Ambulance and emergency medical care (SMP) - a medical organization who is aimed at providing emergency medical, as well as specialized medical care for threatening the life of accidents and acute severe diseases both at the scene and in the way. This type of care is organized for urgent medical care during accidents and sudden heavy diseases that have arisen at home, on the street, during operation and at night, with mass poisoning and other threatening states.
The concept of "urgent states" determines such pathological changes in the human body, which lead to a sharp deterioration of health and can threaten their lives.
Under the "Embracing of Medical Aid" means urgent elimination of all urgent pathological conditions arising unforeseen, which, regardless of the severity of the patient's condition, require immediate diagnostic and therapeutic activities. It is advisable to distinguish between the following main forms of pathological conditions, under which emergency assistance is shown:
- There is a direct threat to life, which without timely medical care can lead to death.
- There is no immediate threat to life, but, based on the pathological condition, a threatening moment may occur at any time.
- There is no threat to life, but you need to facilitate the suffering of the patient
- The patient is in a state of non-hazardous for life, but urgent help is required in the interests of the team.
In the activities of emergency medical institutions, the preservation of patients and victims depends mainly from the timeliness of the arrival of the ambulance brigade in the place of the call and the quality of doggower and therapeutic care.
Basic principles of the organization SMP:
- Full accessibility
- efficiency in work, timeliness
- fullness and high quality assistance
- ensuring unhindered hospitalization
- Maximum continuity in work.
Currently in the Republic of Belarus State System Organization SMP:
- DOGOSPARY STAGE: in the cities of the SMP station with substations and branches, traumatology points; In rural administrative areas - separation of the SMP CRH, in the regions
- Hospital stage: emergency hospital, emergency hospitalization department of the general network of hospital institutions
The activities of ambulance stations (offices, hospitals) are governed by the Order of the Ministry of Health of the Republic of Belarus "On improving the emergency organization of ambulance and emergency medical care."
The station (separation) of emergency medical care is an ambulance and emergency medical care to the adult and the children's population in the threatening life of states, accidents, acute severe diseases and exacerbation of chronic diseases both at the scene and in the way.
Tasks of the SMP station:
1. Provision within the shortest possible time after receiving the challenge of ambulance and emergency medical care to the sick and affected, located outside the LPU and during their transportation to the hospital.
2. Transportation of patients who need emergency assistance, affected, fencers, premature children with their mothers at the request of doctors and the administration of the LPU.
The SMP station provides:
1. Emergency medical care:
A) with sudden diseases that threaten the life of the patient (acutely developing violations of the activities of the CSS, CNS, the respiratory bodies, the abdominal bodies)
B) with accidents (various types of injuries, injuries, burns, electric shock and lightning, foreign bodies of respiratory tract, frostbite, drowning, poisoning, suicidal attempts)
C) under childbirth occurring outside of specialized institutions
D) with mass catastrophes and natural disasters.
2. Emergency care: In exacerbations of various chronic diseases, when the reasons for the appeal do not refer to paragraph 1a) of this Regulation, as well as with acute diseases of children, especially the first year of life.
Category SSMP Depending on the number of departures performed per year: the extractual - over 100 thousand departures per year, I categories - from 75 thousand to 100 thousand, category II - from 50 thousand to 75 thousand, III categories - from 25 thousand to 50 thousand, IV categories - from 10 thousand to 25 thousand, V category - from 5 thousand to 10 thousand. The ambulance station is organized in cities with a population of over 50 thousand and is independent LPO or, The solution of local health authorities is part of the urban hospitals of emergency medical care on the rights of its structural division. The cities with a smaller population are organized by the emergence of emergency care for urban, central district and other hospitals. Each city has only one station or emergency room. The maintenance of the rural district is carried out by the urban SPM or the SMP branch under the CRH. In large cities, the SSMP organized substations in the settlement provision of 15-minute transport accessibility in the city administrative area with a population of 75-200 thousand inhabitants. In the rural area, ambulance posts function with the calculation of 30-minute availability.
Accordingly, the regulations, for every 10 thousand inhabitants, one sanitary machine was allocated and a 0.8 medical or paramedic brigade was approved. The deadline for ambulance - up to 4 minutes, for emergency care - up to 1 hour.
Documentation of stations (departments) ambulance:
1) Magazine or Call Call Recording Call
2) emergency emergency call card
3) Supported sheet with tear-off coupon
4) Diary of the Emergency Care Station
5) Station Report
Call cards and emergency medical recording logs are stored for 3 years. The SSMP does not produce hospital sheets, forensic conclusions, does not conduct an examination of alcohol poisoning.
The SSM is an independent institution and obeys orders and orders of higher bodies of ZO, enjoys the right of a legal entity and has a stamp and stamp with the designation of its name.
Hospital for emergency medical care (BSMP) - Multidisciplinary specialized LGO to provide round-clock emergency stationary medical care to the population in acute diseases, accidents injuries, poisoning, as well as with massacres, catastrophes, natural disasters.
The main tasks of the BSMP:
- provision of emergency specialized medical care patients with life-threatening states requiring resuscitation and intensive therapy with the use of funds and methods of expressadiagnosis and treatment at the level of modern achievements of medical science and practice
- Implementation of organizational and methodological and advisory assistance to therapeutic and preventive institutions of the district in emergency medical care activities
- implementation of measures for the permanent readiness of the hospital to work in extreme conditions for the massive receipts of victims in the city (region, republic)
- ensuring effective continuity and relationships with all therapeutic and preventive institutions of the city in the provision of medical care for patients in the preservation and hospital stages
- Analysis of the quality of emergency medical care and evaluation of the effectiveness of the hospital and its structural units
- Analysis of the needs of the population in emergency medical care at all stages of its organization
- Conducting sanitary education and hygienic education of the population to form a healthy lifestyle, the provision of self-mutual assistance in accidents and sudden diseases, etc.
BSMP is organized in settlements with residents of at least 250 thousand. Hospital management is carried out by the chief physician.
Structural units BSMP:
- Administrative and management part
- Organizing items with the Cabinet of Medical Statistics
- hospital
- Receiving and diagnostic department with reference and information service
- specialized clinical departments of emergency care (surgical, traumatological, neurosurgical, urological, burn, gynecological, cardiac, urgent therapy, etc.)
- Department of Anesthesiology, Resuscitation and Intensive Therapy
- Blood Transfusion
- Department of Physiotherapy and LFC
- pathoanatomical service with histological laboratory
- Medical archive
- Other divisions: Pharmacy, Library, Foodsheel, Economic and Technical Part, Computer Center.
