases. All this is also the work of the children's emergency team and not the children's problems of our time. Any representative of this difficult profession has the right to say: "To love humanity and hate it, you need to work on an ambulance."

Maybe after these emotional lines you will react differently to our “national pride” and with aboutwith the least respect you will treat her servants.

Ambulance  is a type of primary health care. SMP institutions annually carry out about 50 million calls, providing medical care to more than 52 million citizens. Emergency medical care - 24-hour emergency medical care for sudden illnesses that threaten the patient’s life, injuries, poisoning, deliberate self-injuries, childbirth outside medical facilities, as well as disasters and natural disasters.

general characteristics

The characteristic features that fundamentally distinguish emergency medical services from other types of medical care are:

the urgent nature of its provision in cases of emergency medical care and the delayed - when emergency conditions  (emergency medical care);

failure-free nature of its provision;

free procedure for providing NSR;

diagnostic uncertainty in the face of time pressure;

pronounced social significance.

Ambulance conditions:

outside the medical organization (at the place of the brigade’s call, as well as in the vehicle during medical evacuation);

outpatient (in conditions that do not provide for round-the-clock medical supervision and treatment);

stationary (in conditions that provide round-the-clock monitoring and treatment).

Guiding Documents

Decree of the Government of the Russian Federation of October 22, 2012 No. 1074 “On the program of state guarantees of free medical care for citizens for 2013 and for the planning period of 2014 and 2015”.

Federal Law of 21.11.2011 No. 323-ФЗ “On the Basics of Protecting Citizens' Health in the Russian Federation”.

Federal Law of 29.11.2010 No. 326-ФЗ “On Compulsory Health Insurance in the Russian Federation”.

Order of the Ministry of Health of the Russian Federation of March 26, 1999 N 100 “On improving the organization of emergency medical care for the population of the Russian Federation”

Order of the Ministry of Health and Social Development of the Russian Federation of 01.11.2004 N 179 “On approval of the Procedure for the provision of emergency medical care”

Federal Law of November 29, 2010 No. 326-ФЗ “On Compulsory Health Insurance in the Russian Federation”. It is remarkable for the transfer of authority of the Russian Federation in the field of compulsory medical insurance to state authorities of the constituent entities of the Russian Federation, as well as the inclusion of emergency medical care (with the exception of specialized - sanitary-aviation) in the compulsory medical insurance system throughout the Russian Federation from January 1, 2013 . The transition to financing in the system of compulsory health insurance is an important stage in the development of the SME system in the Russian Federation. Emergency medical care (with the exception of specialized - sanitary aviation) is provided as part of the basic compulsory medical insurance program. Financial support for emergency medical care (with the exception of specialized - sanitary-aviation) is carried out at the expense of compulsory medical insurance from January 1, 2013

Main functions

Ambulance is provided to citizens in conditions requiring urgent medical intervention (in case of accidents, injuries, poisoning and other conditions and diseases). In particular, ambulance stations (departments) carry out:

24-hour provision of timely and high-quality medical care in accordance with health care standards sick and injured outside health care facilities, including during disasters and natural disasters.

Timely implementation transportation  (as well as transportation at the request of medical workers) of patients, including infectious, injured and women in labor, who need emergency hospital care.

Providing medical care to patients and victims who applied for help directly to the ambulance station in the office for receiving outpatients.

Notice municipal health authorities  about all emergency situations and accidents in the service area of \u200b\u200bthe ambulance station.

Ensuring uniform acquisition of ambulance teams by medical personnel for all shifts and their full provision in accordance with the approximate list of equipping the ambulance team.

In addition, the ambulance service can transport donated blood and its components, as well as transportation of specialized specialists for emergency consultations. The ambulance service carries out scientific and practical (in Russia there are a number of research institutes of ambulance and emergency medical care), methodological and sanitary-educational work.

Forms of territorial organization

Ambulance station

Emergency department

Ambulance hospital

Emergency department

Ambulance station

The ambulance station is led by the head physician. Depending on the category of a particular ambulance station and the volume of its work, it may have deputies for medical, administrative, technical, and civil defense and emergency situations.

