Introduction. One of the directions of healthcare development today is the development and improvement of the emergency medical care system. The modern development of healthcare is based on the principles of medical and economic efficiency, characterized by increased requirements for the quality and timing of emergency medical care at its implementation stages, the introduction of high-tech diagnostic methods, reduction of the time for initiating etiopathogenetic treatment, and requires overall improvement of the emergency medical care system.

The aim of the study was to assess the staffing of medical organizations providing emergency medical care in municipal entities of the Krasnodar Territory with emergency medical teams and medical transport, and to analyze the procedure for medical evacuation of patients from district central hospitals and medical organizations of cities to medical organizations in the city of Krasnodar.

Materials and methods. Сall maps of emergency medical care organizations of the Krasnodar Territory, passports of medical organizations (district central hospitals, city central hospitals) of the region, stations, substations, and departments of emergency medical care were used in the study.

Results and discussion. Ааssessed the level of staffing of emergency medical care organizations with emergency medical teams and specialized emergency medical teams, provision of medical organizations with medical transport. An analysis of the organization of the procedure for medical evacuation of patients from district central hospitals in rural areas to regional healthcare facilities was carried out.

The problem of achieving high-quality hemostasis in patients with spontaneous nosebleeds (NC) in emergency medical care (SMP) is still relevant.

The purpose: to conduct a comparative assessment of the effectiveness of emergency medical care for patients over 18 years of age with anterior NC in the conditions of the NSR using a developed silicone single-chamber intra-nasal tampon with internal point glues, an intranasal (industrial production) balloon and a generally accepted method of tamponade using gauze turunda.

Objectives: to analyze the prevalence and causes of NC in the structure of NSR calls in patients over 18 years of age in Moscow; to evaluate the effectiveness of the use of a developed medical device in patients with NC — a single-chamber intra-nasal tampon with internal point glues in comparison with the use of an intranasal balloon and gauze turunda.

Materials and methods: An analysis of the structure of calls to patients with NC and an assessment of the effectiveness of stopping NC using an intra-nasal tampon with internal point glues, an intranasal balloon and a gauze turunda were carried out.

The results of the study: It was revealed that in all the studied groups, NC occurred in the range from 28% to 37.3% in patients with hypertension who took anticoagulants/antiplatelet agents and in the range from 30.7% to 32% in patients with hypertension without taking anticoagulants/antiplatelet agents. It was found that in the first group of observations using a singlechamber intra-nasal tampon with internal point glues, the best characteristics of the efficiency of stopping NC were revealed: hemostasis was achieved in 92% of cases; less time spent on performing nasal tamponade was 1.6±0.5 min. and the time of onset of hemostasis  was  1.2  min±0.3;  pain  was  less  pronounced  in patients during nasal tamponade — 0.31±0.01 points; fewer repeated calls with recurrent NC (6.7% of cases) and repeated nasal tamponades (2.7% of cases); the call execution time was reduced by 9.5 min. — from 39.3±1.3 min. to 29.8±1.1 min.

Conclusion: The data obtained as a result of the study indicate an improvement in the quality of medical care for patients with NC and allow us to recommend a promising expansion of the range of medical devices used to create high-quality hemostasis in NC at the prehospital stage.

Introduction. Alcohol is the cause of death, 3 million people on the Planet every year. In Russia there are about 1,2 million people with alcohol dependence, up to 30% of all deaths are related to alcohol. Patients with alcohol use disorder are serious, unreasonable burden on the healthcare system.

Purpose of the study: study of the structure and distribution of emergency medical care calls to patients with signs of alcohol intoxication.

Materials and methods. The material was the data of the St. Petersburg Research Institute of Emergency Medicine named after I. I. Dzhanelidze and the City Emergency Medical Station (GSSMP) for the 5-year period (2018–2022). Statistical and analytical methods used.

Research results. During the study period, more than 2,5 million emergency medical calls, carried out by the GSSMP brigades, including patients with signs of alcohol intoxication (diagnostic sign —  smell of alcohol). 2018–2022: the proportion of visits to sober patients was 8,8% with a tendency to further growth, estimated distribution per 1,000 inhabitants —  10,8 calls per 1,000 inhabitants; highest recorded in the Central region (21,9), in second place is the Admiralty District (18,3), third —  Petrogradsky (13,5). When assessing the distribution of the number of calls by area, the indicator was 64,2 per km², The highest density was recorded in the Central region (274,1 call per km²), 2nd place —  Admiralty District (210,5 calls per km²).

Conclusion. In the course of the study data were obtained, allowing to conclude on the distribution of calls of ambulance crews to patients with signs of alcohol intoxication in the districts of the city, including the density of their distribution per 1000 inhabitants of the district and per 1 km² area of the district; a map of the city is presented, characterizing the distribution of the «alcohol» load on ambulance brigades in the districts of the city. Data allow more rational use and distribution of resources of medical organizations, participating in the provision of medical care to patients with signs of alcohol intoxication.