BSMP provides:
- round-the-clock provision of timely and high emergency medical care patients with sudden diseases, accidents
- Development and improvement of organizational forms and methods for emergency medical care to the population
- coordination, continuity and interaction of therapeutic and preventive institutions of the city to provide emergency medical care to the population;
- conducting examinations of temporary disability of workers and employees, issuance of disability leaves, recommendations on the transfer of patients discharged to another health status
- notice of relevant authorities on all emergencies and accidents in accordance with the special instructions and orders of the Ministry of Health of the Republic of Belarus
BSMP hospitalizes patients at emergency testimony delivered by the ambulance station sent by outpatient polyclinic and other medical and preventive institutions, as well as applied for emergency help directly into the receiving and diagnostic separation. In case of hospitalization of non-core patients, after bringing them away from the state of the patient's threatening life, the hospital has the right to transfer them to other hospitals of the city by profile for fake. To ensure 100% of the probability of hospitalization of emergency patients on a specialized bed, reserve beds are provided (5% of the kainy fund), not taken into account in the preparation of a statistical plan, but funded.
BSMP is in direct management of urban health care. It is an independent health care institution, has a building at its disposal with a designated area, equipment, inventory. BSMP enjoys a legal entity, has a round seal and a stamp indicating its full name.
Emergency medical care to the population in large cities of the Russian Federation is offered by departments (cabinets) of emergency medical care of APU. Department of emergency medical care it is a structural unit of APU, intended to provide round-the-clock medical care in places of continuous and temporary residence of adult and children's population, with acute diseases and exacerbation of chronic diseases that do not require urgent medical intervention. Emergency medical care is provided on the territorial basis by round-the-clock departure brigades of emergency medical care, organized in one or more polyclinics for the population of this administrative area. The borders of the service area of \u200b\u200bemergency care departments are approved by the Healthcare Authority of the Administrative Area.
The main tasks of the emergency medical care are:
Round-the-clock provision of timely medical care in places of permanent and temporary residence of the adult and the children's population, with acute diseases and exacerbation of chronic diseases that do not require urgent medical intervention;
The provision of medical care for patients and affected, applied independently directly to the department (outpatient patients);
Performing active calls to patients in need of dynamic medical observation, ensuring continuity in working with therapeutic and preventive institutions of the city to provide emergency medical care to the population;
The notification of health authorities of the territory and relevant administrative bodies of all emergencies and accidents in the department of service department;
Delivery of patients in the establishment of a social profile (at home-boarding, etc.) in the directions of doctors of the territorial clinic;
Transportation of patients at consultation, surveys, conducting hemodialysis in health care institutions, etc.
The office of emergency medical care is headed by the head of the department, appointed and dismissed by the head physician of a medical and prophylactic institution, whose structural division is the branch of emergency medical care.
The main functional unit of the emergency care department is the departure brigade (medical, sanitary transport for the transportation of patients). As part of the medical team, a doctor is working in the specialty "Ambulance", Feldscher (nurse), Sanitary and Driver. As part of the Feldscher Brigade on the transportation of patients, the paramedic and driver work. The number of shifting the work of the field brigades, their profile, the mode (schedule) of the work is determined by the superior organization on subordination, taking into account the conveyance of the population to the department, the density of the hourly challenges, the number of calls by day of week, months of the year, the number of patients to be emergency and planned hospitalization.
Acceptance of calls and transferring them to field brigades is carried out by paramedic (medical sister) on receiving and transferring calls to the dispatching department of emergency care of medical care. The victims (patients) delivered by the departure brigades of emergency medical care team should be immediately transferred to duty personnel personnel of the hospital office with a mark in the "call card" of their arrival.
The office of emergency medical care does not issue documents certifying temporary disability and forensic opinion, does not conduct an examination of alcohol intoxication, but it gives oral references in the personal appeal of the population or by telephone about the location of patients and affected. If necessary, issues certificates of arbitrary shape, indicating the date, time of circulation, diagnosis, surveys conducted, provided medical care and recommendations for further treatment.
Emergency It turns out to be citizens under states requiring urgent medical intervention (with accidents, injuries, poisoning and other states and overwhelming). It is carried out immediately by therapeutic and proflic institutions, regardless of territorial, conducted subordination and form of ownership, medical workers, as well as persons who are obliged to provide it in the form of per-axis. Ambulance is provided by a special emergency medical care service of the state or municipal health system in the manner established by the Ministry of Health of the Russian Federation. Ambulance Medical assistance to citizens of the Russian Federation and other persons on the territory on its territory, it turns out free of charge at the expense of budgets of all levels. In the threat of life, a citizen of medical workers have the right to use free any existing type of transport for the transport of a citizen to the nearest medical and pro-filactic institution. In case of refusal of an official or the owner of the vehicle, to fulfill the legal requirement of a medical worker about providing transport to transport the victim, they are responsible established by the legislation of the Russian Federation.
Ambulance turns out to be the ambulance stations in power (SMP).
In rural areas, the prefiguration dental ambulance in power turns out to be a medical personnel of the Feldsher-obstetrician items (FAPs). Medical assistance - dentist doctors district and district medical institutions. Ambulance stationit is a medical and pre-lactic institution designed to provide CC-chamber ambulance to the adult and the children's population both at the scene and in the way of following in the hospital under states threatening the health or life of Count-Dan or the surrounding persons caused by sudden diseases, exacerbation of chronic diseases, accidents, injury and poisoning, pregnancy complications and childbirth. The ambulance stations are created in cities with a population of over 50 thousand people as independent medical and prophylactic institutions.
In the settlements with the number of residents up to 50 thousand. Organize offices of emergency medical care in the city, central district and other hospitals.
In cities with a population of more than 100 thousand people, taking into account the length of the settlement and terrain of the area, the under-stations of the general ambulance station are organized as its divisions.
The ambulance station is headed by the chief doctor who is guided in its activities by the legislation of the Russian Federation, the regulatory and methodological documents of the Ministry of Health of the Russian Federation, the charter of the ambulance station, orders and orders of the superior health authority.
The chief physician of the ambulance station carries out the current management of the station's activities on the principles of the Union of Chalihood on issues related to its competence.
The main functional unit of the ambulance station is the exit brigade (Feldsher, medical, intensive therapy and other narrow-profile specialized brigades).
Brigades are created in accordance with regular standards with the exercise of providing round-the-clock variance.
The structure of the ambulance station is provided:
-Operative (dispatch) department;
- the communication of communication;
-Tellification of medical statistics with the archive;
-Bet for receiving outpatient patients;
-Most for storing medical equipment teams and preparation for medical styling;
-Most for storing the stock of medicines equipped with a fire and security alarm;
- Rest recreation for doctors, medium medical staff, drivers of sanitary cars;
-Most for receiving food by duty personnel;
- admistrative and economic and other premises;
- Garage, indoor parking boxes, a fenced platform with a hard coating for parking machines, corresponding to the size of the maximum number of cars that work simultaneously. If necessary, the helicopter platforms are equipped.
The structure of the station may also include other units. The communication department organizes a communication relationship between all sub-separations of the ambulance station. The station should be provided with urban telephone communication at the rate of 2 entry into 50 thousand population, radio communications with departure brigades and direct communication with therapeutic and preventive institutions.
