To identify key managerial problems arising during the construction and preparation for commissioning of modular emergency departments in the context of the federal project «Improving Emergency Medical Care».

Tasks. To assess the frequency of organizational and construction- related difficulties; to describe design, engineering, staffing and pre-launch risks; and to define priority managerial actions for healthcare organizations and regional authorities.

Materials and methods. A cross-sectional descriptive study was  conducted. In February 2026, heads and authorized representatives of healthcare organizations participating in the federal project were surveyed. The analysis included 20 completed questionnaires from 20 constituent entities of the Russian Federation. Absolute values, proportions and qualitative content grouping of open responses were used.

Results. At the preparatory stage, 10 respondents (50.0%) reported approval-related  problems; contractor selection and equipment procurement problems were reported by 9 respondents each (45.0%). Construction- stage difficulties were reported by 11 respondents (55.0%); the most frequent problem was engineering and logistical connection of the module with the existing hospital infrastructure, reported by 10 respondents (50.0%). Staffing difficulties were identified by 10 respondents (50.0%).

Conclusion. A modular emergency department should be regarded not only as a construction project, but also as a complex organizational transformation of a healthcare facility.

Введение . Неудачные вызовы являются серьезной проблемой в неотложной медицинской помощи, связанной со снижением эффективности работы и нерациональным использованием ресурсов, а также с финансовыми и экономическими потерями.

Цель исследования : изучить динамику количества неудачных вызовов бригад скорой помощи и отказов в вызове бригад в Российской Федерации.

Материалы и методы . Использовались данные отраслевой статистической отчетности — форма № 40 (2010–2013 гг.) и федеральной статистической отчетности — форма № 30 (2014–2024 гг.) Российской Федерации; применялись статистические и аналитические методы исследования, электронные таблицы MS Office Excel 2019.

Результаты исследования . За 15 лет наблюдений количество неудачных вызовов скорой медицинской помощи увеличилось на 43,6% (до 2,8 млн в 2024 году), а их доля в общей структуре вызовов возросла (на 74,5% до 7,3% в 2024 году). Такая динамика наблюдается на фоне устойчивой тенденции к снижению общего числа вызовов скорой медицинской помощи в Российской Федерации на 17,7% (8,3 млн за 2010–2024 годы, с 47,5 млн в 2010 году до 39,1 млн в 2024 году). В этой связи особое значение имеют отказы в вызове бригад скорой медицинской помощи (из-за необоснованности вызова); среднее число таких отказов составляет более 1,7 млн ​​в год; за период наблюдения отмечено значительное увеличение их числа (на 170,1%).

Заключение . Сокращение числа неудачных вызовов является важной задачей для службы экстренной медицинской помощи, которая охраняет здоровье пациентов. Разумная экономия усилий и ресурсов медицинской организации в условиях нехватки персонала и бригад скорой помощи, сокращение неосновных расходов — естественное стремление подразделений экстренной медицинской помощи, реализуемое при приеме, сортировке и перенаправлении вызовов. Целенаправленное использование бригад скорой помощи является ключом к доступности и качеству экстренной медицинской помощи, эффективности и результативности ее подразделений.

The purpose of the study was to analyze the database and report forms of call cards with the reason «Heart trouble (chest pain)» and with the diagnosis code «I21» according to ICD-10 in the Emergency Management System program for the period 2019–23, to develop and implement optimization measures and evaluate the results implementations for the period 16.03.24–15.03.25

The materials of the database and reporting forms of call maps of the NSR station for two periods were used: 2019–23 (before the implementation of optimization measures) and 16.03.24–15.03.25 (after implementation), analytical and statistical methods were applied.

The results of the study. When providing emergency medical care to patients with acute myocardial infarction, the proportion of clinical deaths in general medical teams decreased by 4 times (from 0.8% to 0.2%) and by 3 times (from 3.8% to 1.2%) in anesthesiology and intensive care teams relative to the initial study period. In 2024, relative to 2023. The number of patients in severe and moderate severity diagnosed with acute myocardial infarction transferred to the anesthesiology and intensive care teams decreased by 2 times due to a twofold increase in the proportion of calls made by anesthesiology and intensive care teams to patients with acute myocardial infarction (from 14.9% to 28.7%) after the introduction of an optimized reason the challenge.

Conclusion. The creation and introduction of the reason for the call «A man over 40 years old with a bad heart (pain behind the sternum)», which is specialized for anesthesiology and intensive care teams, made it possible to increase the availability and improve the quality of NSR care for patients with acute coronary syndrome with ST segment elevation, with other diagnoses of category «I» according to ICD-10, requiring participation of anesthesiology and intensive care teams (from 26.8% to 38.7%). This reason for the call is recommended for implementation in the work of NSR stations, which include teams of anesthesiology and intensive care.

