Why do you need an ambulance? Where did ambulances first appear? Who invented them

Where did ambulances first appear? Who invented them?

People have been sick for centuries, and have been waiting for help for centuries.
Oddly enough, the proverb “If thunder doesn’t strike, a man won’t cross himself” applies not only to our people.
The creation of the Vienna Voluntary Rescue Society began immediately after the catastrophic fire at the Vienna Comic Opera Theater on December 8, 1881, in which only 479 people died. Despite the abundance of well-equipped clinics, many victims (with burns and injuries) could not get treatment for more than a day medical care. Professor Jaromir Mundi, a surgeon who witnessed the fire, became the founder of the Society.
The ambulance teams included doctors and medical students. And you see the ambulance transport of those years in the photo on the right.
The next Emergency Station was created by Professor Esmarch in Berlin (although the professor is remembered more by his mug - the one for enemas...:).
In Russia, the creation of an ambulance began in 1897 in Warsaw.
By the way, those who wish can open a large image by clicking on the corresponding picture (where it exists, of course :-)
Naturally, the appearance of the automobile could not pass by this area of ​​human life. Already at the dawn of the automobile industry, the idea of ​​using self-propelled wheelchairs for medical purposes appeared.
However, The first motorized “ambulances” (and they apparently appeared in America) had... electric traction. Since March 1, 1900, New York hospitals have used electric ambulances.
According to the magazine "Cars" (No. 1, January 2002, the photo dates from the magazine in 1901), this ambulance is an electric car Columbia (11 mph, range 25 km), which brought US President William McKinley to the hospital after assassination attempts.
By 1906, there were six such machines in New York.

More than a hundred years ago, emergency medical care was created in our country, which has no analogues in the world and works on the principle: “it is not the patient who goes to the doctor, but the doctor who goes to the patient.”

Its main task is to provide medically qualified and specialized assistance sick and injured as soon as possible from the moment the pathological condition occurs at the scene of the incident, during transportation and carrying out the maximum possible volume of therapeutic measures aimed at restoring the functions of vital organs and systems. Foreign doctors call the domestic ambulance service “a subject of national pride for Russians” and envy our population, which has the opportunity to receive emergency medical care at any time of the day or night, without leaving a warm bed and without incurring material costs.

Unfortunately, at present this unique service, the main purpose of which is to save human lives, has been doomed to perform functions unusual for it and solve numerous social problems.

In no country in the world would it occur to anyone to call an ambulance to change the diaper of a paralyzed grandmother. “I can’t cope alone,” her daughter declares without a hint of embarrassment. And in the next entrance, a bedridden patient fell out of bed. And again they call an ambulance, and when they see the women’s team, they are indignant: “We asked to send men!”

A drunk neighbor, who did not reach his floor, is lounging on the stairs and is obstructing the passage. Or a homeless person has chosen a place to sleep at your door. “We need to call an ambulance,” says one of the household members, “let them take you to the hospital.”

Who wants to mess with a dirty, lousy homeless person or a drunk lying in a puddle? What should we do with street children found in basements and attics? There is no need to strain your brain to answer these questions when there is always an ambulance at hand. And what are the numerous social service officials called upon to solve these problems doing at this time?

Only a very rich and wasteful owner will allow specialized medical teams to be sent to search for and deliver homeless people to hospitals, and clinical hospitals use it as a shelter for them. Responsibility for the fate of these unfortunate and disadvantaged people should be borne by government authorities, not health care institutions.

Using an ambulance as a free taxi deserves a special discussion. “Take us to a consultation with an ENT doctor (ophthalmologist, dermatologist, allergist, etc.). I will continue to call an ambulance until they take us where I want!” the mother declares and demands the phone number of the chief doctor so that immediately complain about the “bad” doctor who dared to object to her. You have to carry it, where to go?

And in the hospital emergency room, outrage arises again: “How? Are you leaving already? Who will take us home?

In the sultry summer of 2010, individuals demanded that ambulance teams immediately evacuate from smoky Moscow or urgent hospitalization healthy child"to a hospital with air conditioning." Wouldn’t it be more logical, based on the slogan “Saving drowning people is the work of the drowning people themselves,” to take your family to a safe area or install air conditioning in the apartment?