The ambulance station operates in day-to-day operation and emergency mode.
Tasks of the station in the mode of everyday work:
-Organization and emergency medical assistance treatment and affected at the scene and during their transportation in hospitals;
- Systematic work on improving professional knowledge, practical skills of medical personnel;
- Development and improvement of organizational forms and methods of emergency medical care to the population, introduction of modern medical technologies, raising the quality of medical personnel.
In emergency mode, the station actsby directorate of the territory-rial center of medicine disasters(Republican as part of the Russian Federation, regional, regional, district, urban), which is guided by documents of the headquarters (management, committee) on the Affairs and EFC.
The main features of the ambulance station:
1. Round-the-clock provision of timely and high-quality mediocked assistance to sick and affected, which are outside therapeutic and preventive institutions, in catastrophes and sericulture disasters.
2. Timely transportation (as well as transportation on the application of Me-Ditinist workers) of patients, including infectious, persistent and fencers in need of emergency inpatient care.
3. The provision of medical care for patients and victims, facing the help of directly at the station.
4. Ensuring continuity in working with therapeutic and prevention institutions of the city to provide emergency medical care to the population.
5. Organization of methodical work, development and conduct of events for optimizing emergency medical helpers at all stages.
6. Interaction with local authorities, police department, traffic police, fire apartments and other operational services of the city.
7. Conducting measures to prepare for work in emergency situations, ensuring a permanent unauthorized reserve of re-viscous material and medicines.
8. Notice of health authorities of the administrative territory and the relevant bodies on all emergencies and accidents in the station service area.
9. Uniformly acquisition of exit brigades medical per-sonal in all shifts and full provision of them according to the equipment tablel.
10. Implementation of the norms and rules of sanitary and hygienic and counter-epidemic regimes.
11. Compliance with safety and safety regulations.
12. Control and accounting for the work of sanitary vehicles.
Organization of the work of the ambulance station:
1. The tries of calls and the transfer of them to the departure brigades is carried out by paramedic (medical sister) on the reception and transfer of challenges of the operational department (dispatching) station of ambulance.
2. Theorests (patients) delivered by the outbound teams of the ambulance station, should be utterly transferred to duty personnel of the receiving branch of a hundred cionary with a mark in the "call map" of their arrival.
3.In order to coordinate therapeutic and preventive work, improving continuity in the maintenance of patients, the administration of the Station Center holds regular meetings with the leadership of medical and pro-phylactic institutions located in the service zone.
4. Emergency medical assistance does not give out documents that have completed temporary disability and forensic medical institutions, does not conduct an examination of alcohol intoxication.
5. The oral references in the personal appeal of the population or by telephone about the location of patients and affected. With no accuracy, it issues a certificate of arbitrary shape, indicating the date, time of circulation, diagnosis, surveys, rendered assistance and recommendations for further treatment.
6. The round-the-clock rendering of urgent dental in power in large cities is allocated special dental polyclinics and emergency departments for adults and children who provide round-the-clock outpatient maintenance-visa to ordinary, weekends and holidays and traveling in some cases to the patient by challenges To the house with portable equipment.
7. Employed dental care It turns out in the daytime in dental clinics for adults and children, in dental offices, units of health and sanitary parts and health care, the ambulance service, dental offices in schools, higher and secondary educational institutions, receivers Departments of hospitals.
Emergency conditions include traumatic damage, bleeding, acute pain, etc.
The need for emergency care is approximately 5 to 15% in relation to the population of the city.
Emergency dental care It turns out in dental centers with large polyclinics and hospitals that work around the clock. Home service is carried out on special sanitary transport.
At the heart of the organization of medical assistance, residents of the village lie the same principles as the city's population. However, the features of living in rural areas affect the formation of a system of providing it. The main difference in ensuring the medical care of the rural population is its stratitude:
Fig.1 Stages of the provision of medical and preventive assistance to the rural population
- first stage - These are health facilities for a rural settlement, which are part of the complex therapeutic area. At this stage, rural residents receive prefigure medical care, as well as the main types of qualified medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental). One of the most important structural units of health institutions (district, district, central district hospital), which first turns a rural resident, is feldsher-obstetric item.
- second phase providing medical assistance to the rural population is carried out by healthcare institutions of the municipal district, among which the leading place occupies central District Hospital (CRH).CRH carries out the main types of specialized qualified medical care and at the same time performs the functions of the health management body in the territory of the municipal
- third stage - These are health care facilities, among them the regional role is played by regional (edge, district, republican) hospitals. At this stage, specialized medical care is provided in all major specialties.
Rural medical plot - A complex of medical and preventive institutions that have medical assistance to the rural population (first link).
The rural medical site includes a rural area hospital (or outpatientation), Feldsher, Feldsher-obstetric items, Feldsher Swells at the enterprises and in the state farms located in the site, collective farm maternity hospitals, seasonal and constant nursery, nursery gardens.
All medical institutions of rural medical sites are individually united and operate according to a single integrated plan under the leadership of the head of the site - the chief physician of the rural district hospital or an ambulance.
The average population in the medical site ranges from 5-7 thousand inhabitants with an optimal range of a plot of 7-10 km (different radius depending on the geographic position-in north of 50-100). The number of settlements also different depends on the nature of the distance, the average population and development of the road network.
Tasks of the rural medical site:
The provision of medical and preventive care to the population;
introduction into the practice of modern methods of prevention, diagnosis and treatment of patients;
Development and improvement of organizational forms and methods of medical care of the population, improving the quality and effectiveness of therapeutic and preventive care;
Organization and conduct of a complex of preventive measures among the population population;
Conducting medical and preventive measures to protect the health of the mother and child;
Study of the causes of general morbidity and morbidity with temporary disability and development of measures to reduce it;
Organization and implementation of people's clinicalization, primarily children, adolescents;
Implementation of anti-epidemic measures (vaccinations, detection of infectious patients, dynamic observation of persons who are in contact with them, etc.);
The implementation of the current sanitary supervision over the state of industrial and utility rooms, sources of water supply, children's institutions, catering institutions;
Carrying out medical and preventive measures to combat tuberculosis, skin-venereal diseases, malignant neoplasms;
Organization and conduct of measures for sanitary and hygienic education, promotion of a healthy lifestyle, including rational nutrition, enhancing motor activity;
Fighting alcohol, smoking and other bad habits;
Widely attracting the public to the development and conduct of measures to protect public health.
Duties of a doctor of a rural medical plot:
conducting outpatient reception of the population:
Stationary treatment of patients in a rural district hospital;
Assistance at home;
Providing medical care for acute diseases and accidents;
Direction of patients to other medical institutions for medical reasons;
Conducting examination of temporary disability and issuance of disability leaves;
Organization and conduct of preventive inspections;
Timely taking on dispensary patients;
Carrying out a complex of medical and wellness activities, ensuring monitoring of dispensarization;
Active patronage of children and pregnant women;
Carrying out a set of sanitary and anti-epidemic measures;
Sanitary and educational work;
Preparation of a sanitary asset;
Organization and scheduled departures of doctors to FAPA.