The organization of patient routing affects the quality of medical care provided, the level of mortality, and determines the improvement of the population’s quality of life.

The purpose of the study is to improve the results of specialized care by improving the principles of interregional routing in the North- Western Federal District.

Research objectives: 1) To study the current indicators of interregional interaction in the field of Surgery (burn surgery); 2) To identify the impact of delayed transfer of patients to a burn center on the results of their treatment; 3) To determine ways to improve the principles of organizing telemedicine consultations and interregional routing.

Materials and methods: The study included data obtained from the analysis of 52 case histories of patients transferred for the purpose of receiving high-tech medical care.

Research results: Exceeding the maximum (in accordance with the provisions of the Order —  72 hours) in terms of the duration of the period was stated when assessing the routing of 24 patients with burns. The significant impact of the timing of the transfer of patients with extensive skin burns to the stage of specialized treatment was confirmed. The average duration of prolonged mechanical ventilation in burn patients with delayed evacuation exceeded the same indicator in the case of transfer within 72 hours by more than 2 times (11.5 and 5.3 days, respectively); the period of stay in the intensive care unit was 1.5 times longer (15 and 10 days), and the mortality rate was 3 times higher (42% and 14%, respectively).

Conclusion. During telemedicine consultations, it is necessary to clarify the treatment and diagnostic tactics, as well as to coordinate the transfer to the specialized medical care stage as soon as possible.

Оbjective. To evaluate the impact of prehospital emergency care management on the clinical outcomes of pediatric burn injuries.

Aims. To analyze the components of prehospital emergency care provided to children with burns and to develop predictive models of burn injury outcomes based on prehospital management strategies.

Materials and methods. A retrospective study included 576 pediatric patients (median age 17 months, IQR 13–40 months) admitted to a pediatric burn center between 2016 and 2024 after transportation by emergency medical service (EMS) teams and specialized emergency response teams. Key parameters of prehospital emergency care and their associations with intensive care unit (ICU) length of stay, surgical treatment, and total hospital length of stay were analyzed. Logistic and linear regression models were used to identify predictors of clinical outcomes. Model performance was assessed using receiver operating characteristic (ROC) analysis.

Results. The likelihood of surgical treatment was significantly associated with the administration of infusion therapy (OR=2.060, 95% CI: 1.261–3.386) and burn size. The predictive model demonstrated a 70% probability of correctly identifying patients requiring surgical intervention. ICU length of stay was predicted by the presence of life-threatening conditions (OR=2.067, 95% CI: 1.542–4.284), underestimation of burn size during the prehospital stage (OR=1.206, 95% CI: 1.152–1.271), and administration of infusion therapy (OR=2.477, 95% CI: 0.942–5.861). Prehospital care variables accounted for 38% of the variability in hospital length of stay (R²=0,38).

Conclusion. Underestimation of burn size, administration of infusion therapy, and the development of life-threatening conditions during the prehospital stage significantly influence burn injury outcomes in children. These factors should be considered when providing prehospital emergency care to pediatric burn patients.

The aim is to study the impact of road safety on the specifics of medical care provided to victims of traffic accidents in the Voronezh region.

Objectives. To identify the causes of traffic accidents; to analyze the indicators of road traffic injuries and fatalities in the region from 2020 to 2024; to study the dynamics of hospitalization of traffic accident victims in trauma centers of various levels in the Voronezh region; to analyze the number of traffic accident victims and deaths in trauma centers; to consider promising directions for reducing mortality and negative health consequences for the injured.

Materials and methods. The statistical methods of studying and processing the results of medical care provided in road traffic accidents in the Voronezh Region from 2020 to 2024 were used to conduct the study.

Results. The main causes of road traffic accidents are violations of traffic rules by road users. There is a consistent reduction in the number of road traffic fatalities between 2020 and 2024 (rate of decline –7.84). In most cases, death occurred before the arrival of emergency medical teams. The number of people hospitalized in level II and III trauma centers exceeds the number of people hospitalized in level I trauma centers (3874, 2783 and 609 cases, respectively), the mortality rate decline was –15.68 (51.83, 49.17, 48.57, 52.4 and 43.7, respectively, per 1000 people admitted to trauma centers).

Conclusion. Improving the algorithms for providing medical care to those involved in road accidents is possible only through the coordinated work of all state institutions whose competence is related to the organization of safe road traffic and healthcare.