A child falls and breaks his knee, but there is no green stuff at home - they call an ambulance. The district nurse did not come to give an injection of an antibiotic (vitamin) - they call an ambulance. Sick chronic gastritis calls an ambulance to find out if he can take an analgin tablet for a headache and whether it will harm his stomach. The mother does not know how to give the child an enema, make a compress on the ear, remove a splinter - they call an ambulance, etc. and so on. This list can be continued indefinitely. Therefore, around the clock, and especially in winter during rush hour, which occurs every evening from 20:00 to 2:00 am, calls are transferred to teams with a significant delay, and patients are forced to wait for hours for medical assistance.

The main advantages of ambulance, which we were once proud of - free and accessible - have now turned against our service. And even that is true: why respect it, this “ambulance”, is it possible to value something that is always at hand and does not cost a penny?

Therefore, ambulance teams walk through dark, dirty entrances at night in search of the right apartment, and none of the patient’s relatives bothers to meet them. “Our yard is full of hooligans, it’s scary to go out into the street,” the young dad answers the reproach of the team that came to the baby and spent a long time looking for the right entrance (the numbers are not marked) in the unlit yard. It wouldn’t even occur to him that women, who mainly work on children’s teams, are even more scared in someone else’s yard and dark entrance.

When asked to prepare a clean towel, they may answer: dry yourself with what is hanging.

The remark that the dog must be removed before the brigade arrives is followed by an angry reaction and a promise to set it on the doctors.

If it becomes necessary to carry a patient into a car on a stretcher, and the help of relatives is required, indignation often arises: where are your porters?

When opening the door to the brigade, they can orderly say: take off your shoes, otherwise you will dirty the floor. This order alone already indicates that the call is unreasonable. Tell me, will you worry about the cleanliness of the floor when the baby’s life is in danger?

It boggles the mind: how can you treat people rushing to your aid at any time of the day with such disrespect and even disdain? “An outstretched hand is not bitten,” says folk wisdom, which is forgotten when it comes to emergency care. Doctors and paramedics working in ambulances make up the golden fund of our medicine and deserve high respect, and sometimes even admiration, for their ability to help the victim in a matter of minutes under the most incredible conditions. necessary help, often saving his life. Try to get into a vein and set up an IV drip for a victim who is in a mangled car or crushed by the rubble of a collapsed building. resuscitation measures in a speeding ambulance, deliver a baby at a market stall, and convince a mentally ill patient to put down his kitchen knife and have a “talk for life.”

Thanks to the poet Andrei Voznesensky for his kind words and sympathy for the servants of this difficult profession:

Among business Scorpios,
Living nearby benefits,
Short-haired ambulance
Lives close to misfortune.
Where do you go at midnight?
Freezing. I wish I could sit in the warmth.
Tortured corps,
Who will help you?

To provide emergency assistance to children, special pediatric teams have been created that bear all the children’s suffering and try to alleviate and eliminate them to the best of their ability.

All calls to children received at “03” flow to the children's console of the Moscow Ambulance and Emergency Medical Aid Station. From here the call is transferred to the substation closest to the victim, and a children's team consisting of a pediatrician and a paramedic rushes to help. Almost every substation has one pediatric team, sometimes two, and they are never left without work. Moreover, almost half of the calls to children are carried out by therapists from line teams who have no experience in dealing with sick children.

After all, a child is not a miniature adult. Each age has its own anatomical and physiological characteristics that must be taken into account in treatment, and even more so when providing emergency care.

Only children's doctor is able to deal with a tiny child who cannot speak and communicates his ill health by screaming or by being lethargic and indifferent. An emergency doctor, including a pediatrician, is limited in time and diagnostic capabilities, but a true professional is often helped by his intuition, which helps to make a diagnosis and provide emergency assistance in a matter of minutes. According to Napoleon's definition, “intuition is a calculation made at lightning speed.” But such a calculation is possible only when there is knowledge and experience, coupled with careful observation of a sick child, his behavior, the ability to identify the most inconspicuous symptoms and analyze them. That is why special pediatric ambulance teams were created, which saved many children's lives.

“If among various things your child gets sick,
Neither a pacifier nor sugar can calm it down,
We must not forget: there is a brigade number five
With the best pediatrician on Earth."