Introduction. The ability of an eyewitness to provide immediate and correct first aid to a victim is a key factor of increasing the chances of a favorable outcome in various life­threatening conditions. Informing the population about the importance of the first aid, teaching the necessary algorithms of these actions, and introducing targeted mobile applications can significantly increase the frequency and quality of the first aid.

The aim of the study is to examine the main sources of information about the first aid and to identify perspective directions for increasing public awareness in this problem.

Materials and methods of the study are based on anonymous questionnaire survey among fuel and energy complex workers of the Republic of Belarus in January­June 2023, which was conducted with the questionnaire «Awareness of First Aid». The survey involved 894 respondents without medical education. The survey helped to determine the coverage of respondents by the first aid trainings, to understand their awareness of the first aid, and to realize the main and prospective sources of information about the first aid. Methods of nonparametric statistics were used to analyze the results.

Results. According to the survey results, 93.5% of respondents are familiar with the basic rules of the first aid; 86,8% were trained; 9.7% studied independently. Additional sources of information about the first aid include visual information — 41.5%, first Aid training publications — 30.6%, social networks — 27.6%, and the information from the social environment — 22.0%. Respondents considered the prioritizing sources of information about first aid, which are included visual agitation (37.1%), smart programs «First aid» (35.6%), handouts (25.6%), unified training manual «First aid» (26.2%), etc. According to the respondents, awareness about first aid could be facilitated by wide media coverage (27.0%), introduction of a compulsory training discipline «First Aid» (18.7%), creation of national digital content about first aid (10.9%), compulsory trainings (9.9%). However, the existing educational publications do not have a unified algorithm of first aid and do not support the motivation to render first aid (only 44.1% of respondents consider themselves as full participants of first aid), it also contains outdated or inadmissible recommendations.

Conclusions. The creation of a unified information environment «First Aid» can be an important option for increasing public awareness of the first aid. This information environment could solve the following problems -like increasing the motivation of population to training the first aid, like unification of this training and like implementation the first aid training through the mobile technologies.

Based on the analysis of 96 cases of the use of intraosseous vascular access (IVSD) in the Belgorod region, the article assesses the prospects for its use in the provision of emergency medical care in emergency situations and military conflicts. On the basis of our own material, the indications for VCSD, the expediency of mastering a practical skill at the workplace with the help of the KT UVK M simulator were substantiated. Additional advantages of VCSD in the provision of EMS in conditions of a real threat of enemy fire impact are noted, when patients are in armor protection, unloading, and doctors and paramedics use personal protective equipment — bulletproof vests and helmets.

The purpose of the study. To determine the choice of the method of temporary hemostasis in patients with facial skull injuries resulting from road accidents.

Materials and methods. The work is retrospective, the sample is continuous, based on the analysis of the results of 230 patients with facial skull injuries having both isolated and/or combined injuries sustained in road accidents in the Saratov region from 2010 to 2021. The average age of patients was 29±5 years (M±m). There were 159 men (69,1%) and 71 women (30,9%). Medical histories, outpatient cards, and accompanying sheets of the ambulance team were used as primary documentation. The study included all patients who were delivered by ambulance crews, who had open and closed, isolated, multiple and/or combined injuries to the facial skull resulting from road accidents, starting at the age of 15. Patients with combined injuries of the extremities, cervical spine, pelvis, as well as patients who were not delivered by ambulance crews were excluded. Isolated injuries were detected in 58,6% of the victims, combined and multiple — in 41,7% of people. In the majority of observations — 72,6% — medical care at the prehospital stage was provided by medical teams of emergency medical care, such assistance was provided by paramedic teams only in 27,4% of observations. The time of delivery of the wounded to the medical institution from the moment of injury was on average 27±8 minutes (M±m). At the time of admission, open injuries were registered in 34,4% of people, patients with closed injuries of the facial skull prevailed — 65,6% of the victims.

Results. As a result of the study, it was found that all victims with such injuries can be conditionally divided into three groups, depending on the mechanism of injury: venous bleeding prevailed in the first group — in 6,9%, arterial bleeding was noted in 0,9% of cases, and capillary bleeding — in 3,9%. In the second group, bleeding was distributed as follows: capillary bleeding prevailed — in 13% of cases, arterial bleeding was noted in 2,6% of cases, and venous bleeding — in 4,3%. In the third group, capillary bleeding was detected in all 2.6% of cases. Based on this, the main method of temporary hemostasis was the imposition of a pressure bandage, which was applied in 23,5% of cases, in another 3,5% of cases, an anterior nasal tamponade was used to stop bleeding, in 7,4% of cases, a clamp was applied to stop bleeding. Of the total number of hemostases performed, as can be correctly characterized in 29,6% of cases, which was manifested by stopping bleeding. At the same time, in 4,8% of cases, the method of temporary hemostasis was not chosen correctly, which was manifested by continued bleeding at the time of delivery of the victim to a medical institution.