The aim of the study is to propose ways to optimize gastric lavage from food.

Materials and methods. А series of simulations of gastric lavage through a gastric tube with a diameter of 1 cm from mashed potatoes, oatmeal and rice porridge using a Janet syringe and tap water with temperatures of 15 ^°C, 20 ^°C, 37 ^°C and 45 ^°C.

Results. Regardless of the water temperature, it took the shortest time to wash the stomach model from mashed potatoes: Me 7.6 (Q1–Q3: 6.3–10.8) minutes. The evacuation time of oatmeal porridge was: Me 17.5 (Q1–Q3: 14.1–22.8). When using water with a temperature of 15 ^°C and 20 ^°C, it was not possible to remove rice porridge from the stomach model within 60 minutes, in other cases it took the longest time: Me 19.8 (Q1–Q3: 18.8–21.8) minutes. A decrease in the gastric lavage time was revealed with an increase in water temperature (p<0.05). An original modification of the gastric lavage probe (Patent No. 046881 B1) has been developed, which made it possible to accelerate the evacuation of stomach contents (p<0.05) and increase the effectiveness of the procedure.

Conclusion. An increase in the effectiveness of gastric lavage can be achieved by increasing the temperature of the water used (p<0.05). The developed original modification of the gastric lavage probe also made it possible to reduce the time of evacuation of stomach contents (p<0.05). After testing in experiments on laboratory animals and clinical studies, the data obtained can change approaches to gastric lavage in an urgent situation.

The article discusses the need for premedication in the preoperative period, and presents its own data on the use of clonidine, nefopam, and ketorolac in premedication in patients to prevent hyperergic reactions of the neuro-endocrine  system during arthroscopic surgery.

The aim of the study was to evaluate the effect of the use of clonidine, the combined use of nefopam and ketorolac in premedication and anesthesia to prevent hyperergic reactions of the neuro- endocrine system in patients undergoing arthroscopic surgery.

Materials and methods. Clinical observations were performed in 280 patients undergoing arthroscopic surgery. The comparison group consisted of 100 traumatological patients who received the usual premedication of atropine 0.014 mg/kg; diphenhydramine 0.14 mg/kg; trimeperidine 0.28 mg/kg intramuscularly 30–40 minutes before surgery. In 80 patients, clonidine 1.5 mcg/kg, the main group No. 1, was additionally included in pre-acute drug treatment. In 100 patients, premedication with ketorolac 0.4 mg/kg, atropine 0.014 mg/kg and nefopam 0.27 mg/kg, the main group No. 2, was used. All patients underwent intravenous anesthesia using propofol, ketamine, and fentanyl. The inclusion criteria were: male and female gender; age 18 years and older; presence of intra-ar ticular knee joint injuries.

Results. Mathematical analysis of the heart rhythm has shown that under the influence of psycho- emotional stress before surgery, patients experience tension in the sympathetic part of the autonomic nervous system. Premedication with atropine, diphenhydramine and trimeperidine and introductory anesthesia practically did not change the heart rate in the comparison group of patients, who remained at high levels throughout all stages of the study. The dynamics of heart rate indicators in the 2^nd main group differed slightly from the changes in the 1st main group. However, the combined use of ketorolac and nefopam made it possible to maintain AMo and IN within the physiological norm. The current level of knowledge allows us to establish only a general relationship between the wave structure of the heart rhythm and the anatomical and physiological structure of the control system. Although, the levels of humoral, hormonal, autonomic, and central (cortical) regulation correspond to certain anatomical and physiological structures (subcortical nerve centers, higher autonomic centers, and the central nervous system). However, a complete picture of the quantitative and qualitative endocrine response can only be judged by the concentration of hormones in the blood serum. The inclusion of clonidine in the premedication of patients in the main group No. 1 made it possible to remove excessive hormonal reactions by the time they were admitted to the operating room. Thus, the concentration of cortisol and insulin in the subsequent stages did not significantly differ from the norm. The combined use of ketorolac and nefopam in premedication, even without the use of narcotic analgesics, had a similar effect to clonidine and contributed to the normalization of hormones of the adrenal cortex and pancreas.

Conclusion. The inclusion of clonidine in premedication or the prescription of ketoralac with nefopam (instead of a narcotic analgesic) in premedication for patients undergoing arthroscopic operations may be promising for wide practical use, because takes into account specific clinical and physiological disorders present in the patient.