These words from our colleague’s song give a high professional assessment to children’s doctors working in emergency rooms, and in the overwhelming majority of cases they (the doctors) justify this assessment.

It is all the more annoying to realize that a significant part of the calls carried out by pediatric teams only end with the giving of advice, that is, the child did not need either emergency assistance or hospitalization. And this is good. But why was an ambulance needed? And aren’t those who really need it paying too much for this advice?

Alas! Too many mothers think like this: while you wait for the doctor from the clinic, and while you go to the pharmacy to buy medicine, the ambulance will come and do everything right away.

Such parents give rise to alarming situations when a call comes in with a menacing reason (“turned blue,” “dying,” “choking,” “poisoned”), but there is no children’s team at either the nearest or neighboring substations.

A pediatric call cannot wait; it is immediately transferred to any team, be it cardiology or traumatology, for execution. And “adult” doctors say: “It’s better to go to a complicated heart attack than to treat a child.” And they almost always take the baby to the hospital, from where, after examination by a pediatrician, he often returns home. A general practitioner can understand: having no experience working with children, it is better to be safe than to miss a serious illness.

But how can we understand parents who stubbornly refuse to call a pediatrician from the clinic and don’t know the nursery phone number? emergency care their district, but simply “wanted to consult whether to take the child to kindergarten if he vomited yesterday?”

Every mother should know the telephone number by which she can call a doctor at home, and the telephone number of the round-the-clock medical care department for children in her area, so that, if necessary, she can go there at any time of the day or night, on weekdays and holidays. And leave the ambulance to those who really need it.

The ambulance does not prescribe treatment at home, does not give injections of antibiotics and vitamins, does not issue certificates or issue certificates of incapacity for work. Otolaryngologists, ophthalmologists, surgeons, allergists and other “narrow” specialists do not work in ambulances.

To make it easier to figure out who to call in each specific case, follow the slogan: “An ambulance” does not treat, but saves.” Then real professionals will come to the baby in need of urgent medical care, provide him with qualified assistance and, if necessary, hospitalize him.

But even if your call is transferred to the pediatric team without delay, in many cases they will not arrive on site as quickly as you would like. And there are objective reasons for this.

In recent years in Moscow, perhaps the most important difficulty in the work of ambulances has been traffic jams, which occur at any time of the day and in any place, making it difficult to travel both to the place of call and to transport the patient to the hospital.

If there are car enthusiasts among your readers, answer, hand on heart, the question: “Do you always give way on the road to a car with a red cross?” I'm afraid there will be few positive answers. Now imagine that this car is in a hurry to answer a call for your child.

Look at your house and entrance through the eyes of an emergency doctor: is there a number written on the house, is there a numbering on the entrances, are the numbers of the apartments located in them indicated. Quite often, leaving the elevator, the eyes of doctors come across doors that, for some unknown reason, are devoid of identification marks. Which one would you like to call? IN daytime this does not cause problems: you can contact any one, and your neighbors will point out the one you need. What about at night? Would you like it if a bell wakes you up late at night and someone’s voice outside the door asks for your apartment number?

Many unlit entrances and dark staircases make life difficult for ambulance workers. Try to dial the code for the front door in complete darkness or find the right button in the elevator. Lighters and flashlights are used. It’s also good if they (the buttons) have numbers on them. Otherwise our mischievous children with tenacity worthy best use, love to have fun by erasing all the markings on intercoms and floor indicators in elevators.

Did you know that not only can there be “two ninth carriages” on a train, as described by the comedian, but also two first entrances in the same house? Should you arrive at a house located on one street from a completely different one? And on Krasnykh Zori Street, for example, immediately after house No. 37 there is house No. 61? Where can I look for the required 55? And on another no less mysterious street, house number 9 is for some reason located in the courtyard of number 17. And in the area of ​​Kutuzovsky Prospekt there are also Kutuzovsky Proezd, and Kutuzovsky Lane, and a little further on Kutuzov Street?

Therefore, when calling an ambulance, clearly and distinctly state your address, tell me how best to approach the house, and where the entrance to the entrance is located: from the street or from the yard. And don’t consider it difficult to meet a team on the street, because it’s your child who needs help.

