The purpose of the study: to analyze the state and various components of the readiness of pediatric students to provide first aid to children at various stages of training and to propose intra-university approaches to improving it.
Materials and methods. A survey was conducted at the Ivanovo State Medical University of the Russian Ministry of Health to assess the readiness of students of the pediatric faculty (n=482) to provide first aid to children.
Results. Among respondents, 42.9% of students considered themselves prepared to provide first aid to children, 48.3% rated their knowledge as sufficient, and 42.9% rated their skills as sufficient. 37.7% of respondents knew the conditions for first aid, 42.9% knew the list of conditions for which first aid is provided, and 43.6% knew the list of measures and their sequence. 56.4% considered themselves psychologically prepared to provide first aid to children.
Conclusion. Students’ readiness to provide first aid to children is insufficient, varying across stages of study, with the most unfavorable indicators occurring in the third year. This may negatively impact students’ understanding of the requirements for interaction in providing first aid and emergency medical services, and may reduce the quality of emergency medical care. Student training in first aid should emphasize developing a clear understanding of its status and procedures, understanding the role of specially trained individuals in providing it and interacting with emergency medical services, and the legal implications of training. To develop students’ sustainable readiness to provide first aid to children, systematic supportive, motivational, informational, and educational work is necessary at the university.

Introduction. Ensuring the availability and quality of emergency medical care, including specialized emergency medical care, is a key area for improving the healthcare system in the Russian Federation.
The purpose of this study is to evaluate the medical and statistical indicators of the effectiveness of unified emergency medical care centers in everyday operations and during emergencies in the constituent entities of the Russian Federation.
Materials and methods. Тhe timeliness of medical evacuation of patients, the profile of hospitalization, interaction with outpatient clinics, and other indicators of the emergency medical care system were studied using statistical observation forms in 84 constituent entities of the Russian Federation.
Results. The study revealed a positive impact of the creation of a single emergency medical care center on the following indicators: the proportion of patients with acute coronary syndrome with ST-segment elevation who received thrombolytic therapy outside medical organizations when indicated; the proportion of patients with acute conditions who were transported by emergency medical teams to primary vascular departments and regional vascular centers; timely medical evacuation of patients who required medical care in higher-level medical organizations; transfer of urgent calls to outpatient departments; and response time to emergency and urgent calls.
Conclusion. The conducted study demonstrates that the creation of unified emergency medical care centers in the constituent entities of the Russian Federation has a significant positive impact on key medical and statistical indicators in everyday activities and during emergencies.

The purpose of the study. Based on the data of a multicenter expert survey, to develop and substantiate the organizational and methodological framework for conducting interregional medical evacuation of patients and casualties during emergencies within the general system of medical evacuation support. 
Objectives of the study. Using expert assessments, to identify the main deficiencies of the current system of interregional medical evacuation of patients and casualties in emergencies and to formulate priority directions for improving its organizational and methodological support. 
Materials and methods. А semi-structured expert survey was conducted among 1,034 medical specialists from 100 cities and towns of the Russian Federation (physicians — 59.86%; nursing and paramedical personnel — 40.14%). Roles in interregional medical evacuation were distributed as follows: executors — 77.10%; managers — 5.12%; combined managerial and executive roles — 17.78%. A professional experience of more than 10 years was reported by 69.08% of respondents. Clinical bases included the Federal and Territorial Centers for Disaster Medicine (FCEMC, TCEMC), Regional Centers for Disaster Medicine (RCEMC), ambulance stations and departments, and other medical organizations performing field-based medical work. 
Results. Experts identified the following key problem areas: insufficient coordination between referring and receiving hospitals; inadequate clinical readiness of patients for transportation; mismatch between the profile and equipment of medical evacuation teams and the tasks of prolonged evacuation; imperfect medical documentation; shortage of specialized training materials; and insufficient professional preparation of medical personnel. Proposed solutions include: development and implementation of unified medical documentation forms allowing dynamic recording of patient condition and interventions; establishment of a single algorithm for interregional dispatch coordination; modular optimization of the material and technical equipment of medical evacuation teams; and the introduction of targeted programs of continuing professional education and simulation-based training for field medical specialists.

