Aim: to identify objective criteria for determining the disease conditions under which telemedicine would be most effective, using hypothetical integration models. Research objectives: a) Analysis of risk fac tors; b) Determination of the effectiveness of telemedicine; c) Creation of a predictive model. Material and methods. The study involved a retrospective analysis of 1115 critically ill patients who either sustained in juries in highway accidents or experienced acute exacerbations of various diseases in remote areas, neces sitating emergency medical care. The primary outcome was the mortality rate within the first 24 hours after hospital admission. Risk factors were assessed based on patient age, Glasgow Coma Scale (GCS) scores, coma status, and other clinical indicators. The statistical analysis was conducted using Binary Logistic Regression, and the model›s quality was evaluated through the «Omnibus Tests of Model Coefficients» and «Hosmer and Lemeshow» tests. Results. The study found that the time taken for an ambulance to reach the scene after an emergency call significantly influences the risk of complications and mortality, with a longer delay correlating with a higher probability of death. Although age increases the risk of mortality, this increase is not statistically significant. Lower GCS scores are associated with higher mortality risk, and severe coma conditions. Patients with «Coma 1» have a very low survival rate, underscoring the need to consider such conditions critically in emergency medical decisions. The analysis of diagnoses revealed that certain conditions, such as hyperten sion and cerebrovascular disorders, significantly affect the probability of mortality. Other diagnoses, including pathological pregnancy and closed head trauma, did not show a statistically significant impact. These findings provide crucial insights for medical decision- making and the identification of high-risk groups for telemedicine intervention. Conclusion. This study offers important results that contribute to the identification of objective criteria for enhancing the effectiveness of telemedicine in emergency medical services. By predicting which patient conditions would benefit most from telemedicine, healthcare providers can make strategic decisions that improve service quality and increase the survival chances of critically ill patients.

Purpose. To study the management part of ambulance medical care before and after the formation of a unified vertical ambulance system in the Republic of Uzbekistan. Tasks. Сonduct an analysis of the man agement part of emergency medical care before the formation of a unified vertical system of ambulance medical care in the Republic of Uzbekistan; study the structure and staffing standards of the new unified vertical ambulance system in the Republic of Uzbekistan; analyze the integration of ambulance medical care with institutions providing primary health care to the population of the city of Tashkent. Materials and methods. To conduct the study, statistical methods used to study the work of the ambulance medical ser vice, materials from the analysis of regulatory legal acts regulating the provision of ambulance medical care. The study analyzed statistical data on ambulance medical care for the Republic of Uzbekistan and separately for 2021–2023 around the city of Tashkent. Results. The country is implementing comprehensive measures to develop healthcare, ensure guarantees of citizens› rights to health care by the state, promote a healthy lifestyle for citizens, and make medical care accessible to all segments of the population. The ambulance is the most important component of primary health care for the population. The ambulance is in direct con tact with the consumer of medical services. But the lack of a unified management system did not provide an opportunity to improve quality. In order to radically improve the ambulance system, aimed at radically enhancing its efficiency, technological effectiveness and efficiency, organizing at the highest level the entire complex of medical, scientific, methodological and educational work to provide the population with timely emergency medical care, the Republican Center for Ambulance Medical Care was created and 14 its region al branches. A unified vertical ambulance management system has been introduced. This made it possible to improve the ambulance medical care system. Conclusion. The formation of a unified vertical ambulance medical care system makes it possible to increase the availability and quality of ambulance medical care throughout the Republic.