Purpose of the study: to assess the effectiveness of training medical personnel in the Russian Federation, taking into account the requirements of the Bologna Declaration, to establish promising directions for reforming the higher education system in medical universities, including in the training of personnel for disaster medicine, after Russia›s withdrawal from the Bologna Agreement.

 Materials and methods. Based on information from scientific thematic sources, an analysis of the results of the reform of higher education in Russia under the influence of the Bologna Declaration was carried out, and promising directions for optimizing higher education in medical universities after leaving it were identified. Historical and analytical methods, methods of comparative analysis and scientific generalization were used.

Results. Under the influence of the Bologna Declaration, by 2013, Russian universities switched to a three-level model of higher education, which required the development of training programs and accreditation of educational programs. From 01.09.2017 internship as the first stage of primary specialization of medical personnel ceased to exist, which significantly reduced the quality of practical training of medical specialists. The training of medical personnel in medical universities in the fields of general medicine, pediatrics, pharmacy, etc. is currently carried out according to educational programs of a six-year specialty and a two-year residency.

Conclusion. In connection with the exit from the Bologna system in 2022, developments are underway in Russia to reform higher education. At this stage, it is advisable to consider the issue of introducing an internship institution in order to train highly qualified medical specialists, including for work as part of non-staff units of the disaster medicine service.

Objective. Тo evaluate the possibility of using analgesics, dalargin and correctors of tissue metabolism in multimodal analgesia in victims of road accidents with  combined  chest  and  abdominal trauma.

Tasks: To study the combined effect of multimodal analgesia with the inclusion of dalargin, ketorolac or lornoxicam and a corrector of metabolic disorders on clinical and biochemical parameters, changes in gas composition, acid-base blood state and neuro-humoral condition in victims of road accidents with combined chest and abdominal trauma in the acute period of traumatic illness. 2. To propose standard schemes of multimodal anesthesia that can be applied to groups of victims with combined chest and abdominal trauma of varying severity during evacuation from the scene of a traffic accident by emergency medical personnel.

Materials and methods. A study was conducted in 107 patients with diagnoses of road trauma, combined chest and abdominal trauma. In order to objectify the severity of the patients› condition, the Glasgow com, RAS scales and the method developed by us for assessing the severity of victims with combined trauma were used.

The results of the study. Traumatic shock in victims of road accidents with combined chest and abdominal trauma leads to impaired consciousness, microcirculation, hypoxia, hypotension, while adaptation of the main body functions developed in an irrational way — due to tachycardia. This, in our opinion, is dangerous, as evidenced by the signs of ischemia on the ECG. The combined use of analgesics, dalargin and a tissue metabolism.

Conclusion. The use of multimodal anesthesia in the prehospital period of emergency medical care made it possible to significantly reduce the patient›s hospital stay by 4.8 bed days and reduce the overall mortality rate in severely injured patients from 72.7% in the comparison group to 51.7% in the main group.

The review is devoted to some issues of the pathophysiology of acute dyspnea, its clinical manifestations, approaches to assessing severity, as well as some aspects of laboratory and instrumental diagnostics. Considered the  use  of  oxygen  therapy  and  non-invasive  methods  of  respiratory  support,  which  may be required in the process of providing care to patients with shortness of breath in a hospital emergency department.

The article presents data demonstrated actual situation of the course and long-term prognosis in patients with unstable angina taking into consideration the pathomorphosis of deseasein reperfusion era. Retrospective study was conducted in 316 individuals diagnosed with unstable angina admitted to the Regional Cardiovascular Center of the I. I. Dzhanelidze Research Institute of Emergency Medicine from 2018 to 2022. Long-term results were studied (n=137) after 12 months after primary hospitalization (endpoints: sudden cardiac death, acute cerebrovascular accident, re-hospitalization for acute coronary syndrome, heart failure and paroxysmal atrial fibrillation.

Goal. To analyze the data of foreign and domestic periodical literature on the aspects of the appointment of glucocorticosteroids (GCs) in acute obstructive laryngitis (АOL) in childhood.

Materials and methods. 33 foreign and domestic sources on the studied problem were considered, including 15 sources over the past 5 years.

Results. According to different authors, the following are considered the mechanisms of action of GC drugs, this paper provides evidence of their therapeutic efficacy, justifying their use as treatment of choice in AOL of any severity grade, in the prehospital as well as hospital settings. The characteristics of a range of different GCs (dexamethasone, prednisolone, budesonide, beclometasone, fluticasone) administered through inhalation and other routes are compared in regard to their use in intensive treatment of AOL in pediatric  practice.

Conclusion. It is advisable to prescribe GCs for AOL in children. A better understanding of the particulars of use of GCs in children with AOL should improve the quality of intensive care in this pathology.