Purpose  of  the  study.  Assess  the  knowledge  of  medical  professionals  providing  assistance  to  victims with traumatic injuries to the facial skull, obtained in the context of road accidents.  Materials and methods. For  the  study,  a  special  questionnaire  was  developed,  including  11  questions.  The  annotation  involved 100   medical  professionals working in emergency medical teams. Of these, 50  (50%) people with higher education, the corresponding certificate and holding the positions of doctors providing medical care in the city, another 50  (50%)  people who had secondary medical education and worked as a   paramedic providing medical care in rural conditions. Results.  As a  result  of the study, the following results were obtained: most specialists working in emergency medical teams have sufficient knowledge of medical care for injuries to the facial skull, at the same time, most specialists do not have a   specialized  education in dentistry, which does not in all cases help to provide correct and competent care for such sufficiently specific injuries. This can lead to the choice of wrong tactics, which ultimately affects the treatment results of such victims. In this  regard,  pretexts  to  develop  and  introduce  into  practice  specialized  courses  on  the  improvement  of specialists working in emergency medical teams, which would be conducted by specialists in maxillofacial surgery, as well as disaster medicine. In our opinion, this will reduce the number of errors arising in the provision of medical care to such victims.

Purpose: review and systematisation of publications in scientific medical literature devoted to ultrasound examination of trauma patients at the prehospital stage.  Materials and methods: a   search in scientific databases SCOPUS, Cochrane, PubMed, Russian Science Citation Index (RSCI) by key words: polytrauma, haemorrhage, evacuation of victims, ultrasound examination (US) was carried out. We analysed 46  literature sources  —    2   domestic and 44  foreign,  including data of meta ‑ analyses and systematic reviews; 23   studied articles were published in the last 5  years.  Results:  according to a   number  of scientific studies, ultrasound examination can be successfully used in patients with polytrauma at the prehospital stage, including during air ambulance evacuation on board a   helicopter. Ultrasound examination according to the FAST protocol reduces the time to surgical intervention by 64–76%, reduces the need for radiation exposure, the incidence of complications after injury and the duration of the patient’s hospital stay. According to some authors, the sensitivity, specificity, positive and negative predictive value of the method in detecting intra–abdominal injuries and haemorrhage are 28–76%, 83–97%, 87–96% and 37–94%, respectively, which makes it an important tool for examination of an urgent patient, especially with unstable haemodynamics, influencing the treatment tactics. For the paediatric population in the diagnosis of haemoperitoneum, according to a   meta‑analysis, the specificity of US leaves 95%, sensitivity   —  66%.  The method can be successfully applied in the work of aeromedical teams on board an air ambulance helicopter: according to a   systematic  review and meta‑analysis, the overall sensitivity of ultrasound in the diagnosis of pneumothorax during air ambulance evacuation is 61%, specificity  —  99%.  Conclusion: considering the analysed data from large randomised trials, meta‑analyses and systematic reviews, the use of ultrasound allows to make the right decisions regarding the tactics of treatment of the urgent patient, its transportation and choice of hospital, reduces the number of examinations, shortens the time to get the patient to the operating room and the duration of hospital stay, positively affects the outcome of the disease.

The  aim  of  the  study:  to  improve  the  results  of  treatment  of  victims  with  inhalation  injury  by  reducing the frequency of defects in the provision of medical care at the stages of emergency care.  Objectives of  the  research:  to  study  the  frequency  of  inhalation  injury  and  to  actualize  the  problems  of  treatment of this nosology at various stages of medical care; to analyze the main defects, to develop organization‑al and technological proposals.  Material and methods: to achieve this goal and objectives, a   retrospective analysis of 111   medical histories of victims hospitalized in the clinical units of the burn center of the St. Petersburg  I. I. Dzhanelidze Research Institute of Emergency Medicine in the period 2020–2022  was performed.  Conclusions:  the search for ways to improve the results of treatment of patients with inhalation injury remains relevant. Predictors of respiratory tract damage at the prehospital stage were ignored in 67.6% of observations, which led to a  violation of algorithms for providing medical care to patients.

