Introduction. The current level of healthcare informatization allows for remote organization and control of the treatment and diagnostic process. The aim of the study was to examine the statistics of remote diagnostic rooms (centers) in the Russian Federation for the period 2014–2023. The materials of federal state statistics for Russia, St. Petersburg, Leningrad Region, 2014–2023 were used. Statistical and analytical methods were applied. The results of the study showed a significant increase in the number of rooms (centers) by 77 units (96.3%) for the period 2014–2023. The volume of remote electrocardiograms exceeds 1.6 million studies per year (2023). Conclusion. Remote diagnostic rooms play an important role in providing remote advisory assistance on diagnostics, treatment and patient management tactics. The tasks are to study the experience of regions in remote consultation, to develop a model for organizing a multidisciplinary remote consultation service as an independent unit in the structure of emergency medical care, adapted for implementation in any region of the Russian Federation.

The purpose of the study is to evaluate the results of improving the medical support system for the population of the Tula region in eliminating the consequences of emergencies caused by road accidents based on the development, implementation and evaluation of the effectiveness of new organizational medical support technologies. Materials and methods. Reports on the work of the Territorial Disaster Medicine Center (TCMC) of the Tula region, accounting forms filled out by TCMC specialists in the information system «Monitoring of disaster Medicine Centers» (smk.minzdrav.gov.ru); reporting forms of sectoral statistical observation No. 55 and 56 «Information on the activities of medical organizations providing emergency medical care and medical evacuation during field visits forms of work, including those with departments of emergency advisory medical care» for 2018–2022. The research methods are analytical and statistical. The results of the study and their analysis. A comparative analysis of road traffic injury rates in 15 regions of the Central Federal District of Russia has been performed. The changes that occurred during the improvement of the complex of systemic approaches to the organization of emergency medical care to the population affected by road accidents in the Tula region are analyzed.

Goal. To study the frequency of traumatic fractures of the upper and lower jaws and the results of specialized care on the example of the Saratov region. Materials and methods. The basis for the study was the department of maxillofacial surgery, located in Saratov City Clinical Hospital No. 9. The study is continuous, single-center, retrospective. The primary material used was the medical records of patients treated at the above-mentioned medical institution in the period from September 1, 2023 to August 31, 2024. The criteria for inclusion in the study were: voluntary consent to the study, fractures of the upper and/ or lower jaw, age at least 18 years. Patients who turned out to be excluded from the study, persons under the age of 18, were excluded. Results. As the analysis shows, the majority of patients went to the departments of the maxillofacial region in the early stages up to 3 days after injury, but 5.4% of patients are admitted to a medical institution after the development of complications such as suppuration (manifestations of inflammatory processes), dentition defects, etc., which cannot but affect the results treatment. The average age of patients with injuries to the maxillofacial region is 34.3 years, of which a greater number are men, which demonstrates the need to strengthen work with the population of social services. The predominant cause of injury is domestic injuries, this proves that it is necessary to carry out educational work with the population, which will include teaching people safe household life, monitoring the serviceability of electrical wiring and electrical appliances, not walking on wet floors, following instructions on the use of equipment, etc. Fractures of the lower jaw are more common than fractures of the upper jaw, these indicators dictate the need to find new diagnostic methods, modern methods of treatment and prevention of complications. Conclusions. 1. Jaw fractures occur in 65,0% of cases, with fractures of the lower jaw prevailing over the upper, respectively, 52.1% and 12.8%. 2. In the structure of jaw fractures, domestic injuries accounted for 45,1% of cases, criminal showdowns caused a fracture in 15,8% of cases, in the remaining 4,0% of cases, traffic accidents caused fractures. 3. When analyzing the timing of patients seeking medical care, it was found that in the vast majority of cases — 73,5%, later than three days after receiving a facial injury, the remaining 26,4% of the victims were hospitalized. 4. Medical care at the prehospital stage was provided by emergency medical teams in 52,9% of cases. At the same time, out of this number of patients, the provision of medical care was regarded as complete in 48,4% of the cases. In the remaining 4,5% of cases, assistance was provided, but it was not in full or with errors. 47,1% of the patients were not treated, they were taken to a medical institution by passing transport.