Doctors are often reproached for being callous, callous, because they are used to the pain of others. This is wrong! It is impossible to get used to the pain and suffering of children, to the grief of a mother who has lost a child. This is a kind of defensive reaction, the so-called emotional immunity - and this is included in the category of professional qualities of ambulance workers. In critical situations there is no time to gasp and shed tears. It is necessary to instantly orient yourself in the situation, to “get yourself together” in order to save the patient’s life. In some cases, sometimes you have to shout at relatives whose behavior is interfering with emergency measures.

Ambulance is a special world in which you constantly have to deal with negative, sometimes disgusting phenomena, the “wrong side” of life. Mothers abandon their children at train stations, on trains, and throw newborns in the trash. Drunk father planning to take revenge ex-wife, kills two teenage sons with a kitchen knife. The killer, waiting for the businessman at the entrance, at the same time shoots his preschool daughter. A sexual predator rapes and kills children in elevators and attics. And a twelve-year-old prostitute who cannot read already has a bunch of sexually transmitted and infectious diseases. All this is also the work of the children's ambulance team and is not at all the children's problems of our time. Any representative of this difficult profession has the right to say: “To love humanity and hate it, you have to work in an ambulance.”

Maybe after these emotional lines you will have a different attitude towards our “national pride” and with O You will begin to treat its servants with greater respect.

HISTORY OF THE AMBULANCE SERVICE

MEDICAL CARE IN RUSSIA

(To the 110th anniversary of the creation of ambulance in Russia, a brief history)

Belokrinitsky V.I.

MU "Emergency Medical Station named after. V. F. Kapinos", State Educational Institution of Higher Professional Education "Ural State Medical Academy", Yekaterinburg

HURRY TO DO GOOD!

F.P. Gaaz.

The beginning of development, rudiments, attempts to provide first aid date back to the early Middle Ages. In ancient times, as an outburst of mercy, people felt the need to help the suffering. This desire still exists today. That is why people who have retained this bright desire go to work as an ambulance. That's why the most in mass form The provision of medical care to the sick and injured is the emergency medical service. The oldest institution providing first aid is "k s e n d o k i u." This is a hospice house, many of which were organized on the roads to provide assistance, including medical assistance specifically for numerous wanderers. (Hence the name).

Since its inception, this type of medical care has undergone and is still undergoing numerous changes, driven by the desire to optimize the conditions for providing emergency care, while reducing financial costs to a minimum. In 1092, the Johannite Order was created in England. His task included serving patients in a hospital in Jerusalem and providing first aid to pilgrims on the roads.

At the beginning of the 15th century, in 1417, a service was organized in Holland to provide assistance to drowning people on the numerous canals that abound in this country (after the name of its creator, it was called “Folk”; later emergency medical and emergency technical assistance were added here).

The emergency medical service in our country took a very long time to create; it was a long process that took many years. Back in the 15th - 16th centuries in Russia there also existed “hospital homes” for the sick and disabled, where they, in addition to supervision ( charity) could also receive medical care. These houses provided assistance to wanderers, including pilgrims heading to Jerusalem to venerate the holy places.

The next stage in the development of medical care can be attributed to the 17th century, when, through the efforts and funds of the boyar, one of Tsar Alexei Mikhailovich’s close associates, F. M. Rtishchev, several houses were built in Moscow, the purpose of which was mainly to provide medical care, and not just a shelter for wanderers. A team of messengers, created from his courtyard people, collected the “sick and crippled” from the streets and took them to a kind of hospital. Later, these houses were popularly called “Fyodor Rtishchev’s hospitals.” Accompanying the tsar during the Polish war, Fyodor Mikhailovich traveled around the battlefields and, collecting the wounded into his crew, delivered them to the nearest cities, where he equipped houses for them. This was the prototype of military hospitals. (see photo).

But all this was not a prototype of an ambulance in our understanding, since there was no ambulance transport yet. Help was provided to those patients who reached the hospital themselves, or were delivered by random passing vehicles. But if we still consider these institutions as a prototype of emergency care, then only as its second stage, namely the hospital stage. After the appearance of the “Fyodor Rtishchev hospitals”, initial attempts appeared to organize the delivery of patients to the hospital. This work was carried out by specially designated people from among the street servants, who traveled around Moscow and selected the infirm, injured and sick to “give” (the term of those years) first medical aid to them. In subsequent years, the organization of ambulance, and especially the delivery of victims, was closely connected with the work of the fire and police services. So, in 1804, Count F.R. Rostopchin created a special fire brigade, which, together with the police, delivered accident victims to emergency rooms located at police houses. (see photo).