Рurpose of the research: to evaluate an effectiveness of use of two different construction types of tourniquets (belt type/elastic band/bandage and tourniquet) for extremities arterial haemostasis on volunteers. Research  problem: to  complete  comparative  research  of  the  tourniquets  and  elastic  bandages  in  the  research on volunteers; to evaluate the effectiveness of tourniquets for arterial haemorrhage on extremities; to compare an effect of use of tourniquets and elastic bandages; to evaluate the possibility of the treatment of prolonged external haemorrhage by an ambulance.  Materials and methods: the research has been held on 20   volunteers. The following items were the research objects: tourniquet ЖК‑01; ЖК‑02  designed by Medplant and haemostatic elastic bandage with the loop fastening “Alfa”. The research included 2  stages: use of the items on summertime and wintertime military uniform of participating volunteers. The items were used on upper and lower extremities as a  self‑help and as mutual assistance. Studied parameters: time of application, effectiveness of haemostasis, ergonomic characteristics, the level of discomfort in the place of application of the researched items.  Results: the research results demonstrate that both items‑elastic bandage and the tourniquets effectively stop external arterial haemorrhage. Tourniquets ЖК‑01  and  ЖК‑02  and elastic bandage Alfa have been found to decrease their effectiveness when applied to the wintertime military uniform, which is explained by the presence of extra layers of fabric. Tourniquets ЖК‑01  and  02  allow to level down the discomfort in the place of application in comparison with the bandage Alfa. The benefit of usage of tourniquet type of bandage is that controlled compression may be applied that enables to control the haemorrhage during evacuation and in the hospital.  Conclusion: tourniquets ЖК‑01  and  ЖК‑02  by Medplant are promising tools to be used in injured and wounded patients by ambulance services.

The Ministry of Health of the Russian Federation has approved 74 standards of emergency medical care and approved 409 clinical guidelines. The purpose of the study is to analyze the compliance of the nosological structure of approved standards and clinical guidelines with the actual structure of calls. Materials and methods: the nosological structure of 66948 emergency medical calls of the St. Petersburg State Medical Institution ≪Ambulance Station № 4≫ of the Pushkin relief district for 2023 was analyzed. The diagnoses of the visiting ambulance teams were formalized in accordance with the International Classification of Diseases ICD‑10. The patients were divided into three age groups: group 1 — adults, group 2 — children from 1 to18 years old, group 3 — children under 1 year old. Results. Standards of emergency medical care have not been approved for diagnoses of diseases (conditions) established in 42.8% of cases (group 1 — 43.7%, group 2 — 73.2%, group 3 — 85.4%); clinical guidelines have not been approved for diagnoses of diseases(conditions) established in 29.4% of cases (group 1 — 25.6%, group 2 — 24.0%, group 3 — 21.8%). At the same time, it should be noted that most of the clinical guidelines are not applicable or are only limited in the provision of emergency medical care outside a medical organization, since they were developed without the involvement of appropriate specialists. Conclusion: it is advisable to develop (revise) clinical guidelines and standards of emergency medical care for the most relevant groups of diseases (conditions) and include abstracts-guidelines for emergency medical care in all developed (revised) clinical guidelines.

In order to monitor injuries and improve the provision of medical care to patients with injuries abroad and in the Russian Federation various models of injury registers (trauma registers) are used. The purpose of the study: to form and test a working model of the regional register of patients with injuries according to the registers of compulsory medical insurance accounts. Materials and methods: a register of patients with injuries treated in hospitals has been formed St. Petersburg for the period 01.01.2015–12.31.2022. The register contains information about 1162023 cases of medical care for patients with injuries of various localizations (ICD‑10 codes: S00.0–T09.9). To study long-term results, the register includes information on all cases of medical care provided to patients after discharge from the hospital. The results of the study: an analysis of the gender and age structure of patients with injuries in St. Petersburg, an analysis of the structure of patients in adult and children’s hospitals by localization of injuries and by the option of providing medical care: cases without hospitalization; cases with hospitalization without treatment in the intensive care unit; cases of hospitalization with treatment in the intensive care unit. The indicators of hospital mortality and annual survival of patients treated in intensive care units were also analyzed.