The purpose of the study. Вased on the results of a retrospective analysis of data on 48.406 emergency medical services (EMS) visits to 25.735 patients with chronic obstructive pulmonary disease (COPD) in St. Petersburg (SPb) during the period from 2015 to 2023, to obtain a medical and social characteristic of this group of patients. Objectives of the study. Тo give an overall assessment of the effectiveness of the EMS provided to this group of patients at site, to study the level of interhospital mortality among patients with COPD who were admitted to the city hospitals. The results of the study. The average age of patients with COPD who applied for EMS was 63.0±17.92. There were no significant differences in the sex and age in this group of patients. The number of EMS visits to patients with COPD and the absolute number of patients treated decreased significantly during the COVID‑19 pandemic and began to recover again after its completion. A positive result of treatment by the EMS brigades at the site was achieved only in 38.6% of cases. 21.737 (37%) patients were evacuated to the hospital from their apartments. The intrahospital mortality rate in this group of patients was 39.2%. Conclusion. Providing EMS to patients with COPD exacerbation is a complex medical and social task that is currently not fully solved in SPb. Efforts are required to overcome the existing difficulties.

The purpose of the study: to demonstrate the importance and effectiveness of volunteer activities of medical university students in teaching children the basics of first aid. The objectives of the study: to increase children›s motivation for learning, interest in medicine, level of knowledge and skills of students in first aid. To form and develop leadership qualities, interpersonal skills, responsibility, empathy and teamwork. To create a solid foundation for future professional activities. To emphasize the importance of volunteer activities of medical students in teaching children the rules of first aid. To show positive impact on children, students and society in general. Call for the expansion and strengthening of such cooperation to improve the safety and health of future generations. Materials and methods. An analysis of existing scientific publications, articles and guides on first aid, and also materials related to volunteer activities of medical students has been carried out. This allowed us to identify the main approaches and teaching methods of first aid. Questionnaires have been developed for school children participating in teaching programs. The surveys included questions about the perception of the program, the level of material absorption and satisfaction with the training. Questionnaires have been distributed to participants of grades 7–11 within the same educational institution. The teaching process, including first aid classes, conducted by volunteer students, has been monitored. This allowed to evaluate teaching methods, interaction with children and the level of involvement of participants. Data collected have been analyzed using quantitative and qualitative methods. The results of the surveys and questionnaires have been processed using statistical methods to identify patterns. All participants have been informed about the objectives and methods of the study, and consent has been obtained to participate. Anonymity of responses has been preserved. Results. The results of the research are as follows. Before the training, the knowledge results on first aid rules were within 15.33%. After the master class, the level of knowledge increased to 85%. The difference in average scores was 69.7%, which confirms the effectiveness of the training. All this emphasizes the importance of introducing first aid programs into school courses to improve students› preparedness for emergency situations. Conclusion. The training program of first aid has significantly increased the level of knowledge and skills of schoolchildren in first aid, which, in turn, has helped significantly to reduce the risk of negative consequences in emergency situations and prepare a new generation for active actions in difficult circumstances. 

The theoretical and practical issues of pathogenesis, clinic and diagnosis of traumatic shock are of paramount importance for medical personnel providing emergency medical care, especially at the prehospital
stage to victims with severe shock trauma, both in daily activities and in emergency situations. Purpose.
Review and systematization of publication in scientific medical literature devoted on the problem of etiology, pathogenesis, clinic and diagnosis of traumatic shock outside the hospital organization, including in
emergency conditions. Materials and methods. The analysis of 23 domestic and foreign materials published
in the databases eLibrary, CyberLeninka, PubMed/Medline, and Medical Planet was carried out. The search
for scientific publications was conducted from 1999 to 2024. Results. When analyzing the literature sources, it was found that among the injured, the proportion of people receiving injuries accompanied by shock
(shockogenic injuries) is about 2%, and in the event of various disasters up to 20%. At the same time, the
mortality rate for polytrauma accompanied by shock may exceed 50%. The main cause of traumatic shock
in victims is combined injuries. The most important trigger mechanism of traumatic shock is acute blood
loss, which can be visible and hidden. Acute blood loss leads to a decrease in the volume of circulating
blood, which triggers a complex cascade of responses: a decrease in venous return and cardiac output, hypoperfusion of organs and tissues, numerous metabolic disorders. The diagnosis of traumatic shock is based
on the features of its pathogenesis and is aimed at identifying hemodynamic, hemorheological, and metabolic disorders in the body of the victim. The identification of most violations requires special assessment
methods that are available only at the hospital stage. At the prehospital stage, the possibilities of diagnosing
traumatic shock are limited. Conclusion. The results of the reviews show how that the problem of traumatic shock is relevant and continues to attract the attention of researchers. Within the framework of theoretical aspects, research is continuing aimed at establishing new pathophysiological mechanisms of traumatic
shock. Clinical studies are aimed at solving numerous problems of correcting existing disorders in patients
with traumatic shock.

