Introduction. The problems of ensuring accessibility and quality of medical care for patients with mental and behavioral disorders are pressing.

The purpose of the study: to evaluate the performance of specialized psychiatric emergency medical teams in the Russian Federation over the period 2010–2024.

Materials and methods. The materials of federal state statistics were used (form No. 40, 30) for the Russian Federation, 2010–2024. Statistical and analytical methods were used, MS Office Excel 2019.

Research results. The conducted study revealed 719.3±73.2 psychiatric brigades (6-hour shifts) of emergency medical care in the Russian Federation for 2010–2024, providing medical care to 421.5±47.5 thousand patients per year, which is 1.5±0.2% in the overall structure of emergency medical care brigades and 17.2±2.9% in the structure of specialized brigades. With a decrease in the total number of specialized brigades (by 30.1%), the share of psychiatric brigades increased by 43.9%. Of these, 177.2±6.2 brigades (shifts) (23.5±1.3%) function around the clock with an average workload of 1.6±0.3 patients per shift (6 hours) (or 6.6±1.2 patients per day). Annually, 43.7±3.9 thousand people (11.6±1.1% of patients) require medical evacuation. While the number of psychiatric teams remained relatively constant, a significant and statistically significant decrease (26.9%) in the number of people receiving medical care and a 27.3% decrease in the workload of these teams were significant.

Conclusion. The regional healthcare system must ensure rational routing of patients with mental and behavioral disorders, continuity of care, accessibility, and quality. Ambulance crews play a key role in this system.

Introduction. Diseases of the genitourinary system are one of the serious health problems due to the constant increase in cases of chronic progressive kidney disease, the high prevalence of chronic renal failure and disability of patients starting from childhood.

The aim of the study was to assess the organization of medical care for children with diseases of the urinary system at the outpatient stage of the republic based on the responses of parents of children with diseases of the urinary system before and after the introduction of a set of measures.

Materials and methods. The data obtained during the study were entered into a database on a computer, then statistical data were processed using the SPSS Statistics software package.

The results of the study showed that after the introduction of a set of measures, all the criteria affecting the quality of medical care for children with diseases of the urinary system at the outpatient stage significantly increased.

Conclusion. The results of research indicate the effectiveness of the proposed set of measures to improve medical care for children at the outpatient stage.

The goal. To analyze the reform of the regulatory framework governing from 09/01/2024 first aid in the Russian Federation.

Tasks. To consider changes in legislation in the context of compliance with international standards and achievements of scientific and technological progress, as well as the logic of the educational process in the field of first aid.

Materials and methods. To determine the practical significance, a survey was conducted of different categories of students of first aid courses conducted by the Department of Simulation Training of N. N. Burdenko VSMU.

Results. A survey of first aid course participants showed that the implemented structuring and differentiation of first aid will allow, at the preparation stage, to offset certain negative consequences of rescuers› actions associated with the lack of an approved procedure for providing assistance in life-threatening situations, as well as to introduce tools and devices corresponding to the current level of scientific and technological progress in combating life-threatening situations already at the first aid stage. At the same time, the issues of mass introduction of automatic external defibrillation at the first aid level remain unresolved.

Conclusion. The analysis of the regulatory framework for first aid and the results of the survey reveal the importance of the legislative changes made with regard to the volume of first aid, its differentiation and ordering. The experience of implementing these changes will optimize the further diversification of first aid depending on the level and conditions of its provision in the form of new Procedures, orders on the composition, use, storage and placement of first-aid kits, an adjusted educational and methodological complex. Work has begun on the mass introduction of automatic external defibrillation at the first aid level. This is of particular importance for the emergency medical service, since effective and timely first aid is the initial link in the «life chain», the continuity of which largely affects the favorable outcome in life-threatening conditions.

Objective. To evaluate the effectiveness of kaolinbased local hemostatic agents for temporary control of external bleeding in emergency medical care.

Materials and methods. The study utilized the local hemostatic agent «Kaolin Hemostatic Bandage QuikMed» (Sigmafarm LLC, Russia). Effectiveness was assessed in patients with ongoing external bleeding requiring the use of a tourniquet. The local hemostatic agents were applied by emergency medical teams in Belgorod and Donetsk. The study included patients with uncontrolled ongoing arterial or mixed bleeding, extensive soft tissue wounds with a complex wound channel. Patients with superficial venous bleeding and minor bleeding that could be controlled by a pressure dressing were excluded.