The article presents an analysis of the staffing of the ambulance service in various regions of the Russian Federation. The problems of personnel shortage are outlined and possible ways of their solution are presented. The purpose of the study was to analyze the staffing of the ambulance service in the constituent entities of the Russian Federation.  Methods.  A  retrospective  analysis of the reporting forms of federal statistical observation No. 30  «Information  on a   medical organization» was carried out on the availability, staffing and part ‑time ratio of doctors working in emergency medical care in the Russian Federation, in federal districts and their subjects for the full period from 2016  to 2021.  Results. According to the results of the analysis, a  trend  of aggravation of the personnel shortage in various regions of the Russian Federation was revealed. One of the solutions to this problem was to change the curriculum for 5^th and 6^th year students, after which an increase in students’ interest in emergency medicine was revealed. Another solution to this problem was proposed by the department of the Ivanovo region  —  to increase the financial support of full ‑time employees of the ambulance service through various programs. Thanks to these changes, it was possible to increase the staffing of medical personnel by 20% in the period from 2021   to 2023.  Conclusion. To address the staffing shortage issue, various solutions are possible, including increasing the interest of young professionals through changes in curricula and increasing the salaries of emergency medical staff through various funding programs.

The article presents the accumulated experience of using minimal gastrostomy through minilaparotomy, which allows us to consider these methods of forming a nutritious fistula as an alternative to puncture gastrostomy in conditions of import substitution and possible unavailability of the necessary imported consumables.

The main purpose of the study was to assess the quality and effectiveness of emergency medical care (EMC)in atrial fibrillation paroxysm (AF) at the prehospital stage. Materials and methods: the analysis included 111 patients who called an ambulance due to AF paroxysm. The patients were divided into groups depending on the recovery of sinus rhythm in the presence of a team. A telephone survey of patients was conducted 30 days after seeking medical help. Results: the sinus rhythm in the presence of the brigade was restored in 40% of cases. At the same time, the median recovery time of the rhythm was 32 minutes [Q1–Q3: 29–50]. 9% of patients were hospitalized. 53% of patients refused hospitalization. The probability of rhythm recovery increased with the help of a medical team and was not associated with the choice of an antiarrhythmic and the use of potassium and magnesium drugs. At the same time, in the next 30 days, complications (hospitalization, recurrence of AF and repeated call an ambulance) were observed more often among patients with restored rhythm (43% vs. 12%;p=0.00022). In 60.5% of patients who were trying to restore the rhythm, No anticoagulants were used, and in 7% 2 anticoagulants were used simultaneously. Conclusion. When providing EMC at the prehospital stage, rhythm restoration in the presence of a team is observed in 40% of cases, which is associated with a large number of complications in the next 30 days and a large percentage of errors associated with anticoagulant therapy.

The article reveals the problem of diagnosing urgent pathology in childhood at the prehospital stage of emergency and emergency medical care. The revealed diagnostic errors make it possible to focus the attention of doctors on the most common discrepancies in the diagnoses of the prehospital and inpatient stages. The purpose of the work: to identify the structure of the discrepancy of diagnoses in the provision of SMP to children with the data of the reception department of a children’s hospital. Materials and methods:13957 case histories of children aged 0 to 17 years hospitalized by ambulance and emergency medical teams were analyzed. The frequency of discrepancies between the diagnoses of the prehospital stage and the reception department of the hospital, depending on the nosological variant of pathology and the age of children, was determined. The results of the study: The most frequent discrepancies in diagnoses were found in children of the first 7 years of life with acute respiratory pathology and infectious diseases. In children from 12 to 17 years of age, the differences in diagnoses were mainly due to cases of acute surgical pathology and were associated with over diagnosis and the complexity of assessing the child’s condition. Conclusion: Based on the results obtained, it is shown that there is a need for a more in-depth study of the features of the diagnosis of acute infectious diseases and respiratory pathology in children, as well as a differential approach in cases of urgent surgical pathology during advanced training and professional retraining of emergency and emergency physicians.