The FAP is organized in settlements with the number of residents from 700 or more than 2 km from the nearest medical institution, and if the distance exceeds 7 km, then in settlements with the number of residents up to 700 people.
The Feldsher-Okushersky Point is a large complex of health care tasks:
Carrying out measures aimed at preventing and reducing the incidence, injury and poisoning among the rural population; reduced mortality, primarily children's, maternal, in working age;
An increase in the sanitary and hygienic culture of the population;
Providing advantageous medical care;
Participation in the current sanitary supervision of institutions for children and adolescents, communal, food, industrial and other objects, water supply and cleaning of settlements;
Conducting household details in epidemic indications in order to identify infectious patients, contacts with them and suspicious infectious diseases.
The functions of the pharmacy point for the sale of the population of finished dosage forms and other pharmaceutical goods may be imposed on the FAP.
FAP's work is directly heading the head of the main tasks of which are:
Organization of medical and preventive and sanitary-pre-lactic work, as well as ensuring the population living on a plot, medicines and medical products;
Outpatient reception and treatment of patients at home;
Provision of successful medical care for acute diseases and accidents (injuries, bleeding, poisoning, and others), followed by the direction of the patient to the nearest treatment and prophylactic institution;
Preparation of patients with a doctor's reception at the Feldshera-Okushersky paragraph and carrying out the rechasery of the population, preventive vaccinations;
Conducting anti-epidemic activities, in particular residential trafficking in epidemic indications in order to identify infectious patients, contacts with them and suspicious infectious diseases;
Conducting sanitary and educational work among the population;
Organization of medical care for children in children's nursery, gardens, nursery gardens, orphanages, schools located on the territory of Fapa and not having relevant secondary medical professionals in their states.
A person who received the middle medical education is appointed to the position of the head of Phapom, and having a certificate with a degree in therapeutic matter.
In addition to the head, at the Feldsher-Okushersky point there are obstetrics and a patronage medical sister.
Obstep of the Feldsherko-Obstetric Pointit is responsible for ensuring and the level of prefiguring medical care for pregnant and gynecological patients, as well as for sanitary and educational work among the population on maternal and childhood protection.
The midwife is directly subordinated to the heads of the Feldsher-obstetric point, and the methodological management of its work is carried out by the doctor an obstetrician-gynecologist of the medical and prophylactic institution, which is responsible for the provision of obstetric and gynecological assistance to the population on the territory of FAPA.
Patronizing Medical Sister of the Feldsherko-Obstetric Pointcarried out preventive measures to improve the children's population. To this end, it solves the following tasks:
He spends the patronage of healthy children under the age of 1, including newborns at home, controls the rational feeding of the child;
Performs measures for the prevention of rickets and hypotrophy;
Conducts preventive vaccinations and diagnostic samples;
Conducts preventive work in children's nursery, gardens, nursery gardens, orphanages, schools (located on the territory of FAPA and not having relevant secondary medical professionals in their states);
Provides prefabricated medical care for children in acute diseases and accidents (injuries, bleeding, poisoning, and others), followed by a doctor's challenge or a child's direction to the appropriate medical and prophylactic institution;
Prepares sick children to receive a doctor at the Feldsher-Okushersky paragraph;
Conducts household traversions over epidemic indications in order to identify infectious patients, contact with them and persons with suspected infectious diseases, etc.
Due to the fact that the FAP is the medical assistance to the entire rural population, and not just the female, the room in which it is located, should consist of two half: Feldsher and obstetric.
In the absence of an obstetric hospital and a patronage medical sister in the state of the Feldshera-Okup, their responsibilities performs the head of the FAP. In the absence of an obstetrics, an observation of the health and development of children of the first year of life, in the state of the position of the patronage medical sister of the midwife, in addition to his duties.
Despite the important place of the FAPs in the primary health care system, the leading medical institution at the first stage of rural health - section Hospital, which in its composition may have a hospital and a medical ambulatory. The nature and amount of medical care in the precinct hospital is determined by the capacity, equipping, the presence of specialist doctors. However, regardless of the capacity, in its task, first of all, the provision of outpatient care with therapeutic and infectious patients, child assistance, medical and preventive assistance to children, emergency surgical and traumatological assistance.
The organization of outpatient polyclinic assistance to the population is the most important section of the work of the district hospital. It can be provided with an ambulatory part of the hospital structure, or independent. The main task of this institution is to carry out preventive measures to prevent and reduce morbidity, early detection of patients, dispensarization, the provision of qualified medical care to the population.
Doctors are receiving adults and children, challenges home and emergency care. Feldscher can take part in the reception of patients, however, outpatient assistance in a rural medical ambulance should mainly have doctors. In the district hospital, an examination of temporary disability is carried out, and if necessary, patients are sent to ITU.
Doctors of the central (urban, district) hospital leave the ambulatory and the FAPA on a certain schedule for consultative reception. Recently, in many subjects of the Russian Federation, the process of reorganization of district hospitals and an ambulatory in the centers of the general medical (family) practice occurs.
The capacity of the CRH depends on the population, its provision of other hospital institutions, other medical and organizational factors, and is established by the administration of municipalities. As a rule, the capacity of the CRH is from 100 to 500 beds.
Fig.2 Sample organizational structure of the Central District Hospital
Profile and number of specialized departments in the CRH depend on its power, but their optimal number should be at least five: therapeutic; Surgical with traumatology, pediatric, infectious, maternity and gynecological (if there is no maternity hospital in the area).
Chief Doctor of the Central District Hospital He is the head of the health of the municipal district. Organizes work and manages the activities of medium and younger medical staff main medical sister Hospitals.
Methodological, organizational and advisory assistance to the doctors of complex therapeutic sites, Fapov's paramedicians carry out specialists from central district hospitals. Each of them, according to the approved schedule, leaves for a comprehensive therapeutic area for medical examinations, analysis of dispensary work, selection of patients to hospitalization.
In order to approach specialized medical care to the rural population can be created interdistrict medical centers . The functions of such centers are carried out by major CRHs that can provide the population of this municipal area missing types of specialized, highly qualified stationary or outpatient polyclinic medical care.
In the structure of the CRH there is a clinic, which provides primary health care to the rural population in the directions of Fapov's paramedics, ambulatory doctors, centers of the general medical (family) practice.
The provision of non-hospital and stationary medical and preventive care for children in the municipal district is assigned to children's consultations (clinics) and children's departments of central district hospitals. The preventive and therapeutic work of children's clinic and children's departments of district hospitals is carried out on the same principles as in urban children's clinics.