Introduction. The need for modernizing ambulance interiors arises from the necessity to improve their er-gonomics. Objectives: to optimize the prototype of an ambulance interior based on feedback and recommen-dations from the expert community. Tasks: Evaluate the prototype of the ambulance interior, refine the design based on feedback, implement modifications into production models, conduct a reassessment of the results including operational evaluation, and identify directions for further improvements. Materials and methods. The study was conducted in two stages: 255 respondents were surveyed in the first stage, and 245 in the sec-ond. Descriptive statistical methods and the Mann- Whitney test were used to assess the statistical significance of differences between prototype and production model indicators. Results. The analysis showed improve-ments in the versatility of mounts (rating increased from 4.49 to 4.71), patient comfort (from 4.67 to 4.80), and ease of cleaning (from 4.52 to 4.74). Overall, 84% of feedback was positive, confirming a high level of satis-faction within the medical community. Conclusion. Integrating feedback from the medical community into the design process of ambulance vehicles enabled the development of functional and reliable solutions that meet modern requirements and improve working conditions for ambulance crews. The developed methodolo-gy proved effective and can be utilized for further modernization of medical transport.

At the end of 2023, the Russian Government approved the Concept for Reducing Alcohol Consumption in the Russian Federation until 2030 and beyond. Planning of measures within the framework of solving one of the main tasks of the Concept — prevention of alcohol abuse, improving the quality and accessibility of medical care for persons with alcohol dependence and persons with harmful use of alcohol — requires studying the prevalence and features of its use among patients and victims hospitalized in an urgent multidisciplinary hospital. Purpose of the study. Screening of the prevalence and peculiarities of daily alcohol consumption by patients who sought emergency medical care in the inpatient emergency department of the St. Petersburg I.I. Dzhanelidze research institute of emergency medicine. Materials and methods. Тhe study sample included 586 patients of both sexes, hospitalized in GBU SPB Dzhanelidze Research Institute of Emergency Medicine in connection with somatic pathology. Screening was performed with a structured interview method, including questions of Alcohol Use Disorders Identification Test (RUSAUDIT). The results of the study. An analysis of the pattern of alcohol use by patients of an emergency hospital by age group, sex, frequency, type and volume of alcohol consumed, and their association with the presence of chronic diseases is provided. Signs of harmful alcohol use were assessed in the respondents and a significant number of respondents were found to have tendency to binge drinking, withdrawal from usual activities and guilt related to alcohol use.

Prevention of hypothermia in the wounded and injured remains an urgent problem in providing assistance to the wounded and injured with polytrauma. The purpose of the study was to evaluate the effectiveness and safety of using a thermal cover designed to prevent hypothermia of the victim in an experiment with the participation of volunteers. Materials and methods. The study was carried out with the participation of volunteers who were exposed to cold temperatures with and without the use of a thermal blanket. The subjects were lying motionless on a stretcher in a thermal chamber for 60 minutes at an ambient temperature of 00C, the air humidity was 50%. Temperature sensors were located on the skin, on the upper layer of clothing and on the surface of the thermal cover. Results. The use of thermal seals at negative ambient temperatures contributes to a slower cooling of the body due to the reflection of heat from the inner surface of the product. The subjective feelings of the volunteers showed statistically significant differences in heat perception when using thermal covers. In the experimental group, the volunteers did not note that they were «cold» at any stage, in the control group, after 45 minutes of observation, in 4 cases they were given 1 point («cold»), and one of the volunteers wished to stop the study. At the same time, thermal blankets contribute to a slower cooling of the body. In the group using a thermal blanket, the core temperature (the sensor is installed in the oral cavity) was on average 4,2 °C higher compared to the group of volunteers without a thermal blanket. Thus, thermal blankets can help prevent hypothermia in victims during evacuation by emergency medical teams. Conclusion: the presented samples of thermal coating products are effective means of preventing hypothermia in low ambient temperatures.

The aim of our study was to develop an express diagnosis of closed traumatic skin detachment at an early stage in patients after high-energy injuries at the stage of emergency medical care. Materials and methods. The results of treatment of 25 patients who were admitted to the Institute were analyzed. Dzhanelidze after high-energy injuries. Everyone underwent a study — laser Doppler flowmetry (LDF) on the first day after the injury. The perfusion index, measured with LDF, makes it possible to diagnose closed traumatic skin detachment with high accuracy. With perfusion indices (N) of the damaged area less than N of the symmetrical intact skin area or with N of the damaged area less than 4 p. units, a closed traumatic skin detachment is diagnosed. If the perfusion parameters correspond to the values in the symmetrical area or are higher/equal to the value of 4 percentage points, then the diagnosis is excluded. The diagnostic criteria for making this diagnosis were determined, which made it possible to propose an algorithm for diagnosing closed traumatic skin detachment. The application of the approaches developed by us to the diagnosis of closed traumatic skin detachment will improve the treatment results of this category of victims.