Results. The study included 23 patients showing signs of ongoing external bleeding. Among them, 7 cases of arterial, 1 case of venous, and 15 cases of mixed bleeding were recorded. Anatomical locations of arterial bleeding included the arm (1 case), thigh (4 cases), lower leg (1 case), and supraclavicular area (1 case). In 100% of cases, the use of the kaolinbased local hemostatic agent achieved temporary hemostasis, effectively preventing re-bleeding during transportation. Data analysis showed that the effectiveness of the kaolin-b ased local hemostatic agent was statistically comparable to that of chitosan-b ased local hemostatic agent (P≥0.05).

Conclusion. Kaolin-b ased local hemostatic agents demonstrated high effectiveness in achieving rapid temporary hemostasis in the pre-hospital setting. The ability to stop bleeding when a tourniquet cannot be used makes them an important and practical tool for emergency medical teams. Owing to their ease of use and reliability, these agents can be considered a promising component of emergency care standards for external bleeding.

The purpose of our study was to study the structure of diagnostic errors at the prehospital stage in order to optimize the routing of patients with Lyell’s syndrome.

Materials and methods. A retrospective analysis of the case histories of all the victims admitted to the inpatient department of the GBU «St. Petersburg Scientific Research Institute of Emergency Medicine named after I. I. Dzhanelidze in the period from 2020 to 2024 was performed. 76 patients were delivered with the leading diagnosis of the sending institution, suggesting a history of Lyell›s syndrome. The frequency of diagnostic errors at the pre-nutritional stage of the NSR was 33% (25 patients). The main groups of nosological forms simulating Lyell›s syndrome are the dermatological group of diseases (48%), as well as the pathology of the traumatological profile (20%), infectious surgical pathology (16%), vascular diseases (8%), systemic (4%) and infectious diseases (4%). The analysis of the structure of diagnostic errors at the pre-hospital stage revealed a number of problems in the qualification of primary care physicians, issues of continuity of medical care, interaction between links in the chain of medical care, the solution of which will reduce the frequency of differential diagnostic errors, improve the quality of medical care for this category of patients.

Introduction. The ambulance intensive care medical staff are the first ones who take care of critically ill patients. The diagnosis is often not clear, so treatment may not be optimal, which will lead to a worsening of the patient›s condition. The prehospital diagnostic capabilities of are limited. There is a need for informative, safe, and fast methods of examining critically ill patients. Ultrasound diagnostics seems to be just such a convenient and effective method.

The purpose of the work. To evaluate the effect of ultrasonography on the accuracy of diagnosis in patients with different types of shock, developed prehospitally, as well as on the hemodynamic state of patients at the time of their admission to the hospital.

Materials and methods. A prospective cohort study was conducted: a comparison was performed between two groups of patients over the age of 18 who were diagnosed with traumatic, hypovolemic, or cardiogenic shock by ambulance intensive care teams. The first group (67 patients) underwent ultrasound with a portable ultrasound scanner using the eFast protocol, followed by measurement of the diameter of the IVC during inhalation and exhalation and calculation of the IVC collapsibility index. The second group (97 patients) was a control group, without performing ultrasound. The following parameters were analyzed for both groups: the dynamics of blood pressure, pulse, and the Algover index, the volume of infusion, the total time of prehospital (ambulance) care, and difference in the diagnoses of the ambulance and the hospital.

Results and discussion. In patients with traumatic shock, the diagnosis was correctly established in 90% of cases, in the control group — i n 77% of cases. In patients with hypovolemic shock, the diagnosis was correctly established in 91%, in the control group — in 85%. There were no differences in diagnostic accuracy between the groups for cardiogenic shock. In patients of the first group with signs of traumatic and hypovolemic shocks, a statistically significant increase in systolic and mean blood pressure, a decrease in heart rate and the Algover index were detected after prehospital treatment. The volume of intravenous infusion in the first group was also significantly higher. The ultrasound did not affect the duration of prehospital medical care.

Conclusion. Emergency ultrasound performed on ambulance for patients in a state of traumatic and hypovolemic shock is appeared to be an informative method that affects the therapeutic tactics of the ambulance intensive care teams. It is associated with higher hemodynamic parameters of patients admitting to the hospital after prehospital therapy. It leads to a statistically significant decrease in the differences in diagnoses of the ambulance and hospital.

Introduction. Patient transportation on VA ECMO (veno-arterial extracorporeal membrane oxygenation) is poorly described in the international and Russian literature. Mostly, shortdistance (423±89 km) patient transportation due to respiratory failure has been described, with a duration of 175±14 minutes.