The provision of obstetric and gynecological assistance to women in the municipal district is assigned to women's consultations, the birth and gynecological departments of central district hospitals.
The functional responsibilities of medium-sized medical workers of the CRH are not fundamentally different from the duties of the middle medical personnel of urban hospitals and outpatient polyclinic institutions.
Regional (Edge, District, Republican) Hospital- This is a large multidisciplinary medical and prophylactic institution, designed to provide highly qualified specialized assistance not only to rural, but also to all residents of the subject of the Russian Federation. It is a center for organizational and methodological management by medical institutions posted on the territory of the region (edges, district, republic), the basis of specialization and advanced training of doctors and medium medical personnel.
Fig.3 Exemplary Organizational Structure of the regional (regional, district, republican) hospital
The functional responsibilities of medium and junior medical personnel are not fundamentally different from those in the city or central district hospital. At the same time, the organization of the work of the regional hospital has its own characteristics. One of them serves as a hospital regional Advisory Polyclinic (OKP) , where the help of all municipal regions of the region come for help. For their placement, the hospital organizes a pension or a hotel for patients.
Patients are directed to the regional advisory clinic, as a rule, after preliminary consultation and surveys from district specialist doctors.
Power distinguished 4 categories of hospitals:
Regional hospital is due to the presence in its composition departments of emergency and planning and advisory assistance , which, using sanitary aviation or ground vehicles, provides emergency and advisory assistance with departure to remote settlements. In addition, the department delivers patients to specialized regional and federal medical institutions.
The emergency and planning and advisory department works in close connection with the regional disaster medicine center.
In this case, practical work on the implementation of sanitary assignments is carried out by brigades of specialized medical care permanent readiness.
Unlike urban, in the regional hospital functions of the organizational and methodological department Much wider. In fact, it serves as a scientific and methodological base of health management body for the introduction of advanced organizational forms and methods of medical care.
The organizational activity of the department includes the holding of regional hospital conferences, the generalization and dissemination of experience of advanced institutions, the organization of complex medical examinations of the population, planned departures, drawing up and publishing instructive-methodical and regulatory materials. Organizational forms of scientific and practical work include planning research, introduction of scientific research results into practical work of medical institutions, communications with departments of medical universities and departments of research institutes, organization of scientific conferences and seminars, attracting doctors to participate in the work of scientific societies, publishing materials et al. In recent years, to improve the quality and efficiency of counseling patients in other health facilities, modern telemedicine technologies have become widely used by scientific conferences and other events.
Emergency(SMP) is one of the types of primary health care.
Emergency - round-the-clock emergency medical care in sudden diseases that threaten the lives of patient, injuries, poisoning, deliberate self-injunations, childbirth outside medical institutions, as well as disasters and natural disasters.
The ambulance, including the ambulance, medical care is in the following conditions:
a) outside the medical organization - at the place of calling the brigade of the ambulance, including emergency specialized, medical care, as well as in the vehicle during medical evacuation;
b) outpatient (in conditions not providing for round-the-clock medical observation and treatment);
c) stationary (under conditions providing round-the-clock medical observation and treatment).
Ambassador, including ambulance, medical care is in the following forms:
a) emergency - with sudden acute diseases, states, exacerbation of chronic diseases, representing the threat of the patient's life;
b) urgent - with sudden acute diseases, states, exacerbation of chronic diseases without explicit signs of the threat of the patient's life.
The occasions to call ambulance in emergency form are:
a) violations of consciousness pose a threat to life;
b) respiratory disorders that pose a threat to life;
c) violations of the circulatory system representing a threat to life;
d) mental disorders accompanied by a patient's actions representing the immediate danger to him or other persons;
e) sudden pain syndrome representing a threat to life;
e) sudden violations of the function of a body or system of organs pose a threat to life;
g) injuries of any etiology, representing a threat to life;
h) thermal and chemical burns that pose a threat to life;
and) sudden bleeding, pose a threat to life;
k) childbirth, threat of abortion;
l) duty in the threat of emergency emergency, providing emergency medical care and medical evacuation when eliminating the health effects of an emergency.
In the case of the receipt of emergency medical care, the nearest free general public outlet team of emergency medical care or specialized emergency team of emergency care is sent to the challenge.
The occasions to call emergency medical care in urgent form are:
· Sudden acute diseases (states) without explicit signs of the threat of life, requiring urgent medical intervention;
· Sudden exacerbations of chronic diseases without explicit signs of the threat of life, requiring urgent medical intervention;
· The statement of death (with the exception of hours of work of medical organizations providing medical assistance in outpatient conditions).
In the case of an emergency call for emergency care, the nearest free general public outlet team of emergency medical care is sent to the call in the absence of emergency challenges in emergency form.
SMP is carried out by citizens of the Russian Federation and other persons on its territory, for free in accordance with the program of state order.
In the structure of the SMP. Pass stations, substations, SMP hospitals, as well as separation of the SMP as part of hospital institutions.
Station SMP As independent medical and preventive institutions create over 50 thousand people in cities with a population. In cities with a population of more than 100 thousand people, taking into account the length of the settlement and terrain, the SMP substations are organized as station divisions (in the zone of 20-minute transport accessibility). In settlements with the number of inhabitants up to 50 thousand, the SMP branches are organized as part of central district, urban and other hospitals.
Station (substation, separation) of the SMP is a medical and prophylactic institution that operates in day-to-day work and emergency situations (emergency).
Heads the work of the SMP station Chief doctor, and substations and branches - the head.
Deputy Chief Doctor for Medical Parts and for Operational Work.
Receiving calls and transferring them to field brigades feldscher (medical sister) at the reception and transmission of calls for the operational department of the SMP station .
In the structure of the ambulance station, the departments of emergency medical care polyclinics (hospitals, hospitals of emergency medical care) are recommended:
a) operational department;
b) department of communication (radio);
c) division to ensure the transport of infectious patients;
d) an economic department;
d) pharmacy (pharmacy warehouse);
e) remote-advisory post (center);
g) transport division;
h) the department of informatization and computing (in ambulance stations, emergency medical departments Polyclinics (hospitals, emergency hospitals) provided by an automated system for registering and processing calls with software);
and) the organizational and methodological department of ambulance;
k) linear control department (linear control service);
l) Department (Cabinet) Statistics with Archive;
m) department of hospitalization;
n) ambulance substation;
o) branches (posts, tracks) emergency medical care;
p) Cabinet preparation for medical styling.
Exit brigades emergency medical care in its composition divided into medical and paramedic, by his profile Universal on general-profile, specialized, emergency advisory, obstetric, aircraft. Specialized exit brigades Emergency care is divided into the brigades of anesthesiology-resuscitation, pediatric, pediatric anesthesiology-resuscitation, psychiatric, obstetric-gynecological.
Feldshera brigades include two medium-sized medical workers, sanitary and driver. The medical team consists of a doctor, two medium-sized medical workers, Sanitar and Driver.