Somewhat later, the famous humanist doctor, F. P. Haaz, the chief physician of Moscow prisons, starting in 1826, sought the introduction of the position of “a special doctor to oversee the organization of care for suddenly ill people in need of immediate help.” Presenting data on sudden deaths in Moscow during 1825, he indicated: “in total - 176, including from apoplexy hemorrhagic stroke due to chest water disease - 2). He reasonably believed “that the death of many resulted from the untimely assistance given to them and even from the complete absence of it.” The personality of this person deserves to be told about him in a little more detail. (see photo).

Friedrich Joseph Haas (Fedor Petrovich Haas) was born in 1780 in the small German town of Bad Münsterreifel. He received his medical education in Göttingen. In Vienna he met the Russian diplomat Prince Repnin, who convinced him to move to Russia. In his new homeland, he first led the organization of medical care in Moscow, and from 1829 until his death (1853) he was the chief physician of Moscow prisons. Having become acquainted with the earthly prison hell, F. P. Haaz not only did not harden his soul, but was imbued with enormous pity for the prisoners and did everything possible (and impossible!) to alleviate their suffering. The prison hospital was reconstructed with his funds, he bought medicines, bread, and fruits for convicts. In all the years of work in this position, he only (once!), due to illness, missed seeing off a group of prisoners, to whom he always gave his invariable buns, which became a legend among prisoners, when leaving the prison gates. He came to Russia as a fairly wealthy man, then increased his fortune through extensive practice among wealthy patients. And he was buried at the expense of the police department, since after his death in the poor apartment of the great Doctor they did not find funds even for burial. A crowd of twenty thousand Orthodox Muscovites followed the Catholic’s coffin. The fate of Dr. Haass is tragic. In the era of the “Russian Renaissance”, against the backdrop of such sparkling personalities as N.I. Pirogov, F.I. Inozemtsev, M.Ya. Mudrov, and many others, the modest figure in a shabby frock coat with bulging pockets, which always contained either money or apples for the next prisoner, was completely lost. When Haaz died, he was very quickly completely forgotten... The memory of Dr. Gaza faded much faster than his bones decayed. There is a legend that, having learned about the death of the Holy Doctor, prisoners lit candles in all Russian prisons...

To all requests and well-founded arguments, he received from the General Governor of Moscow, Prince D.V. Golitsyn, the same answer: “this idea is unnecessary and useless, since each police unit already has a doctor on staff.” Only in 1844, having overcome the resistance of the Moscow authorities, Fyodor Petrovich achieved the opening in Moscow (in Malo-Kazenny Lane on Pokrovka), in an abandoned building falling into disrepair, of a “police hospital for the homeless,” which the grateful common people dubbed “Gaazovskaya.” But without its own transport and field staff, the hospital could provide assistance only to those who could walk to the hospital themselves or were transported by random passing transport.