The use of lidocaine in a regimen of multimodal anesthesia to reduce doses of anesthetics compared to classical anesthesia is a promising direction in modern anesthesiology. The widespread use of local anesthetics in anesthesiological practice has made it possible to identify their significant effect on the neuromuscular profile. However, the available research on combinations of these drugs with muscle relaxants is very contradictory. Objective. To study the effects of preoperative intravenous lidocaine on neuromuscular conduction. Materials and methods. In order to assess the effect of lidocaine on neuromuscular conduction, 60 patients (ASA I–II) were examined, who underwent laparoscopic cholecystectomy for chronic calculous cholecystitis. Two groups were formed: patients using lidocaine at a dose of 2 mg·kg-1 (30 people, the first group), and patients who used saline (30 people, the second group). Neuromuscular conduction was assessed using the acceleromyography method (monitor TOF-Watch SX). Results. The rate of recovery of neuromuscular conduction was within 47 and 48 minutes in groups 1 and 2, respectively (p=0.92). Conclusion. As a result of the study, it was found that lidocaine did not statistically have a significant effect on neuromuscular transmission.

Objective. To conduct a medical and social analysis of the patients› demand for emergency medical care for uncontrolled arterial hypertension in St. Petersburg and to calculate the expected economic effect. Objectives of the study. 1. To study the structure of patients› visits in connection with increased blood pressure and to assess their five-year survival rate, as well as to identify the most common emergency conditions; 2. To study and assess the prevalence, dynamics of treatments, distribution by gender and age of patients associated with uncontrolled arterial hypertension during 2015–2017; 3. Using neural networks, to predict changes in the number of patients in connection with an increase in blood pressure; 4. Taking into account the previous study, calculate the estimated economic effect of self-help prescription. Materials and methods of research. A retrospective analysis of patients› appeals from St. Petersburg in the period 2015–2017 was carried out. In total, the study included 250413 patients who sought help during this period 388603 times. Outcomes. As a result of the work carried out, the most common emergency conditions were identified, the structure of appeals in connection with uncontrolled arterial hypertension was clarified, and their dynamics and distribution of patients by age and gender were determined. A forecast of changes in the number of patients who sought emergency medical care due to increased blood pressure was carried out. The survival rate of patients was assessed and the estimated economic effect of self-care was calculated. Conclusion. The study showed that in the structure of appeals in connection with an increase in blood pressure in St. Petersburg, the number of calls for uncontrolled hypertension was 94.6%. Appeals on this occasion in 2015–2017 increased by 17.8%, due to repeated and for the first time in this year appeals from elderly, senile and long-lived women. At the same time, 90.8% of patients did not require intensive care and/ or hospitalization. The five-year survival rate of patients seeking help for high blood pressure was high and the probability that he would live five years was more than 0,98 (98%). Prognostic modeling of the number of women living in the district or city has shown that the larger the number of older female patients living in the district or city, the more the number of women seeking help in this regard will increase. The estimated economic effect of the appointment of self-help may amount to 80 026 743,8 rubles per year.