Most large stations  in its composition have various departments and structural units.

The ambulance station can operate in 2 modes - daily and in mode emergency. In emergency mode, station management transfers to the Regional Center disaster medicine.

Operations department

The largest and most important of all units of large ambulance stations is operations department . It is from his organization and order that the entire operational work of the station depends. The department negotiates with people calling an ambulance, accepts a call or refuses it, transfers orders for execution to visiting teams, controls the location of teams and ambulances. Manages the department senior doctor on duty  or shift supervisor. In addition to it, the unit includes: senior dispatcher, direction manager, hospitalization dispatcher  and medical tow trucks. Senior doctor on duty  or shift supervisor  manages the duty personnel of the operational department and the station, that is, all the operational activities of the station. Only the senior doctor can decide not to accept a call to a person. For granted, this refusal must be motivated and substantiated. The senior doctor is negotiating with visiting doctors, doctors of outpatient and inpatient treatment and prevention institutions, as well as with representatives of the investigating and law enforcement agencies and emergency response services (firefighters, rescuers, etc.). All issues related to the provision of emergency medical care is decided by the senior doctor on duty. Senior dispatcher  he supervises the work of the dispatching office, manages dispatchers by direction, selects cards, grouping them according to the areas of receipt and urgency, then he hands them to subordinate dispatchers to transfer calls to district substations, which are structural units of the central city ambulance station, and also monitors the location of exit brigades. Direction Manager  communicates with the duty staff of the central station and regional and specialized substations, gives them call addresses, monitors the location of ambulance vehicles, the working hours of field staff, keeps records of calls made by making appropriate entries in call accounting cards. Hospitalization dispatcher  distributes patients to inpatient hospitals, keeps records of available places in hospitals. Medical tow trucks  or ambulance dispatchers receive and record calls from the public, officials, law enforcement agencies, emergency services, etc., the completed call record cards are transferred to the senior dispatcher, if there is any doubt about a call, the conversation is switched to the senior shift doctor. By order of the latter, this or that information is reported to law enforcement agencies and / or emergency response services.

Department of hospitalization of acute and somatic patients

This structure carries out the transportation of patients and injured at the request (directions) of doctors of hospitals, clinics, emergency rooms  and managers health centers, in inpatient treatment facilities, distributes patients to hospitals. This structural unit is headed by a doctor on duty, it includes a registry and a dispatch service that manages the work of paramedics transporting patients and victims.

Department of hospitalization of women in labor and gynecological patients

This unit carries out both the organization of the provision, the immediate provision of emergency medical care and hospitalization, as well as the transportation of women in childbirth and patients with acute and exacerbation of chronic gynecology. He accepts applications both from doctors of outpatient and inpatient medical institutions, and directly from the population, representatives of law enforcement agencies and emergency response services. Information from the “emergency” women in labor flows here from the operational department. The outfits are performed by obstetricians (the composition includes an obstetrician-midwife (or, simply, an obstetrician (midwife)) and a driver) or obstetrician-gynecological (includes an obstetrician-gynecologist, an obstetrician-paramedic (paramedic or nurse (nurse)) and a driver) located directly at the central city station or district or at specialized (obstetric-gynecological) substations. This department is also responsible for the delivery of consultants to gynecological departments, obstetric departments and maternity hospitals for emergency surgical and resuscitation interventions. The department is led by a senior doctor. The department also includes registrars and dispatchers.

Infectious Disease Department

This department provides emergency medical care for various acute infections and the transportation of infectious patients. He knows the distribution of beds in infectious diseases hospitals. It has its own transport and field teams.

Department of Medical Statistics

This unit records and develops statistical data, analyzes the performance indicators of the central city station, as well as regional and specialized substations that are part of its structure.

Communications department

He provides maintenance of communication panels, telephones and radio stations of all structural units of the central city ambulance station.

Inquiry Office

Faik

or otherwise information desk, help desk  It is intended for the issuance of reference information about patients and victims who were provided with emergency medical care and / or who were hospitalized by ambulance teams. Such inquiries are issued on a special hotline or at a personal visit of citizens and / or officials.