Тhe article proposes a treatment regimen for patients depending on the severity of aspiration syndrome, according to the previously developed and clinically validated scale for assessing the severity of aspiration syndrome. The aim of this work was to improve the results of diagnosis and treatment of patients with aspiration syndrome. The material for the implementation of this goal was the results of examination and treatment of 102 patients hospitalized in the St. Petersburg State Budgetary Healthcare Institution «City Hospital of the Holy Martyr Elizabeth» with a diagnosis of «Aspiration Syndrome» from 2020 to 2023. The percentage of complications of aspiration syndrome in patients of the main group (n=49), compared with the percentage of complications in patients of the control group (n=53), decreased by 53.23% (p < 0.05). Mortality associated with aspiration syndrome in patients of the main group decreased by 51.91% (p< 0.05). The developed computer program «Aspiration Syndrome Severity Assessment Scale» is adapted for ease of use, including emergency medical care. It provides a quick and objective assessment of the patient›s condition, thereby optimizing patient care and improving the prognosis. Treatment tactics, depending on the severity of aspiration syndrome, focus on emergency and urgent measures and patient stabilization in conditions of limited resources. It has been proven to reduce mortality and increase the effectiveness of aspiration syndrome treatment.

The aim of the study is a comparative experimental evaluation of the efficacy of the surgical polysaccharide absorbable hemostatic agent «Hemospas®Med». For this purpose, the hemostatic efficacy of Hemospas®Med and the comparative agent, AgistaAN, was assessed in a standard model of rabbit liver wound bleeding. Materials and methods. The study was performed in an acute experiment on a biomodel of bleeding from a rabbit liver wound. Hemostatic efficacy was evaluated by the time of bleeding stoppage and the volume of blood loss, calculated relative to the animal›s total blood volume (TBV). Results. According to the results of experimental preclinical approval, the efficacy of «Hemospas®Med» hemostatic surgical polysaccharide absorbent, developed within the framework of import substitution, is comparable to a foreign sample of hemostatic agent based on modified starch. Conclusion. The local hemostatic agent «Hemospas®Med» is as effective as its foreign counterpart and can successfully replace it in the practice of emergency surgery as a supplement to the classical methods of surgical hemostasis in abdominal and retroperitoneal surgery.

Objective. To analyze the literature data and summarize the results of the research on the study and implementation of new and alternative methods of cardiopulmonary resuscitation. Materials and methods. Study and review of modern domestic and foreign literature data on the subject of application and evaluation of the results of implementation of new and alternative methods of cardiopulmonary resuscitation. Results. According to the conducted literature analysis, the use of alternative techniques in cardiopulmonary resuscitation (hereinafter CPR) increases the effectiveness of resuscitation, and in some cases increases the survival rate and improves the further prognosis. Conclusion. Alternative techniques of cardiopulmonary resuscitation require further study.

Poisoning by poisonous mushrooms remains an important cause of morbidity and mortality. Up to 83.38% of mushroom poisoning cases are registered in Russia from July to the end of October, which corresponds to the mushroom growing season. In 95% of cases, mushroom poisoning occurs as a result of incorrect identification of edible and poisonous mushroom species. This is due to both insufficient public awareness of the properties of mushrooms and the lack of sufficient knowledge of their appearance. The purpose of the study: analytical toxicological analysis, consideration of the mechanism of toxic action, features of diagnostics and intensive care of patients hospitalized with toxic effects of poisonous mushrooms in the toxicological center of a metropolis. Materials and methods of research. The medical records of 130 patients admitted to the Acute Poisoning Center of the State Budgetary Institution «St. Petersburg Research Institute of Emergency Care named after I. I. Dzhanelidze» in 2021–2023 with the diagnosis: «Toxic effect of other toxic substances contained in eaten mushrooms» were analyzed. ICD‑10 rubric: T62. The mechanism of toxic action was studied, statistical, laboratory and instrumental studies were carried out upon admission of patients to a specialized hospital and in dynamics after intensive care. Research results. According to the Acute Poisoning Center of the State Budgetary Institution of St. Petersburg Research Institute of Emergency Medicine named after I. I. Dzhanelidze, the number of patients with toxic effects of poisonous mushrooms was: 2021–41 admitted (1 fatal outcome); 2022–30 patients (1 fatal outcome); 2023–59 patients. All admitted patients with acute poisoning were in serious condition with disorders of vital organs. Conclusion. The toxic effect of poisonous mushrooms currently occupies one of the leading places among acute poisonings of chemical etiology in terms of the number of adverse outcomes. Timely, full and high-quality provision of medical care at the stage of emergency medical care outside a medical organization has a significant impact on the course and prognosis of the disease. Scientific and practical significance lies in the generalization of modern ideas about the pathogenesis of the toxic effect of poisonous mushrooms, principles of diagnosis and treatment. The materials can be used in clinical guidelines.

