In order to improve the system of emergency medical aid in the Republic of Uzbekistan, the issues of its availability and quality, as well as resources, technology and the results of the functioning of the system should be considered and analyzed taking into account the opinion of the heads of medical organizations, medical workers providing emergency medical care, as well as from the standpoint of study of patient satisfaction. To this end, a sociological study was conducted in 2021, the program of which included studying the opinions of the heads of medical organizations providing emergency medical care (stage 1) and employees of mobile ambulance teams (stage 2). Statistical and analytical methods were used. The data obtained allow us to note, in general, a positive assessment of the state of emergency medical care in the Republic of Uzbekistan by the heads of medical organizations. At the same time, according to the survey data, the medical workers themselves need to improve the working conditions of mobile teams, due to the significant volumes of non-core work, as well as the heavy work-load due to the high population density in the service area. The problems are exacerbated by the lack of informatization and automation of ambulance units, as well as the factor of “professional burnout” of personnel.

   The dynamics and forecasting of the population’s calls for emergency medical care due to an increase in blood pressure are determined. A comparative analysis and prediction of the number of calls served with the final diagnoses of “hypertensive disease” and “hypertensive crisis” were carried out.

   Goal — was to assess the quality of life and the functional state of the cardiovascular system of patients who have had COVID-19, to outline the further tactics of recovery of the cardiovascular system.

   Materials and methods. The study included 131 patients, men (n = 84) and women (n = 47), aged 41–76 years, with the presence of cardiovascular disease. Patients for a long time 4.4 ± 1.3 years, are under outpatient supervision in polyclinic No. 3, Makhachkala. Of the 131 patients included in the study: ischemic heart disease: angina pectoris I-II functional class was in n = 59 (45.0 %), arterial hypertension in n = 72 (55.0 %). All patients filled out the World Health Organization’s quality of life questionnaire, daily monitoring of electrocardiography, blood pressure, echocardiography and other types of examination was performed. The research was carried out in accordance with the norms and principles of the Declaration of Helsinki.

   Results. After 2 months. after the COVID-19 illness, the survey showed that 62 patients (47.3 %) (p = 0.0026) were dissatisfied with the quality of life, before the illness, this figure was (28.3 %). Another 69 patients (52.7 %) are not satisfied with their state of health (p = 0.0048), against (30.4 %) — before coronavirus disease. Physical pain interferes with life — 48 patients (36.6 %) (p = 0.0019), before illness, only (24.5 %), and so on. Thus, the change in the status of quality of life “before and after” was statistically significant, p < 0.05. After 2 months. after coronavirus disease and discharge from the hospital, the daily monitoring of electrocardiography showed that in patients with exertional angina pectoris I-II functional class, ischemic and arrhythmic indicators were significant compared with the primary data p < 0.05. At the same time, the data of daily monitoring of electrocardiography in patients with arterial hypertension reached the indicators of patients with angina pectoris I-II functional class. The results of 24-hour monitoring of blood pressure before and after coronavirus disease showed that patients with increased numbers of systolic and diastolic blood pressure increased, with grade II arterial hypertension by n = 7, and with grade III. by n = 6. Hypertensive crisis began to be noted, almost every third patient had 16 (22.2 %), only 2 (2.8 %) patients were hospitalized with a stroke. Initial and after COVID-19, echocardiographic parameters were as follows, a significant decrease in left ventricular end-diastolic volume from 133.2 ± 4.2 to 127.0 ± 3.4, end-systolic volume from 77.3 ± 2.6 to 72.4 ± 7.01. The total ejection fraction significantly decreased in comparison with the initial data: from 49.6 ± 4.2 to 41.9 ± 7.3. There was a significant decrease in stroke volume from 61.7 ± 4.1 to 54.0 ± 5.8.

   Conclusion. After analyzing the laboratory and instrumental data of the patients’ examination, we noticed that the real functional state decreased by a quarter in comparison with the initial indicators. But the survey of the quality of life showed that patients tend to overestimate the problems of their functional state by up to 30–40 %. At the same time, almost one third of our patients have developed post-ovarian syndrome, most of them developed depression, anxiety and fear for their health.

   In 94 patients, suffering from complicated or uncomplicated hypertensic crisis, the efficiency and safety of esmolol administration in pre-hospital stage of emergency medical care was examined. Unique pharmacokinetics of esmolol allow us to achieve significant arterial tension decrease during the first minutes of the intravenous injection, meanwhile antihypertensive effect increases till 20 minutes and elimination half-life is 9 minutes. Esmolol dosage was selected depending on initial hemodynamic indicators and hypertensic crisis complications. In order to evaluate efficiency and safety in this research the following indicators were measured: sistolic blood pressure, diastolic blood pressure, heart rate, electrocardiogram and SpO₂ , respiratory function monitoring.

   Medical evacuation of patients between medical organizations and intensive care units is a complex and urgent problem. To objectify the transportability of patients, the authors proposed calculating the comorbidity index, assessing the severity of multiple organ dysfunction and its structure. The study showed a high role of the patient’s age and the severity of polyhedral dysfunction and an insignificant role of the comorbidity index.

   The article is devoted to the analysis of the provision of emergency surgical care to patients of a multispecialty hospital, repurposed for the treatment of patients with a new coronavirus infection and suspected of it. As a comparison period, a similar period of time outside of work in the conditions of CAVID-19 is taken. An increase in thrombosis and pneumothorax was reversed.