An exit crew of emergency medical care performs the following functions:
a) carries out immediate departure (entering the flight, departure) to the place of emergency emergency care;
b) providing an ambulance medical care based on medical care standards, including the establishment of leading syndrome and preliminary diagnosis of the disease (state), the implementation of measures to promote stabilization or improving the patient's condition;
c) defines a medical organization to provide a patient for medical care;
d) carries out a medical evacuation of the patient in the presence of medical testimony;
e) immediately transfers the patient and the corresponding medical records to the doctor of the receiving department of a medical organization with a mark in the map of emergency medical care time and the date of receipt, surnames and signatures of the adopted;
(e) Immediately reports Feldeshra at the reception of emergency medical call challenges and the transfer of their emergency medical care teams (medical sister for receiving emergency medical assistance and the transfer of their emergency medical care teams) on the completion of the call and its result;
g) ensures sorting of patients (victims) and establishes a sequence of medical care in mass diseases, injuries or other states.
Requirements for the work of exit brigades:
- operational (After receiving a call, a brigade leaves for the first 4 minutes, comes to the call site on the optimal route and reports on arrival in the operational department, spends the minimum time to qualitative assistance in full)
- high-quality emergency medical care(Proper recognition of diseases and damage, the fulfillment of the necessary medical measures, a true tactical solution)
- high-quality registration of medical documents(Full description in call map anamnesis and data objective examination of the patient, as well as additional research (express tests, ECG); logical and consistent diagnosis formulation (ICD-10); Standard time stamps from the beginning to the end of the call; When delivery to the hospital compulsory filling accompanying sheet (f.114 / y) with a brief description "When and what happened", the state of the patient rendered to assistance and additional information)
- interaction with employees of other team of emergency medical care, as well as with the staff of therapeutic and preventive and law enforcement agencies (carried out both in the interests of the patient and workers of the field brigade; strict performance of job descriptions and other regulatory documents)
The main tasks of stations (substations, offices) of the SMP are:
· Rendering round-the-clock emergency medical care for sick and affected, outside therapeutic and preventive institutions, in catastrophes and natural disasters;
· Timely transportation of patients suffered and feminine in hospital hospitals;
· Providing medical care for patients and victims, applied for help directly at the station (substation, separation) of the SMP;
· Preparation and retraining of personnel on emergency medical care;
· In the CS mode - conducting medical and evacuation measures and participation in the work on the liquidation of health effects of the emergency.
SMP does not give out documentsA certifying temporary disability and forensic opinion does not conduct an examination of alcohol intoxication (but may issue an arbitrary form reference with the date, the time of treatment, the diagnosis conducted by surveys rendered medical care and recommendations for further treatment).
Statistical reporting of the SMP station:
Magazine recording emergency medical assistance (F.109 / y)
Emergency emergency call card (F.110 / y)
Accompanying sheet of ambulance station with coupon to it (F.114 / y)
Diary of the station (separation) of ambulance (F.115 / y)
Report station (separation), emergency hospital (F.40 / y)
SMP indicators:
SPEP Security Indicator
The timeliness of the emergence of emergency brigades
The indicator of the discrepancy of diagnoses of SMP and hospitals
Response indicator of repeated calls
Specific Resuscitation Specific Resuscitation Indicator
EXAMPLICATION OF THE SPECIFIC WEIGHT OF EXTREMES
Emergency Medical Aid Service (NMP) is a division of the territorial emergency medical system.
6.8. Organization of emergency medical care.
One of the most significant composite health care systems in providing the help of the population at the pre-hospital stage is the emergency service (SMP).
The section discusses the issues of the history of the establishment of the service and its role in the overall system for the provision of medical and preventive care.
A significant place is assigned to the organization of the SMP in the conditions of the city and village (institution, structure, categories, states, the main tasks, functions, rights and obligations of individual units and officials).
The data section is completed about its further specialization.
Service emergency medical careit is a relatively newly created form of community-friendly civilian population. Perhaps, for the first time, its organization arose after in 1881 during a fire in the Viennese theater, hundreds of people were injured, who did not receive any help for a long time, although clinics and hospitals worked in the city. After that, the tragic case of the Viennese doctor Yarmir Mundi proposed to organize a point of permanent duty of doctors, ready for the exit to the place of disaster and providing medical care. He called him a "ambulance station". Later, the idea has gained widespread, and emergency medical care has begun to appear in many countries.
The initiator of the creation of emergency medical care in Russia was the head of the hospital under the Alexander Community of the Red Cross Karl Karlovich Reaner. In November in 1881, he suggested organizing stations in St. Petersburg. The first institutions began to function in Moscow in 1886 after the events on the Khodynsky field, when during the massive guys and distribution of gifts due to the coronation of Nicholas II, more than 2 thousand died. Man and tens of thousands were injured. Due to the lack of medical care, the wounded died at the event site.
In early 1889, five stations were opened in St. Petersburg. As in Moscow, the impetus to their organization became a disaster - a strong flood in the spring of 1898
In 1902, in Kiev, paragraphs on the provision of medical care during accidents were opened at voluntary principles. In 1903, medical assistance in accidents in cases of accidents began to be provided in Odessa to donate Millionaire MM Top began.
On April 25, 1910, at the initiative of Professor N.I. Bolensky, a station was opened in Kharkov and the first partnership of emergency medical care was organized.
In more detail, the history of ambulance stations is presented in the book "Emergency Ambulance" edited by prof. V.V. Nikonova, Kharkov 1997, the materials of which we were gratefully used.
During the years of Soviet government, there is a gradual development of the service emergency medical care, especially in cities. In rural areas, she was in a state of the embryo.
In the late 70s, the development of the service in all republics of the former Union was determined by the Resolution of the Council of Ministers of the USSR of September 22, 77. " About further improvement in population health", And in Ukraine issued by Decree of MD No. 870 dated December 14, 2007, which regulated their implementation.
The documents emphasized the need for the relationship between the clinic and station, the development of its material and technical base, the creation specialized species of SMP,preparation of medical personnel and their improvement, Introduction subordaturaand the continuation of the timing of training in the internship to two years.
Significant achievement in the development of the system of advanced training doctors has become the opening of special department of ambulance and emergency care. In 1980 In Kharkov, the First Department was opened at the Institute of Improvement of Doctors, then in Leningrad (1982), in Kiev, in Simferopol (1988).
The further development of the SMP service was determined by the Resolution of the Council of Ministers of the USSR No. 773 of 19.08.82. " About additional measures to improve medical care to rural population" It said about the need organizations of emergency and emergency medical care in rural areas.
Decree of the Ministry of Health of the USSR No. 1490 of 24.12.84. "Pro Activities for further development and improvement of ambulance and emergency medical care to the rural population"provisions of the station (separation) were approved.
For many years we have existed two independent services to serve the urban population - ambulance and emergency medical care. One was only in small towns and rural areas.