The terrible Khodynka disaster on May 18, 1868 during the coronation of Nicholas II, which claimed the lives of almost 2,000 people, was clear evidence of the absence in Russia of any coherent system for providing emergency medical care. A crowd of half a million that had accumulated on Khodynskoe Field (an area of ​​approximately one square kilometer), which was not regulated in any way by anyone, according to the comrade prosecutor of the Moscow District Court, A. A. Lopukhin, had merged into a single mass and was slowly swaying from side to side. (People were told that in honor of the coronation, gifts would be given out from specially installed kiosks). The density was so great that it was impossible to free yourself or raise your hand. Many, wanting to save their children, whom they took with them, obviously expecting to receive gifts for them as well, sent them over their heads. In the crowd for several hours there were hundreds of people killed as a result of asphyxia. When the kiosks were opened, people rushed for gifts, leaving behind heaps of shapeless bodies. Only after 4 hours (!) it was possible to gather medical workers in the city, but they, according to the same A. A. Lopukhin, had no choice “to do anything except supervise the dispersal of bodies.” This disaster contributed to the creation of an ambulance in the country, as it clearly showed that there is no such service in Russia. The first station in Russia was opened in 1897 in Warsaw. Then the cities of Lodz, Vilna, Kyiv, Odessa, Riga (then Russia). Somewhat later, stations opened in the cities of Kharkov, St. Petersburg and Moscow. Two years after the Khodynka disaster, in 1898, three emergency medical aid stations were opened in Moscow at the Tagansky, Lefortovo and Yakimansky police houses. (According to other authors, the first stations to be opened were at the Sushchevsky and Sretensky police stations). Life itself demanded the creation of ambulances. At that time, the Ladies' Charitable Society of Grand Duchess Olga existed in Moscow. It patronized emergency departments at police stations, hospitals and charitable institutions. Among the board members of the society was an honorary hereditary citizen, merchant Anna Ivanovna Kuznetsova, an active participant in this society. She maintained a gynecological hospital at her own expense. On the need to create an ambulance A.I. Kuznetsova responded with understanding and allocated the necessary amount of funds. At her expense at the Sushchevsky and Sretensky police stations April 28, 1898 The first emergency medical stations were opened. (This date is considered the day the ambulance service was founded in Russia. In 1998, the 100th anniversary of this date was solemnly celebrated in Moscow, and 2008, at the suggestion of the team of the Volgograd ambulance station and the Department of Emergency Medicine of the Volgograd Medical University, is considered the year 110- anniversary of this event).

At each of the open stations there was a medical horse-drawn carriage equipped with dressings, instruments, medicines, and stretchers. The stations were run by local police doctors. The carriage contained a paramedic and an orderly, and in some cases a doctor. After assistance was provided, the patient was sent to a hospital or apartment. Both regular and supernumerary doctors were on duty, including medical students. (It is interesting to note that many historical materials on emergency medicine traditionally note the participation of medical students). The service radius was limited to the boundaries of its police unit. Each call was recorded in a special journal. Passport details, volume of assistance, where and at what time it was delivered were indicated. The call was accepted only on the streets. Visits to apartments were prohibited.

Due to the small number of private telephones, the police unit entered into an agreement with their owners to provide the opportunity to call an ambulance around the clock; only officials had the right to call an ambulance: a policeman, a janitor, a night watchman. All emergency incidents were reported to the senior police doctor. Already in the first months of its work, the ambulance confirmed its right to exist. Realizing the need for a new structure, the chief police chief ordered to expand the service radius, without waiting for the opening of new stations. The results of the first months exceeded all expectations: (adjusted for those times and the size of the population in the city) - in two months, 82 calls were made and 12 transports of seriously ill patients to hospitals were made. This took 64 hours and 32 minutes. The first place among those in need of emergency assistance were persons intoxicated - 27 people. And on June 13, 1898, the first disaster occurred in the history of Moscow, where an ambulance was called. A stone wall under construction fell on Jerusalem Passage. 9 people were injured, both carriages were leaving, five people were hospitalized. In 1899, three more stations were opened in the city - at the Lefortovo, Tagansky and Yakimansky police stations. In January 1900, another station was opened at the Prechistensky fire station - the sixth in a row. The last, seventh station was opened in 1902, on May 15.

Thus, in the then Moscow, within the Kamer-Kollezhsky Val, including Butyrskie Streets, 7 ambulance stations appeared, served by 7 horse-drawn carriages. Increasing the number of stations and the volume of work required increased costs, but the financial capabilities of A. I. Kuznetsova were not limitless. Therefore, from 1899, carriages began to travel only for very serious calls; the main work began to be performed only by paramedics and orderlies. In 1900, the Chief of Police turned to the City Duma with a request to take over ambulances for the maintenance of the city. The issue was discussed previously at the commission “On the benefits and needs of the public.” It was proposed to finance the carriages from the city budget, and carry out repairs at the expense of A.I. Kuznetsova. A significant event in 1903 was the appearance in the city of a special carriage for transporting women in labor at the maternity hospital of the Bakhrushin brothers. Moscow was growing: population, transport, industry were growing. The police department no longer had enough carriages.