Objective. To familiarize the Russian medical community with the first long-distance vehicle transportation of a patient on VA ECMO for cardiac indications in the Republic of Tatarstan, Russian Federation.

Clinical сase. This article describes a clinical case of a 40-year-old patient admitted to the Interregional Clinical and Diagnostic Center in Kazan with critical aortic stenosis and extremely reduced left ventricular contractility (ejection fraction less than 10%). An algorithm for making decisions on patient management tactics during the in-hospital phase is presented, as well as the process of long-term (over 8 hours) interhospital patient transport to the V. I. Shumakov National Medical Research Center of Transplantology and Orthopedics, Ministry of Health of the Russian Federation (Moscow) using exclusively ambulance vehicles.

Discussion. The wider use of mechanical circulatory support devices challenges anesthesiologists and resuscitators regarding interhospital patient transport using this technology. Theoretical training and careful patient monitoring will reduce the likelihood of complications during patient transport using VA ECMO.

Introduction. Acute decompensation of chronic heart failure (ADCHF) is one of the leading causes of hospitalization in cardiac intensive care units (ICUs), associated with high mortality (up to 43% in the first year). The prognosis for patients requiring inotropic and/or vasopressor drugs is particularly unfavorable, creating a need to improve risk stratification methods.

Objective. To develop a model for predicting the need for inotropic and/or vasopressor therapy in patients with acute decompensation of chronic heart failure.

Methods. A prospective cohort study of 140 patients in the ICU. An analysis of clinicaldemographic, laboratory, and instrumental data was performed using multivariate logistic regression and ROC-analysis.

Results. A highly accurate model was created (AUROC 0.96), including three independent predictors: creatinine level >136.9 µmol/L (OR=22.32), alkaline phosphatase >120.1 U/L (OR=41.78), and the assessment of the HF phenotype. At a threshold of 9 points, the model’s sensitivity was 100%, specificity — 79%. Mortality in the group requiring support was significantly higher (32% vs.12.2%).

Conclusion. The model allows for accurate risk stratification of the need for inotropic/vasopressor drugs, which is especially important in emergency care settings and opens up opportunities for changing approaches to pharmacotherapy in patients with ADHF.

The purpose of the study: conducting an analysis of periodical medical literature on the problem of the occurrence of oxygen-induced hypercapnia in patients with severe chronic and acute respiratory failure (RF) and its significance in providing emergency care to patients with chronic obstructive pulmonary disease (COPD).

Objectives of the study. 18 articles on the subject of the review were analyzed.

The results of the study. During emergency medical care (EMC), patients with respiratory failure are at risk of developing complications from oxygen therapy, such as increased blood carbon dioxide levels, which can significantly worsen the prognosis. This complication is particularly likely in severely ill patients with underlying hypercapnia associated with obstructive airway disease. Inappropriately high oxygen flow during inhalation plays a significant role in the development of this complication.

Conclusion. This analysis of literature may have practical importance for medical staff of ambulance brigades, as well as for physicians in hospital›s emergency room when providing medical care to patients with worsening bronchoobstructive diseases.

The article presents data comparing the incidence of out-of-hospital emergency medical care visits for atrial fibrillation in St. Petersburg during the pre-pandemic period of the novel coronavirus infection (2017–2019) and the post-pandemic period (2023–2024). A comparison of the age and gender structure of visits between these periods was also conducted, along with an analysis of seasonal patterns. The study analyzed the need for medical evacuation of patients with atrial fibrillation during emergency medical care between an institution that routinely uses propafenone and the citywide average indicators.

Aim. 43 foreign and domestic sources on arterial hypertension in children and adolescents were analyzed, including 15 sources from the last 5 years at the pre-hospital stage.

Materials and methods. A feature of modern pediatrics is the increasing incidence of arterial hypertension (AH) in childhood. In 2025, the Russian Ministry of Health approved the clinical guidelines «Arterial Hypertension in Children», which define the acceptable age-related deviations of blood pressure from the norm, depending on gender and height, and provide characteristics of primary (essential) or secondary (symptomatic) hypertension. Hypertension is formed more often in children with certain risk factors: chronic diseases, obesity, chronic kidney disease (CKD), diabetes, sleep apnea, and preterm infants. To prevent hypertension, it is necessary to perform early diagnostic screening of blood pressure in children, starting from an early age of development and especially during adolescence, with the possible use of the term «prehypertension». Therapeutic approaches to pediatric hypertension include adequate dietary recommendations, prevention of psychogenic hypertension, and timely drug treatment. Children with symptomatic AH are prescribed angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics, which are highly effective and safe.