Emergency care was distinguished by insufficient efficiency, it was sometimes impossible to distinguish between these services. There were cases of duplication of departures. This led to its liquidation in 1970 with the transfer of the respective obligations of the SMP.
The combined emergency medical care system had its pros and cons. The main disadvantage was the unreasonable increase in the workload of the SMP brigade due to the disadvantages in the work of the outpatient polyclinical institutions, which were self-inserted from its provision.
In order to eliminate accumulated disadvantages, it was planned to organize paraclinics (branches) of medical care at home, in territorial clinics to create the service of duty therapeutors and pediatricians. In connection with the transfer of providing medical care to patients with acute diseases and exacerbations of chronic polyclinics, it was decided to replace the name "Station (separation) of ambulance and emergency medical assistance" to the nomenclature of health care institutions "Stations (separations) ambulance" and create in republican, regional, regional centers the corresponding association.
Resolutions of the Council of Ministers of the USSR and the Decree of the Ministry of Health of the USSR in our time they lost legal force, but the accumulated extensive experience in organizing the work of the service is taken into account now.
In order to further improve the service in 1989, the Ministry of Health of Ukraine issued a similar decree. It pays serious attention to its organization in each rural area, equipping in large cities and regional centers with computing equipment, creating automated control systems " Ambulance and Advisory Medical Assistance", Providing motor vehicles and medical equipment.
But the implementation of the Decree in recent years has deteriorated significantly due to the difficult economic condition of the country. But there is some workers. For example, they received further development of the CMP centers and medicine disasters (Kiev, Dnepropetrovsk, Zaporizhia). At the base of institutions and faculties of improvements to doctors, the Department of Medicine Disasters (Kiev, Zaporizhia, Kharkov) is open.
In some medical schools, the creation of large cities in Ukraine is practiced departments for the preparation of Feldshers SMPaccording to specially developed programs, it will give the opportunity to carry out the scheduled structural restructuring Brigades SMP- increase the number of paramedic (up to 35-40% of their total number) with the right of independent treatment of patients. It is especially necessary in mind the specifics of the structural service of challenges and hospitalization of patients, especially in villages.
Unlike cities in the countryside, where part of the paramedic brigades reaches 90%, 70-75% of patients are hospitalized in their directions. A good preparation of medium medical personnel will be allowed to further increase the quality of diagnostics in villages, treatment at the prehospital stage.
Service emergency medical carein Ukraine, represented by special institutions - stations, substations (points), emergency hospitals.
SMP is emergency community-friendly medical care in the maximum volume with sudden diseases and accidents in place and during transportation in hospitals.
Helping patients with acute diseases or exacerbations of chronic, which are on the outpatient maintenance of territorial polyclinic, belongs to emergency medical care.It turns out to be a duty doctor of polyclinic (from the composition of the polyclinic), who, together with a medical sister, go to the challenge to the patient to provide emergency medical care at home.
Ambulance station according to " Regulation about the ambulance station"(Decree of the Ministry of Health of Ukraine No. 175 dated 19.06.96) is a medical institution, which provides round-the-clock emergency medical assistance to the adult and the children's population at the pre-hospital stage in accidents and states with the threat of life or health.
Emergency medical assistance, if necessary, everyone call location, during transportationto therapeutic institutions direct handling. Its level of rendering is determined by the medical and economic standards.
Station functions in mode round-the-clock duty and readiness for emergency medical care to the population certain service area,and in case of emergency situations - and beyond.
In other regions of Ukraine, exit brigades are sent only by decree of the local health authority to which they are subordinated.
Station is an integral part of the emergency medical system in emergency situationsand ensures its functioning if necessary. For this, the station must have a constant monthly stock of medicines, dressing material, emergency medical supplies, stretcher, equipment, styling boxes, sets for the formation of additional exit brigades in order to use them on site and when traveling to other regions in case of emergencies (disasters, Accidents, natural disasters, mass poisoning, etc.), as well as stable and autonomous energy supply, uninterrupted wired and radiotelephone operational communication and spare vehicles.
Station does not give outhospital sheets do not decideissues of temporary, long-term disability of patients and victims, does not conduct expertiseforensic, alcoholic or drug intoxication, does not enduretherefore, the decisions, written certificates, does not performconsultative surveys I. does not giverecommendations for further treatment.
He heads station chief physicianwhich is personal responsibility for all types of its activities. The station is subordinate to local health management bodies, and when entering the association or territorial emergency medical center - their leaders.
Figure No. 26.SMP Station Management Scheme
Chief doctor
Deputy Technique Senior Doctor
Chief Feldsher
Statistical Department Central Dispatch
Head specialist. Services
Substation Service General SMP
Cardiology service
Anti-slip service
Pediatric service
Neurological service
Psychiatric service
Communication service
At the present stage of the development of the SMP in connection with the organization of associations and hospitals of the SMP with powerful hospitals, the republication of at least 50% of general medical teams in the intensive care team changes to a certain extent the place of the station itself in the medical support system. It becomes the initial link of rapid diagnosis, intensive therapy, and if necessary, the operational and target hospitalization of patients.
Main goalsstation (separation) ambulance:
providing medical care for patients and affected at the scene and during transportation to the hospital as soon as possible after receiving the call;
transportation of patients with emergency assistance (with the exception of infectious), affected, fencers, premature children with mothers according to the applications of doctors and the administration of the LPU.
The station provides emergency medical care in sudden diseases that threaten the life of the patient (acute violations of the activities of the CSS and the CNS, the respiration organs, the abdominal cavity), as well as during childbirth outside of specialized branches and institutions.
Main functionsambulance stations:
reception from the population of challenges and their provision;
rendering at the pre-hospital stage according to medical and economic standards of emergency medical care patients and victims;
transportation of patients and victims that require medical support in hospitals of LPU;
preparation and direction of visiting brigades outside the territory of service to participate in the elimination of health effects of emergency situations;
keeping accounting for free beds in LPU hospitals and the definition of emergency hospitalization;
diagnostic advisory and reference and information services by the telephone population;
accumulation and renewal of reserves of medicines, dressing material, medical products, installation-sets for work in everyday conditions and in emergency situations;
ensuring interaction with other medical institutions, law enforcement agencies, fire units, emergency medical care for emergency situations, other rescue and operational and repair services;
ensuring continuity and interconnection with LPU when providing emergency medical care;
operational informing of health authorities and other interested organizations on accidents, catastrophes, emergency and other specific situations.
Depending on the number of people, which lives in the territory of cities and rural administrative areas (Decree of the Ministry of Health of Ukraine No. 175 dated 19.06.96), or calls, the station are divided into the following categories:
Accordingly, a regular schedule and control apparatus is formed. When serving over 2 million people or more than 100 thousand station calls relate to necategorical.
The station of regional centers and the cities of Sevastopol are organizational and methodological institutions for services of relevant administrative territories, therefore their status increases for one category. Republican organizational and methodical centeris Kiev SMP.