The proposal to change the status of the ambulance was made by the provincial medical inspector Vladimir Petrovich Pomortsov. He suggested providing an ambulance from the police department. The proposal was supported by other community leaders, but faced obstacles from city officials. Moscow University professor Pyotr Ivanovich Dyakonov (1855 – 1908) proposed creating a voluntary ambulance society with the involvement of private capital. Due to the premature death of the professor, the society was headed by Sulima. It decided to apply everything advanced that had been accumulated by that time in matters of providing emergency assistance. The secretary of the society, Melenevsky, was sent to Frankfurt am Main to attend an ambulance congress. In addition to Frankfurt, he visited Vienna, Odessa, and other cities that had ambulance services at that time. The history of the ambulance service in Odessa deserves attention. Before the station was established, the city's population experienced difficulties in providing emergency assistance, especially at night. On the initiative of the Dean of the Faculty of Medicine V.V. Podvysotsky, night medical centers were organized, the addresses of which were known to all cab drivers and night janitors. The organization of the points was undertaken by the local medical society. The station itself was opened in Odessa in 1903. It arose according to the idea and funds of the famous merchant and philanthropist M. M. Tolstoy, who approached the society with a proposal to organize an ambulance station. The enthusiast's proposal was accepted, a special commission was created, of which Tolstoy became the chairman. He went to the Vienna ambulance station, was interested in all the details, participated in visits - with all this he provided invaluable assistance to the work of the commission. He spent a lot of money on the construction of the building and equipment - over 100,000 rubles (!). In addition, he annually spent 30,000 rubles from his own funds. The Odessa station has become an exemplary one. The station did a lot of work, especially in the July and October days of 1905. The Chairman of the Society of Odessa Doctors, Y. Yu. Bardakh, did a lot for the development of the station. However, in 1909, a group of Black Hundreds, members of the Odessa City Duma, began a campaign against the ambulance station. Their motivation is that the society consists mainly of Jews, so the Duma members demanded that the ambulance be separated from the society, which would be tantamount to its liquidation. The demands of the Black Hundreds were supported by mayor Tolmachev, who “glorified” himself by participating in mass pogroms against Jews. However, the harassment of the Black Hundreds was not successful. Later, the rich experience of the Odessa station was used by Moscow colleagues.

In St. Petersburg, the idea of ​​​​creating an ambulance was expressed by the Court Advisor to the Russian Imperial Service, Doctor of Medicine G. L. von Attenhofer. In 1818, long before the creation of the ambulance in Vienna, he proposed “A project for an institution in St. Petersburg to save those who suddenly die or who have put their lives in danger.”

He motivated the need to create such an institution by the fact that in “ in St. Petersburg there are very many circumstances connected that serve as the reason for such unfortunate adventures: a large number of canals, a very cold climate, fast driving, houses that are sweltering in winter - all this is the cause of many disasters, which, with slow or inexperienced attempts at rescue, approximately increase mortality and are often stolen from states of people, perhaps very useful"

Convincing the government to begin creating this institution, Attenhofer argued that the device would not require significant expenses, since “ To accommodate it, you don’t need to have any special building; the rental houses located in different parts of the city provide all the conveniences for this.”« The people needed for this can be appointed from among the servants who already receive a salary from the treasury, and if they want to make some increase from the treasury or appropriate other benefits, then all the more zeal and diligence can be expected from them.” Finally, to grant them distinction, so that their management and maintenance are not hampered by any obstacles and are removed from all such private relations with other places or institutions.”

Attenhofer's project contained instructions for providing " benefits from the rescue institution for drowned, frozen, drunk, crushed by driving, burnt and injured in other accidents.”

The same project contained instructions for providing first-aid care: “Instructions for police guards” and “Instructions for medical assistants.” Thus, the court physician not only was the author of a wonderful idea, but also offered valuable advice for the implementation of this idea. The project characterizes the author as an expert in the organization and delivery of first aid. In addition to its historical value, this document, adjusted for time, is also valuable to us, the descendants of the author, since it corresponds to our ideas about the organization of the “supply” of ambulance.