In the Republic of Dagestan the implementation of the regional project «Combating Cardiovascular Diseases» continues, with the functioning of vascular centers, while the use of a pharmacoinvasive strategy at the pre-hospital stage is of great importance in patients with acute myocardial infarction. Aim: to study data on prehospital systemic thrombolysis in patients with STEMI (acute myocardial infarction with ST segment elevation) throughout the Republic of Dagestan. The objectives of the study were to analyze statistical data on the work of the emergency medical service in the RD for 2022, 2023 and 6 months of 2024, as well as study materials on the use of the drug Fortelysin as a component of intensive prehospital therapy for STEMI, with justification for the need to develop and implement a protocol for an effective strategy for providing emergency medical care in patients with STEMI throughout the entire territory of the Republic of Dagestan. Materials and methods of research. The study included 103 emergency medical care call cards for patients with acute myocardial infarction for the period 2022, 2023 and the first 6 months of 2024. on the territory of the Republic of Dagestan. Fortelysin used as a thrombolytic in all patients. Research results. The use of fortelysin in patients with AMI in the conditions of emergency medical care RD showed high efficiency (cessation of pain syndrome observed in 73% of cases, and a decrease in the ST-segment by 50% from the initial one recorded in 52% of patients) and safety (there was a low likelihood of serious side effects). Also, it is necessary to note a trend towards a decrease in the use of pharmacoinvasive strategies at the pre-hospital stage, to a greater extent in the mountainous regions of the Republic. Conclusion. The reasons for the decrease in the use of pharmacoinvasive strategy at the pre-hospital stage, mainly in the mountainous regions of the Republic, have been identified. Specialists of district ambulance services have insufficient knowledge about modern fibrinolytics. They are guided by their fears of reperfusion arrhythmia and bleeding when making a decision to perform TLT. The remoteness of medical institutions providing specialized care, geographical peculiarities of the region also contributes to the refusal of TLT. The efficacy, safety and convenience of fortelisin application (standard dosage) at the prehospital stage are shown. The use of an easy-to-use, easy-to-use, effective and safe thrombolytic, which does not require complex calculations and special equipment, throughout the whole territory of the RD will contribute to the improvement of treatment results of patients with STEMI and reduction of mortality from cardiovascular diseases in the region.

The article discusses the contribution of atrial fibrillation (AF) to the structure of ambulance calls to patients with arrhythmias in St. Petersburg, diagnosis, clinical assessment of this group of patients and providing them with assistance within the framework of the clinical and tactical scheme. The author analyzes our own experience in studying the effectiveness of drug cardioversion of the paroxysmal form of AF and suggests directions for optimizing the provision of medical care at the pre-hospital stage.

In children and adolescents with type 1 diabetes mellitus (DM), diabetic ketoacidosis (DKA) represents an acute and severe complication with a high risk of further complications and death. DKA is a grave condition that requires the hospitalization of a child into an intensive care unit. The quality of prehospital emergency care for DKA in pediatric practice is a pressing issue. Aim: to assess the impact of infusion therapy at the stage of prehospital care on the duration of hospital DKA treatment in children and adolescents. Methods. The study involved 104 children with DKA (60 boys and 44 girls with a mean age of 8.4±0.98 years) receiving treatment in an intensive care unit. Based on the volume of care received during the prehospital stage, two study groups were formed, namely, group I (n=52) — fluid resuscitation; and group II (n=52) — receiving no medication. At their admission to the clinic, patients underwent testing to assess the levels of their blood glucose and glycated hemoglobin (HbA1c), as well as urinary ketone bodies, had their level of consciousness estimated using the Glasgow Coma Scale, and severity of their DKA evaluated. Once the symptoms of DKA were resolved, the patient›s duration of hospital treatment was recorded. Statistical assessment of data involved the use of the Mann–Whitney test. Results and discussion. Group I children, who had received the fluid resuscitation during their prehospital care period, spent significantly less time undergoing hospital DKA treatment (p=0.0000) and had the lowest blood glucose (р=0.0001) and HbA1c (p=0.0000) levels. Children from group II, who had not received any medicaments at the prehospital stage, had the highest prevalence of DKA graded as severe. Fluid management at the prehospital stage are well-justified tactical interventions that reduce the duration of hospital DKA treatment of children and adolescents. Conclusion. Combining fluid management as part of prehospital care of children with DKA is the most efficient method for decreasing the clinical manifestations and complications of DKA during hospital treatment.