Other units

An integral part of both the central city ambulance station, and district and specialized substations are: economic and technical departments, accounting, human resources and a pharmacy. Direct emergency medical care for the sick and injured is provided by field teams (See Types of teams and their purpose below) for both the central city station and regional and specialized substations.

Ambulance substation

District (in the city) ambulance substations, The staff of large regional substations includes head of, senior shift doctors, senior paramedic, dispatcher. defectar, mistress sister, nurses  and field staff: doctors, paramedics, paramedic. Head of  provides overall management of the substation, monitors and directs the work of field personnel. They report on their activities to the chief physician of the central city station. Senior substation shift doctor  provides operational management of the substation, replaces the manager in the absence of the latter, monitors the correctness of the diagnosis, the quality and volume of emergency medical care provided, organizes and conducts scientific and practical medical and paramedical conferences, and promotes the implementation of the achievements of medical science. Senior paramedic  He is the leader and mentor of the nursing and nursing staff of the substation. His responsibilities include:

scheduling shifts for a month;

daily picking of field teams;

maintaining strict control over the proper operation of expensive equipment;

ensuring replacement of worn-out equipment with a new one;

participation in the organization of the supply of medicines, linen, furniture;

organization of cleaning and sanitation of premises;

control the timing of sterilization of reusable medical instruments and equipment, dressings;

keeping records of the working hours of substation personnel.

Along with the production tasks, the duties of the senior paramedic also include the duties of participating in the organization of life and leisure of medical personnel, and timely upgrading of their qualifications. In addition, the senior paramedic participates in the organization of paramedic conferences. Substation Manager  receives calls from the operational department of the central city station, hospitalization departments for acute surgical, chronic patients, the department for hospitalization of women in labor and gynecological patients, etc., and then, in order of priority, transfers the outfits to visiting teams. Before the start of the shift, the dispatcher informs the operational department of the central station about the vehicle numbers and personal data of the members of the visiting teams. The dispatcher writes the call on a special form, enters brief information into the database of the dispatching service and invites the brigade to leave for intercom. Control over the timely departure of the teams is also entrusted to the dispatcher. In addition to all of the above, the dispatcher has a backup cabinet with medicines and tools that he gives out to teams as necessary. There are frequent cases when people seek medical help directly to an emergency substation. In such cases, the dispatcher is obliged to invite a doctor or paramedic (if the paramedic team) of the next team, and if urgent hospitalization of such a patient is necessary, obtain an outfit from the dispatcher of the operational department for a place in the hospital. At the end of the duty, the dispatcher draws up a statistical certificate of the work of the visiting brigades over the past day. In the absence of a staffing unit for the substation dispatcher, or if this place is vacant for any reason, its functions are performed by the responsible paramedic of the next brigade. Defect of pharmacy takes care of the timely supply of field teams with medicines and tools. Every day, before the start of the shift and after each brigade departure, the defectar checks the contents of the stacking boxes and replenishes them with the missing drugs. His responsibilities also include sterilizing reusable instruments. A spacious, well-ventilated room is allocated for a pharmacy to store a stock of medicines, dressings, tools and equipment specified by the regulations. In the absence of a defectar position, or if his place is vacant for any reason, his duties are assigned to the senior assistant paramedic of the substation. Mistress sister  manages the issuance and receipt of linen for staff and the serving contingent, monitors the cleanliness of tools, supervises the work of nurses.

Smaller and smaller stations and substations have a simpler organizational structure, but perform similar functions .

Types of ambulance crews and their purpose

In Russia, there are several types of SMP teams:

emergency, popularly referred to as "ambulance" - doctor  and the driver (as a rule, such teams are attached to district clinics);

doctors - a doctor, two paramedic, orderly and driver;

paramedics - two paramedics, a paramedic and a driver;

obstetric - obstetrician (midwife)  and the driver.

Some teams may include two paramedics or a paramedic and nurse. The obstetric team may include two obstetricians, an obstetrician and a paramedic, or an obstetrician and a nurse (nurse).

Also, teams are divided into linear (general) - they are both medical and paramedic, and specialized (only medical).