Relevance. Criteria and scales for assessing the transportability of the wounded are necessary for organizing their timely evacuation to the stage of providing specialized, including high-tech, medical care.
The purpose of the study is to develop and test a scale for assessing the transportability of the wounded, which is applicable in the field conditions.
Materials and methods. Based on the RTS (Revised Trauma Score) scale, the NRTS (New Revised Trauma Score) scale has been developed with an expanded list of criteria for assessing the severity of the condition and transportability, which can be applied in field conditions. The NRTS scale was used to assess the transportability of 1,121 wounded, including 52.4% with moderate injuries (ISS<18), 27.3% with severe injuries (ISS 18–24), 16.7% with extremely severe injuries (ISS 25–42), and critical injuries (ISS>42) — 3,7%.
Research results. The transportable group included 85.2% of the wounded; the accuracy of the forecast in this group was 100%. The conditionally transportable group (high-risk evacuation) included 12.2% of the wounded; the accuracy of the forecast in this group was 94.9%. The non-transportable group included 2.6% of the wounded; the accuracy of the forecast in this group was 100%.
Conclusion. The NRTS scale can be recommended for assessing the transportability of the wounded in the field (in the conditions of military medical organizations of the second and third level).

Background. Administration of blood products components therapy can significantly affect the outcome of hemorrhagic shock. In modern emergency medicine, the question of the need transfusion already at the prehospital stage is increasingly being raised. However, standard methods of access to the venous bed do not always allow us to effectively solve this problem. The capacity of peripheral and bone catheters is limited, which makes it difficult to quickly introduce «viscous» blood products.
The purpose of the study is to substantiate the choice of optimal venous access for prehospital stage in military field and emergency medicine for massive infusion and transfusion therapy, for which purpose to review the literature on international experience, to consider indications, contraindications and risks when using central vein catheterization for prehospital stage.
Materials and methods. A review of literary sources on keywords over the past 10 years has been conducted using databases eLibrary RU, PubMed and Google Scholar, 1286 sources were found, 24 sources were selected, of which 4 fully corresponded to the tasks set.
Results. The optimal solution is to central vein catheterization, which provides direct access to a larger diameter venous channel and allows for high-speed injection of blood products. The use of ultrasound navigation reduces the risks of central vein puncture and catheterization, increases the accuracy of manipulation and reduces the likelihood of complications, which justifies performing this procedure on prehospital stage even in difficult conditions.
Conclusion. Key factors determining success remain personnel qualification, environmental conditions, and the availability of appropriate equipment and logistical support.

The article presents a view on the ways to improve the effectiveness of anesthetic care in traumatological patients.
The aim of the study is to theoretically substantiate, develop and introduce into clinical practice schemes of premedication and anesthesia during arthroscopic surgeries, by using clonidine, nefopam and ketorolac.
Materials and methods of the study. Clinical observations were performed in 280 patients undergoing arthroscopic surgery. The comparison group consisted of 100 traumatological patients who received intramuscular premedication of atropine 0,014 mg/kg; diphenhydramine 0,14 mg/kg; trimeperidine 0,28 mg/kg 30–40 minutes before surgery. In 80 patients, clonidine 1.5 mcg/kg was additionally included in preacute drug treatment — the main group No. 1. In 100 patients, premedication was used with ketorolac 0,4 mg/kg, atropine 0,014 mg / kg and nefopam 0,27 mg/kg — the main group No. 2. All patients underwent intravenous anesthesia using propofol, ketamine, and fentanyl. The inclusion criteria were: male and female gender; age 18 years and older; presence of intra-articular knee joint injuries.
Results. A detailed analysis of the immediate preoperative period showed that 25% of patients in all groups had a negative reaction to the upcoming surgery and anesthesia. Although 52,5% of the patients were calm, only 22,5% of the patients were indifferent to the upcoming surgery. The use of premedication with atropine, diphenhydramine and trimeperidine did not correct disorders from the psycho-emotional sphere, moreover, all patients experienced fear and tension, which were relieved by drugs for introductory anesthesia. Inadequate preoperative mental preparation was accompanied by a hemodynamic reaction. Our studies have shown that patients in the comparison group had a significant decrease in SaO2 after delivery to the operating room. However, the inclusion of clonidine in the premedication significantly changed the above picture. All patients did not experience negative emotions after being taken to the operating room, and 9 of them (22,5%) were sleepy. The stabilization of hemodynamics in patients of the main group No. 1 made it possible to maintain HDD and SaO2 in optimal condition at all stages of the study. After premedication with ketorolac and nefopam, all patients experienced a significant sedative effect — 36 patients entered the operating room in a drowsy state, and 3 were even asleep. Our studies have shown that the combined use of ketorolac and nefopam significantly optimized hemodynamic parameters.
Conclusion. The inclusion of clonidine in premedication or the prescription of ketoralac with nefopam (instead of a narcotic analgesic) in premedication for patients undergoing arthroscopic operations may be promising for wide practical use, because takes into account specific clinical and physiological disorders present in the patient.

