The purpose of the study: to study the clinical and epidemiological aspects of severe trauma (polytrauma), accompanied by shock and (or) coma, in military personnel in peacetime.

Material and methods. During the period 2015–2021, 280 cases of severe trauma were studied in servicemen who were initially hospitalized in medical or military medical organizations of the zone of territorial medical responsibility of the Western Military District of the Russian Defense Ministry. Polytrauma (ISS≥18 points, “Berlin Definition”) was recorded in 137 cases (48.9%). 252 victims (90.0%) were subsequently evacuated to higher-level trauma centers for medical, tactical and organizational reasons. Statistical processing of information and analytical work were carried out with the help of the original trauma register.

Results and discussion. In the structure of the causes of severe trauma (traumogenesis) military personnel in peacetime, as well as in the whole of the Russian Federation, were dominated by traffic accidents. The injury structure д. was dominated by injury without severe leading damage (max AIS=2 points). The most severe and unfavorable in prognostic terms were injuries of two or more anatomical areas; injuries with leading damage to soft tissues and breast organs. In general, compliance with the principles of primary routing of victims with mechanical injuries was noted, the proportion of victims with polytrauma taken to level 3 trauma centers is minimal. More than half of the victims (52.1%) are initially taken to trauma centers after hours, when their medical and diagnostic resources are limited. During the initial delivery to military medical organizations, military personnel are more often delivered to level 3 trauma centers. Victims with an ISS index of less than 18 points were taken to trauma centers of all levels in approximately equal proportions. The proportion of polytrauma victims taken to level 3 trauma centers was minimal. Inter-hospital transportation of victims from level 3 trauma centers was carried out on average 27 hours earlier than from level 2 trauma centers.

Conclusions. Timely inter-hospital transportation of victims with polytrauma increased their chances of a favorable outcome. When studying the problem of severe trauma, the trauma register allows you to conduct high-quality analytical work. The problem of timeliness of inter-hospital transportation for medical and tactical indications is still relevant, especially in the central area of medical responsibility of the Western Military District.

 To study the functioning of emergency medical services in the city of Yakutsk during the new coronavirus infection, a retrospective comparative analysis of main performance indicators of the Yakutsk Ambulance Service in the period 2017–2021 was conducted. It was revealed that the number of calls in Yakutsk City and its suburbs had been growing annually. However, compared to 2019, the end of 2021 saw a decreased number of total visits by 1.2.%; of efficient visits — by 1.5%; of patients having received aid — by 1.1.%. At the same time, in 2020–2021, in order to ensure timely and quality response to all the calls, the Service had to tackle a range of managerial challenges (deficit of ambulance teams, 32% incidence in doctors and assistants, difficulties with admitting the patients with pathologies other than the COVID-19). 

Purpose: to analyze the structure of the reasons for non-transportability during pretransport therapy of newborns and its relationship with the outcomes of the hospital stage.

Materials and methods. А cohort study of 604 cases of a transport team visits for 564 newborn hospitalized in medical organizations of the Sverdlovsk region. In the studied sample, according to the tactical decision of the transport team, subgroups of transportable (n=497) and non-transportable patients (n=46) were identified. Anamnesis data, the structure of the causes of non-transportability, and the outcomes of the hospital stage were analyzed.

Results. Тhe main causes of non-transportability were respiratory failure (86.96%) and circulatory failure (43.48%), in 50% of cases a combination of two or more reasons was observed. The presence of two causes of non-transportability significantly increases the risk of death (RR=4.09 [2.01–8.32]) and 7-day mortality (RR=5.14 [1.78–14.85]). The combination of circulatory failure and respiratory failure significantly increases the risk of death (RR=7.76 [4.39–13.71]) and 7-day mortality (RR=12.2 [5.12–29.08]).

Conclusion. Respiratory failure and circulatory failure predominate in the structure of the reasons for the non-transportability of newborns. The greatest growth of total and 7-day mortality is observed with a combination of respiratory failure and circulatory failure.

Objective. The purpose of the study: to substantiate the economic orientation of emergency medical care in a hospital in the profile of “obstetrics and gynecology».

Materials and methods. In 1367 patients of the St. Pete rsburg I. I. Dzhanelidze Research Institute of Emergency Medicine with a follow-up period of up to three days, a comparative analysis of the use of specialized medical services and emergency medical services tariffs was carried out.

Results. Тhe use of tariffs for emergency medical care allows you to get a superior financial effect, the maximum effect from the use of tariffs for specialized medical care is 2.7 times (p<0.01).