Emergency medical care are created departure brigades,the number and type of which is determined by the chief physician as needed, but not less than 0.7 per 10 thousand population. Each station (except IV and V categories) must have specialized Brigades:
cardioreanimative;
psychiatric;
neurological;
intensive therapy and resuscitation, including children's resuscitation.
For execution basic tasks and functionsthe station creates the following divisions:
dispatching for receiving calls and transferring calls to away brigades;
division of the accounting of free beds in the LPU and the organization of regulation of the flow of emergency hospitalization of patients within the limited staff;
consultative and Help Service for public information on emergency medical issues;
division of transport with a park of sanitary and other machines;
division of medical statistics;
training classes to ensure the systematic training of health workers and drivers of sanitary vehicles on emergency assistance issues at the pre-hospital stage.
In the structure of the ambulance station there are operational department (dispatch),which accepts and provides calls.
Registration of the needs of the population and management of brigades is carried out with a sufficient and reliable radiotelephone connection with the calls sign "03".
All the work of the operational department begins with medical tow truck.It is to him refer to the population with a challenge. The medical tow truck (dispatcher) of the operational department when answering the phone call must, first of all, call your personal number, clarify the cause of the call, address, surname, age of the subscriber, to enter the data to the call card with the time stamp. With any doubts or need to consult, he switches the console to the console senior doctor.The phone call during this is not interrupted, which permits in full solve a variety of situations.
Call maptransmitted to the senior dispatcher of the operational department for making a decision on the direction of the brigade with a preliminary definition of its profile. On the doctor's telephone call, as well as in case of etching or accident, immediately determine the presenceplaces in the appropriate hospital and transfercall for performing a dispatcher.
If there is no free brigade in this direction, the call serves a brigade with the nearest substation or the senior war dispatcher is looking for a brigade through the operational department, which was released after the call.
If a dispatcher is assigned in large ambulance stations to provide information about the time of departure brigade to the challenge.
After making a brigade call, notifies the dispatcher about the help of patient or affected ( "Delivered to the hospital", "left at home"). In case of accidents, information is provided more detailed. They are recorded in the challenge card and are transferred to the dispatcher in the reference service of the operational department for subsequent information of the militia and relatives.
Even this schematic list indicates the intense round-the-clock operation of a large number of people in organizing the fastest medical care.
As noted earlier, station of medical care also deals with transportation of patients and affectedat the request of the doctors of the LPU, transportation of guinea.It provides special division,the composition of which includes a duty officer, a group of medical tow trucks for receiving calls, management dispatcher of sanitary transport teams, paramedic and driver. Brigades are fixed behind ambulance substations.
Work medium medical staffat ambulance station heads senior Feldsher.He is responsible for the preparation of medium and younger medical staff, controls the timely replenishment of medicines, replacing the equipment used, systematically monitors the serviceability of the equipment and teaches the staff to correctly use it.
Before the mandatory internship, the Senior Feldsher acquains with the new employee with the nature of future work, with the equipment of brigades and cars. After determining the level of material development and mastery, practical skills form groups with which the senior paramedic and doctors specialized brigades conduct cycle of classes in a special program.
In the future, one or twice a month, Senior Feldscher in the presence of specialized team doctors conducts classes with medium medical staff, informing and familiarizing employees with new medicines and new resuscitation methods.
Senior Feldscher controls the provision of divisions and services with the necessary equipment, equipment, medical products and other property.
It also monitors the implementation of sanitary and hygienic and anti-epidemic regimes, the implementation of the rules of asepsis and antiseptics.
Ambulance station has the right to:
deny the population to help with unfounded treatment and transfer challenges as needed to outpatiently polyclinic institutions;
direction of exit brigades only to the borders of the lesions of the defeat, if they constitute a threat to the life or health of the members of the brigade;
hospitalize patients or victims to the nearest facilities to provide emergency medical care, regardless of the availability of free beds, subordination, forms of ownership;
demand from LPU twice a day about the availability of free beds;
in emergency situations to mobilize and send employees to any regions to participate in the liquidation of health effects;
collaborate with state, non-state institutions when planning and conducting emergency medical assistance activities.
The main sourcefinancing the ambulance station is the local budget. Additionalthere may be tools obtained:
from institutions, organizations and the population for the provision of paid medical services;
as a result of the economic activity of the station, which does not contradict the current legislation and is provided for by this Regulation;
for renting and selling exhaust, outdated and unused property, respectively, current legislation;
from individuals, charitable foundations, organizations;
budget financing allocated to eliminate emergency consequences.
Substation (point) emergency medical care - a structural unit for the rights of the department,which provides timely emergency medical care at the pre-hospital stage to the adult and the children's population in the states threatening or health.
It is organized on the territory of servicing ambulance station with considering:
15-minute in urban and 30-minute in the countryside of transport accessibility to the service area;
population population;
the presence and status of transport pathways;
saturation with transport enterprises and agricultural complexes;
the presence of LPU and the material base for their placement.
The maintenance area determines and, if necessary, changes the leadership of the ambulance station.
Heads and is responsible for all types of activity headsubstation.
The ambulance station according to the current standards is planning work, determines the states, provides frames, vehicles, equipment, equipment, medicines.
The dispatch substation is receiving calls from the dispatcher station of ambulance and ensures their implementation.
The list of basic functions of a substation for emergency medical care for patients and victims, their hospitalization, transportation of feminines, newborns and other functions, then they are detailed in the section " The main features of the ambulance station».
In addition to those listed earlier, at the ambulance substation related features to collect the necessary informationpro cases of mass lesions and injuries of people, accidents, criminal and suicidal cases, detection of patientswith suspicion of quarantine and especially dangerous infections, AIDS, mental illness, sudden death and identification of factorsharmful to people's health with informing relevant bodies, services, institutions, enterprises.
If it is impossible for its own and means to serve the challenge substation has the right toinform about it a senior duty officer of the ambulance station and ask for help.
The substation works B. around the clock.The shifts of duty team are carried out, as a rule, at 7-00 and 19-00. From 11-00 to 23-00, when the greatest number of appeals arrives, the day brigade is additionally operating. If there are several substations in the city changing duty should not be carried out at all substations at the same time.
Brigade SMP is working with a minimum number of subsidies for the substationdue to the receipt of calls from the substation, the central dispatching during the movement.
From the reception offices of the hospital hospitals does not transport patients to the house. This question can solve an exclusively senior doctor.
Performance the main tasks and features of the substation ensures the relevant units:
cabinets of the head, senior doctor and paramedic;
dispatch station;
point of replenishment and configuration of medicines, dressing materials, products and medical kits;
a room for storing medicines, potent and narcotic drugs;
premises for emergency medical care in direct contact with the substation;
premises for classes with the staff of the substation;
recreation room on duty teams and drivers.
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