One of the main problems faced by team members performing medical evacuation of patients in serious or critical condition is to provide adequate anesthesia and sedation for neurovegetative protection. Those affected in this condition are in particular need of adequate sedation and analgesia, which prevent agitation and ensure the implementation of intensive care measures, in particular, invasive manipulations. During transportation, including aviation medical, this component becomes more important due to the impact of additional triggers such as vibration, engine noise, acceleration, etc. Recently, there has been an increasing number of studies confirming the benefits of inhaled sedatives as an alternative to intravenous sedatives, especially in patients with invasive respiratory support. Currently, the literature widely presents the results of studies on the use of inhalation sedation in the intensive care unit and intensive care unit, and practically does not cover its use at the pre-hospital stage, especially when performing air medical evacuation, which served as the basis for presenting the following clinical observation to your attention.
The purpose of the study is to demonstrate the possibilities and results of sedation with an inhaled anesthetic to a victim with severe concomitant trauma in critical condition on a ventilator during inter–hospital transportation by a light-class ambulance helicopter.
Materials and methods. The work uses data from the automated information and analytical system «Disaster Medicine of the city of Moscow» of the Moscow State Medical University of a special type «Moscow Territorial Scientific and Practical Center for Disaster Medicine DM», concerning the inter-hospital transportation of patients in critical condition. A call card for ambulance (emergency) medical care teams at the MTNPCMK (CEMP) DZM State Medical Institution.
Methodology. The use of an AnaConDa device for inhalation sedation, which allows for more precise monitoring the dosage and effect of drugs in the cabin of a light-class ambulance helicopter.
The results and their analysis. A clinical case of successful implementation of inhalation sedation and anesthesia on a ventilator during inter-hospital transportation by a light-class helicopter of a victim in critical condition due to a combined injury is presented.
Conclusion. The presented clinical case showed that inhaled sedation and anesthesia with an inhaled anesthetic using an AnaConDa device during hospital-to-hospital transportation of a critically ill patient on a ventilator provides a number of positive effects with a relatively simple and safe technique. In the future, the use of inhaled anesthetics in ambulance practice may help to avoid polypragmasia and, accordingly, reduce the risk of unpredictable side effects and enable sedation and analgesia for severe victims at the scene before immobilization, providing venous access and delivery to the cabin of vehicles or on board an aircraft. It should be noted that performing sedation and anesthesia with inhaled anesthetics at the prehospital stage in critically ill patients requires continued research in this area.

The purpose of this study was to analyze publications on the use of extended domestic non-invasive mechanical ventilation (NIV) in patients with chronic obstructive pulmonary disease (COPD), and to discuss the tactics of EMS physicians when providing care to these patients as their condition worsens.
Methods. Аnalyzing 30 foreign and domestic sources, 21 of which were published in the last 5 years, was the method employed.
Results. The data presented in the analyzed studies provide basic information on the indications for and technique of NIV in COPD. NIV in these individuals improves life quality and expectancy, but does not eliminate the risk of side effects. The overall number of such patients is steadily increasing. EMS physicians must be aware of this treatment method in order to be able to provide the necessary assistance if needed.
Conclusion. The review’s data has practical significance for emergency medical services physicians.

According to the Federal State Statistics Service of the Russian Federation, in 2021, the proportion of victims exposed to carbon monoxide intoxication amounted to 3.2% of the total number of poisonings (about 3.5 thousand people), and in terms of the number of deaths from acute poisoning, carbon monoxide intoxication is in second place and amounts to about 20%.
The purpose of the study: statistical toxicological analysis, consideration of the mechanism of toxic action, features of diagnosis and treatment of patients hospitalized with acute poisoning with carbon monoxide and combustion products in the toxicology center of the hospital.
Materials and methods of research. The medical records of 483 patients admitted to the Acute Poisoning Center of the State Budgetary Institution «St. Petersburg Research Institute of Emergency Care named after I. I. Dzhanelidze» in 2022–2024 with the diagnosis: «Acute poisoning with carbon monoxide and combustion products» were analyzed. The mechanism of toxic action was studied, statistical, laboratory and instrumental studies were carried out upon admission of patients to a multidisciplinary hospital and in dynamics after intensive care.
Research results. According to the reports of the toxicology center of the State Budgetary Institution «St. Petersburg Research Institute of Emergency Care named after I. I. Dzhanelidze», the number of patients with acute poisoning with carbon monoxide and combustion products was: 2022–129 admitted (of which 10 patients died); 2023–141 patients (6 deaths); 2024 — out of 213 admitted with acute poisoning with carbon monoxide and combustion products, 8 patients died. All patients with acute poisoning were in serious condition with disorders of vital organs.
Conclusion. Acute poisoning with carbon monoxide and combustion products occupies one of the leading places among acute poisonings of chemical etiology in terms of the number of adverse outcomes. Timely, full and high-quality provision of medical care at the stage of emergency medical care outside a medical organization has a significant impact on the course and prognosis of the disease. Scientific and practical significance lies in the generalization of modern concepts of the pathogenesis of poisoning with carbon monoxide and combustion products, principles of diagnosis and treatment. The materials can be used in clinical guidelines.