   Relevance. Spontaneous hematomas (SG) appear after 2–3 weeks from the start of treatment for COVID infection and are observed mainly in elderly people with concomitant pathology. The predisposing factors for the development of SG in patients with COVID-19 are coagulopathies. The mortality rate in SG is 04–30 %, while in patients with COVID infection in severe cases increases to 30–50 %.

   The purpose of the study. To determine the role of coagulological changes in the development of soft tissue SG and to identify the features of the course, taking into account localization in patients with COVID infection.

   Materials and methods. The results of diagnosis and treatment of 54 patients with spontaneous hematomas were analyzed. The average age was 68.5 years (38–93), there were 45 women (83.3 %), 9 men (16.7 %). Lung damage by CT in most patients was severe. Anticoagulant and antiplatelet therapy was prescribed to all patients from the moment of admission. The management tactics of patients was carried out on the basis of a comprehensive instrumental assessment.

   Results. SG was mainly observed in retroperitoneal tissue (28) of patients, chest wall (14), rectus abdominis muscle (6), combination of hematoma of preperitoneal and retroperitoneal tissue (3), other localization of neck, hip, mediastinum (3). The volume of SG ranged from 60 to 2850 cm³. Unfractionated heparin was used as anticoagulant therapy. All patients had a statistically significant decrease in the level of hemoglobin and erythrocytes relative to the norm during all study periods (p < 0.05). The number of platelets decreased statistically significantly in the group with SG with localization in retroperitoneal tissue and in the chest (p < 0.05). The level of PH at admission was reduced in patients with SG with localization in retroperitoneal tissue and in the chest relative to the norm (p<0.05). The value of D-dimer was statistically significantly increased relative to the norm during all study periods in all groups. The treatment was aimed at correcting hemostasis, hemotransfusion with a decrease in hemoglobin levels below 60 g/l, plasma transfusion and thromboconcentrate.

   Conclusions. The severity of patients with SSG of various localization is due not only to the volume of SG against the background of COVID infection, but also to a variety of concomitant diseases, features of localization, volume and nature of SG. In patients who initially have deviations in the indicators of the hemostasis system, the risk of OHSS is higher, they need to more carefully select the optimal doses and the course of thromboprophylaxis. Early diagnosis using ultrasound, CT, X-ray endovascular hemostasis against the background of hemostatic therapy contributes to the stabilization of the condition and a favorable outcome.

   An analysis of the Yakutsk Emergency Department documentation for 2018–2022 was carried out in order to assess the effectiveness of prehospital cardiopulmonary resuscitation. It was revealed that over a number of years, the Department has maintained a fairly high level of successful resuscitation with restored cardiac activity (increased from 0 % in 2005 to 44.7 % in 2022). The result was achieved through continuous managerial efforts (training of mobile team personnel, increasing readiness for extended resuscitation in all mobile teams, gradual acquisition of technical equipment for providing comprehensive emergency services, daily quality control of medical services provided to patients, effective functioning of the operational department). A high-quality resuscitation performed by the teams contributes to the reduced mortality from preventable causes.

   Review of literature on the rationale and features of the application of noninvasive mechanical ventilation in CPAP mode in providing emergency medical care to patients with exacerbation of COPD and acute cardiogenic pulmonary edema.

   The article presents the results of clinical trials of innovative technology of intraosseous access to the human circulatory system in the provision of emergency medical care in the Belgorod region. 32 cases of the use of a domestic device for intraosseous access of UVK M for the treatment of patients with urgent conditions who had difficulties performing puncture / catheterization of veins were studied. The data on the high social and economic efficiency of intraosseous access technology in the practice of emergency medical care are presented.

   The purpose of the study was to identify the care provision defects on prehospital stage in patients with stroke in order to improve the quality of care for this category of patients.

   Objectives of the research: to study the frequency of hospitalization the patients with suspected stroke, depending on gender and age; to evaluate the efficiency of the ambulance team’s departure to the patient and the timing of the patient’s delivery to the hospital; to assess the quality of diagnosis and drug therapy at the prehospital stage.

   Materials and methods. The analysis of statistical observation forms No. 30, form № 109/y, accounting form № 110/y Stavropol Regional Clinical Emergency Medical Station, as well as case histories of patients with stroke in City Clinical Hospital No. 3, Stavropol, from 2016 to 2020.

   Results. A retrospective analysis of accounting and statistical documents of the Ambulance in a five-year period showed a fairly high efficiency in the work of dispatchers – 74.3 % of correct interviewing of patients to identify risk categories; ambulance crew within the framework of efficiency indicators – the time to reach the specialized department in Stavropol was 44 ± 4.1 minutes. However, the analysis of case histories of the ICU revealed violations in the observance of the algorithm for providing medical care to patients with stroke, in the form of: lack of protection of the upper respiratory tract and maintenance of adequate oxygenation — 43 cases (93.4 %); poorly correctable OSHF at the prehospital stage — 12 cases (14.5 %); non-compliance with the algorithm for examining a patient with stroke at the prehospital stage – 11 (13.2 %); lack of provision of adequate venous access – 9 (10.8 %) cases.

   Conclusion. The revealed defects of the prehospital stage contributed to the worsening of acute cerebral insufficiency, changes in the volume of the lesion, increased dislocation of brain structures, and in some cases led to daily mortality.

   February 20, 2023 marks the anniversary of Boris Dmitrievich Komarov, participant in the Stalingrad meeting, corresponding member of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, surgeon professor, scientist, one of the largest creators of the Soviet state system of emergency medical care.