Introduction. Ischemic heart disease (IHD) remains the leading cause of mortality, and its prevalence steadily increases with population aging. Elderly patients constitute the majority of individuals in cardiology departments and emergency medical teams. However, existing reference intervals for laboratory parameters are often standardized and fail to account for age- and gender- related characteristics.

Objective. To conduct a quantitative analysis of changes in blood parameters in patients with IHD depending on age and gender in order to optimize the interpretation of laboratory data at the prehospital stage.

Materials and methods. The study included 3,357 patients with IHD aged 45 to 102 years (median 62 years) treated at the I. I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine between 2020 and 2025. Complete blood count, biochemical blood tests, and INR measurement were performed. Patients were divided into four age groups: middle age (45–60 years), elderly (61–75 years), senile (76–90 years), and long-livers (91+ years). Statistical analysis was performed using two-way ANOVA followed by Sidak’s post hoc test.

Results. In elderly men, hemoglobin decreased by 5% and creatinine increased by 7%; in senile men, hemoglobin decreased by 21% and creatinine increased by 18% compared to middle-aged men. In women, a 10% decrease in hemoglobin and a 20% increase in creatinine were first observed in the senile age group; among long-livers, these changes reached 17% and 38%, respectively. A 14% decrease in leukocytes, an 11% increase in neutrophils, and a 29% increase in platelets in the senile age were observed only in men. An increase in INR was 16% in senile men, 15% in senile women, and 49% in female long-livers. MCH, glucose, total bilirubin, and potassium levels showed no significant age-related changes in either sex.

Conclusion. Gender differences in the age-related dynamics of laboratory parameters were identified in patients with IHD. The most pronounced changes were observed in hemoglobin, creatinine, and INR levels. In men, changes involved a broader range of parameters and were detected starting from elderly age, whereas in women, significant deviations occurred in senile age and among long-livers. These findings support the need for a differentiated interpretation of laboratory results in patients with IHD, taking into account both age group and gender.

Objective. To assess the descriptive epidemiological characteristics and adherence to therapy of patients who sought emergency medical care for elevated blood pressure.

Materials and methods. A retrospective analysis of emergency medical care requests from residents of one of the districts of St. Petersburg in 2015– 2022 was carried out. A total of 44,456 patients were included in the study, who sought emergency medical care 62,630 times during this period. Additionally, in some patients who sought emergency medical care due to increased blood pressure (n=79), adherence to therapy was assessed (using the KP-25 questionnaire).

Outcomes. It has been shown that during the period 2015–2022, there was a high incidence of emergency medical care requests for high blood pressure, primarily due to calls for patients in the older age group (over 60 years), with a higher proportion of women (77%). The frequency of patients’ requests for emergency medical care due to high blood pressure with complications was 7.4%. At the same time, in young and middle-aged men, the frequency of complications in the form of myocardial infarction and/or cerebrovascular disorders when seeking emergency medical care was 4.7 times higher than in women, which is associated with a lower adherence to treatment in men than in women (97.7% vs. 87.9%). It has been shown that a decrease in adherence (by 9.8%) to treatment is primarily associated with an increase in complications when blood pressure rises at the pre-hospital stage in young and middle-aged men.

Conclusion. The structure of patients’ visits to emergency medical services for high blood pressure, as well as their distribution by age and gender, has been clarified. The most severe complications of emergency conditions associated with high blood pressure have been identified, and their frequency has been determined based on the gender and age of patients. The impact of adherence to treatment on the frequency of complications associated with high blood pressure has been assessed.

Aim. To determine the clinical and diagnostic markers of hypoxia in order to improve the diagnosis, prognosis, and dynamic monitoring of emergency therapy for newborns with perinatal hypoxia at the emergency medical care stage.

Materials and methods.103 case histories of full-term newborns who were admitted to the Perinatal Center of the St. Petersburg State Pediatric Medical University between 2016 and 2024 were analyzed. The mechanisms of hypoxia were studied based on biochemical parameters (glucose, urea, total protein, ALT, and AST levels). The relationship between the severity of hypoxia and biochemical blood parameters was determined.

Research results. To determine the compensatory mechanism in hypoxia in newborns, which is aimed at increasing blood glucose levels and replenishing the body’s cells’ energy potential, it is necessary to consider a combination of factors (p<0.01): an episode of hypoxia/anoxia, a decrease in sat02 below 92%, an increase in ALT and AST within 1–2 days after the episode of hypoxia, an increase in urea levels, a decrease in total protein levels in the blood, an increase in blood glucose levels, and a decrease in the AST/ALT ratio. This allows us to assess the state of the compensation mechanisms (glucose- alanine shunt) with hypoxia.