Introduction. The current level of digitalization in healthcare allows for remote monitoring of the diagnostic process, including real-time transmission and interpretation of electrocardiograms.
The aim of this study is to scientifically substantiate and evaluate the clinical and preventive effectiveness of remote ECG telemetry in preventing the transformation of acute coronary syndrome into myocardial infarction.
Materials and methods. The study was conducted at medical facilities in the Fergana region and involved 220 patients with acute coronary syndrome. Patients were divided into the main group (n=110, use of ECG-telemetry) and the control group (n=110, standard protocol). The time intervals «symptom-hospitalization», «symptomreperfusion», the frequency of myocardial infarction development and the coefficient of relative risk reduction were estimated.
Results. The use of telemetry reduced the time to detect ischemia from 95±18 to 28±7 min (–70.5%), the time from symptom to hospitalization from 157±22 to 47±9 min (–70.1%), and the time from symptom to reperfusion from 265±35 to 118±21 min (–55.5%) (p<0.001). The frequency of acute coronary syndrome transformation into myocardial infarction decreased from 25% to 3%. The relative risk reduction was 88%.
Conclusion. The implementation of ECG-telemetry significantly increases the effectiveness of early diagnosis and prevention of myocardial infarction and can be recommended for widespread implementation in the structure of the emergency medical care service.

Objective. To study the impact of a pharmacoinvasive strategy on the incidence of coronary thrombosis and the no-reflow phenomenon in acute myocardial infarction.
Objectives. The main objectives include the analysis of no-reflow mechanisms, evaluation of the effectiveness of prehospital thrombolytic therapy, and comparison of the results of percutaneous coronary intervention using pharmacoinvasive techniques and primary percutaneous coronary intervention without prior preparation.
Materials and Methods. An analysis of current scientific literature on the no-reflow phenomenon and pharmacoinvasive therapy in open sources (PubMed, Scopus, eLIBRARY) for 2013–2024 was conducted. Randomized clinical trials, meta-analyses, and observational studies on the impact of this technique on complications in acute myocardial infarction with ST-segment elevation were examined. The focus was on articles from the last five years (2019–2024), including key indicators of coronary blood flow, microcirculation, and disease outcomes. Data from the Primorsky region (n=124) on the results of combined thrombolysis and angioplasty were additionally analyzed.
Results. The no-reflow phenomenon is manifested by a disruption of the blood supply to small vessels after the elimination of a large thrombosis and is caused by microembolization mechanisms, ischemic injury, inflammatory reactions, and vascular spasms. Diagnosis is based on angiography, microvascular resistance index and imaging methods: magnetic resonance imaging and ultrasound diagnostics. Risk factors include late hospitalization, large infarct size, and the presence of comorbidities. A pharmacoinvasive strategy effectively prevents no-reflow thanks to early thrombolytic therapy, which reduces thrombotic volume and improves tissue perfusion and is associated with better myocardial function and less necrosis. If signs of microcirculatory impairment persist, antithrombotic agents, thrombus removal, delayed stenting, and vasodilators are used. Prevention and correction of no-reflow require a comprehensive approach and thorough diagnostics.
Conclusion. The no-reflow phenomenon worsens the treatment outcomes of acute myocardial infarction, therefore, a pharmacoinvasive strategy including thrombolysis and antithrombotic therapy should be used to quickly restore blood flow and reduce myocardial damage. The identified risk factors will allow physicians to assess the likelihood of this phenomenon occurring in a given patient and plan prevention and treatment in advance. Furthermore, the impact of innovative diagnostic methods and therapeutic approaches (robotic systems, intracardiac devices) on preventing no-reflow is further studied, as is the need for further clinical trials to evaluate optimal drug combinations and timing of administration.

Objective. To review current national and international data on the diagnosis and emergency management of acute oral poisoning in children in the prehospital setting.
Materials and Methods. 22 sources were analyzed, including clinical guidelines, original studies, and recent reviews, with a focus on early diagnostic strategies and therapeutic approaches prior to hospital admission.
Results. Acute poisonings remain a significant cause of mortality in children, particularly among those under five years of age and adolescents with intentional intoxications. Key priorities in the prehospital phase include history taking, recognition of toxidromes, stabilization of vital functions, gastrointestinal decontamination (gastric lavage, activated charcoal), initiation of infusion therapy, and, when indicated, administration of antidotes.
Conclusion. Proficiency in emergency care algorithms for acute pediatric poisonings substantially reduces complications and mortality risk, underscoring the practical relevance of these data for emergency medical service physicians and pediatric anesthesiologists-intensivists.