Introduction. The Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan in Kazan is a hospital with 1,180 beds, designed for planned and emergency care throughout the Republic of Tatarstan. In stationary medical institutions there are 5 intensive care units, ambulance transport services with numerous resuscitation vehicles, and an air ambulance service. Every year, more than 10,000 (up to 15,000) planned surgical interventions are performed at the hospital, and almost all patients of varying severity are treated at the institution. As in all world practice, despite the high level of professionalism of nursing staff and doctors, the widespread use of modern peripheral and central venous catheters, ultrasound equipment and other devices to assist in catheterization, the rate of unsuccessful catheterization attempts remains quite high, especially in the emergency segment. medical care.

Tasks: systematization of knowledge on intraosseous vascular access (IVA), analysis of the work performed. At the current stage of providing medical care to the pediatric population, our hospital maintains a protocol for vascular access in pediatrics and has developed an internal protocol for intraosseous access to analyze the work done, take into account complications and evaluate its effectiveness.

Materials and methods. An analysis was carried out for the installation of intraosseous vascular access for two-year periods, starting from 2015. This article considers the period of 2017–2018, for which the most complete data were collected. During this period, 58 protocols were recorded in children of various age groups with various pathologies in a critical situation.

Purpose of the study. Тo analyze the dynamics of traumatism, mortality and lethality from injuries with sharp objects in Leningrad — St. Petersburg, taking into account economic processes, regulation of the alcoholic beverages market and the capabilities of the ambulance service.

Materials and methods. The work is based on archival material of the St. Petersburg State Budgetary Healthcare Institution “Bureau of Forensic Medicine” for 1978–2020.

Results and discussion. For 43 years in the evolution of traumatism, mortality and lethality from injuries from sharp objects, periods have been traced: pre-crisis (1978–1990), crisis with phases of rise (1991–1993), turning-point (1994) and recession (1995–2004), exit from the crisis or the beginning of stabilization (2005–2011), post-crisis stabilization (2012–2020). The dynamics of statisti cal indicators was influenced by the anti-alcohol campaign (1985), the destabilization of the alcohol market and the elimination of the state monopoly on alcohol (1990–1992), the restoration of state regulation of the turnover of alcoholic products (1993), and the restriction of alcohol consumption (since 1995), financial and economic crises (1991, 1998, 2008–2009), improvement of the emergency medical service (2004, 2013).

Conclusions. Economic crises were accompanied by negative dynamics of traumatism. The destabilization of the alcoholic beverages market was accompanied by an increase in traumatism and mortality. The well-organized work of the ambulance service ensures an acceptable level of lethality and mortality.

 Review of foreign and domestic literature on the diagnosis and provision of emergency prehospital medical care during severe exacerbations of chronic obstructive pulmonary disease. 

Introduction. Hemostasis disorders presented in the form of thrombosis in various vascular territories are one of the main causes of death against the background of COVID-19. Their threat persists even after recovery as part of the post-COVID syndrome. Recent studies demonstrate that the development of thromboin-flammatory syndrome is possible not only in the lungs. At the same time, the frequency of revealed venous thrombosis is 10–35% and 60% according to autopsy data. One of the localizations of venous thrombosis in COVID-19 may be the portal system. Portal vein thrombosis is a rarely diagnosed disease that remains asymptomatic for a long period, which makes its timely diagnosis difficult. At the same time, the prognosis for PVT is mostly unfavorable with deaths occurring in half of the cases.

The purpose of the study is to demonstrate the features of diagnosis and treatment of PVT on the example of a clinical case in a patient who had a mild coronavirus infection.

Description of clinical case. The article describes a clinical case of diagnosis and successful treatment of extended thrombosis of the portal, splenic and superior mesenteric veins against the background of direct anticoagulant therapy and thrombolysis by means of the percutaneous transhepatic portal access. The disease in patient K.V.A., 49 years old who had a moderate coronavirus infection (liver disease and congenital thrombophilia as a cause of thrombosis are excluded) was complicated by spleen infarcts, hydroperitoneum, partial small bowel obstruction.

Conclusion. This clinical case is of interest for the possibility of a successful combination of anticoagulant and regional thrombolytic therapy without surgical intervention in complicated thrombosis of the portal vein and its tributaries in a patient in the post-COVID period, and also dictates the need for a personalized approach to the duration and choice of doses of anticoagulant therapy after a COVID-19 infection.