The goal. To examine patients with somatoform autonomic dysfunction who were urgently taken to the hospital with symptoms of coronary heart disease, to identify the cause of their pathology by examining the spinal column with a magnetic resonance imaging scanner. Materials and methods of research. The study was conducted in the city of Makhachkala, hospital No. 2, on the basis of the department: outpatient therapy, cardiology and general medical practice, from 2021 to 2023. 84 patients, men (n=34) and women (n=50) aged 23–62 years, were selected for the study. All patients were admitted urgently or planned to the department of cardiology, therapy and neurology with various preliminary diagnoses. All patients were tested with A. M. Vein›s questionnaire to identify autonomic dysfunction. The study was conducted in accordance with the standards of the Declaration of Helsinki. Before inclusion in the study, patients were informed about all the nuances of the examination and signed a written agreement. Results. We used the Wein questionnaire, which is used to determine the severity of autonomic dysfunction in patients with somatoform autonomic dysfunction, to select them among patients with a presumptive diagnosis of coronary heart disease. It should be noted that the Wayne questionnaire coped with its task, but with a slight deviation of 5.34%, and the error was not so significant p0.05), ventricular 11 to 29 (p>0.05). An examination on a magnetic resonance imaging scanner revealed that spinal pathology in the 1st group was detected in n=40 (97.6%) cases, in the 2nd group in n=59 (65.5%), the deviation value was p < 0.05. Degenerative-dystrophic diseases of the spine were observed in both groups, but diseases such as ankylosing spondylitis, rheumatoid arthritis, and hemangioma significantly predominated in patients with somatoform autonomic dysfunction, deviation p < 0.05. It turned out that 30.6% of patients with somatoform autonomic dysfunction are admitted to the hospital erroneously with a diagnosis of coronary heart disease; significant differences were p < 0.05. Conclusion. Thus, the study allows us to conclude that at present the somatic approach to the treatment of diseases continues to dominate, denying the central role of psychological factors in etiopathogenesis. It is psychologists in many civilized countries who help patients with somatoform autonomic dysfunction, and the patient, knowing about his illness, first of all calls his psychologist, and not an ambulance. Long-term study of the history of somatoform autonomic dysfunction — multiple interpretations of the diagnosis, the problem of functional disorders and a large amount of accumulated evidence could reduce the burden at all stages of medical care. Improving the quality of life of patients with somatoform autonomic dysfunction remains relevant to this day, linking spinal pathology and somatoform autonomic dysfunction into one whole. Then we can expect success from new conceptual approaches to the diagnosis and treatment of somatoform autonomic dysfunction.

Aim. To analyze the domestic and foreign literature on the problems of emergency care in children and adolescents with severe bronchial asthma (BA) at the prehospital stage. Materials and methods. A total of 26 international and national sources dealing with issues relevant to BA were analyzed, including 10 papers published in the last 5 years. Results. At the prehospital stage, children and adolescents with severe forms of asthma need to carefully collect an anamnesis and an objective examination to identify a severe or critical course of the disease. The drugs of choice for asthma relief are β2‑agnoists and glucocorticosteroids, with the ineffectiveness of which methylxanthines, anticholinergics, magnesium sulfate and adrenaline are used. Oxygen therapy is mandatory, and in rare cases, tracheal intubation and artificial lung ventilation. Conclusion. The analysis of the literature is of practical importance for emergency physicians in providing emergency care to children and adolescents with severe forms BA at the prehospital stage.