This progressive man’s understanding of the importance of healthcare can be confirmed by his statement dating back to 1820: “An enlightened and wise government considers among its first and most sacred duties to have care for the preservation of the health of its fellow citizens, which is so closely connected with state welfare.” These wonderful words have not lost their relevance today. Partial implementation of the project began only in 1824. It was this year that, by order of the Governor-General of St. Petersburg, Count M.A. Miloradovich, an “institution for rescuing drowning people” was set up on the St. Petersburg side. The historian recalls that in the same year, 1824, the northern capital experienced a terrible natural disaster - a flood, which cost the lives of many city residents. (A.S. Pushkin described his experiences associated with the tragedy in his famous “ Bronze Horseman"). It is very likely to assume that this tragedy helped to begin the implementation of Dr. Attenhofer’s plan. Another date worth noting: December 4, 1828. On this day, Tsar Nicholas I approved the Regulations of the Committee of Ministers “On the establishment in St. Petersburg of institutions for providing emergency aid to suddenly dying and injured people.”

At the origins of the origin and development of emergency care there were famous scientists - surgeons who really understood the importance of providing emergency care in the shortest possible time from the start of an accident (remember today's concept - the golden hour): this is Professor K. K. Reyer - the founder of the domestic method of intraosseous osteosynthesis using a metal rod. His students, G. I. Turner and N. A. Velyaminov, made a great contribution. (see photo).

In 1889, G.I. Turner published a “Course of lectures on administering first aid for sudden illnesses (before the doctor arrives).” These lectures were given to a wide audience. In 1894, in the first issue of the Journal of the Russian Society for the Protection of Public Health, he published a report “On the organization of first aid in accidents and sudden illnesses.” In this article, the author examines in detail the issues of preventing wound infection, options for stopping external bleeding, transport immobilization, the possibility of reviving the injured, and other issues of providing emergency assistance. It should be especially noted that N.A. Velyaminov made a huge contribution to the development of the ambulance service not only in St. Petersburg, but throughout Russia. With his direct participation, in January - February 1899, five ambulance stations were organized in the city, work was carried out to recruit orderlies, this was the beginning of the creation of an ambulance in St. Petersburg. The official opening took place on March 7, 1899 in a solemn atmosphere. Empress Maria Feodorovna was present at the opening. The first head of all five stations was Professor G.I. Turner.

In 1909, N. A. Velyaminov was appointed Chairman of the Management Committee of the Russian Red Cross Society for providing first aid in accidents and victims of public disasters. In the same year, his report on the activities of the Committee, “First Aid in St. Petersburg,” was published. This work testifies to the highest professionalism of the author in matters of organizing and improving emergency care. The report analyzes clinical and statistical data by month, season, year, by type of injury or disease, and outcomes of first aid. The calculations carried out by N. A. Velyaminov regarding the duty schedules of medical personnel, wage costs and cab drivers are impressive. Anticipating an increase in appeal, the author emphasizes the need to increase the number of stations. “The more posts, the closer the arrival of help to the scene of the accident.” Thus, the outstanding organizer predetermined the principles of modern ambulance work.

Paying tribute to deep respect to those who stood at the origins and creation of the domestic ambulance, it is necessary to highlight the names of two talented organizers in the period after 1917. This is Alexander Sergeevich Puchkov, the chief physician of the Moscow ambulance station, and Meyer Abramovich Messel, the chief physician of the Leningrad ambulance station. Each of them headed the station for 30 years, almost at the same time: M.A. Messel - from 1920 to 1950 (including the years of the blockade), A.S. Puchkov - from 1922 to 1952. Over the years of leadership, they turned their stations into a well-organized system of providing assistance in case of emergencies and accidents. During these years, the development of emergency care in the two largest cities of the country was greatly influenced by prominent scientists from large clinics in these cities. In Leningrad, this is the permanent consultant on emergency therapy, Professor M. D. Tushinsky, and the talented surgeon I. I. Dzhanelidze (remember his words, which became the motto of the ambulance: “If in doubt, go to hospital, and the sooner the better!)

The service was greatly benefited by the friendly contact between these scientists and the Honored Doctor of the Russian Federation, Ph.D. medical sciences M. A. Messel. Thanks to the creative contact of these scientists, the ambulance service of Leningrad was improved and enriched with elements of scientific research, without which it is impossible to move forward. It was precisely this contact that led to the creation of the Scientific and Practical Institute of Emergency Medicine in Leningrad, which was headed by M. A. Messel from 1932 to 1935. Now NIISMP is named after I. I. Dzhanelidze, who was its permanent scientific director.

An important stage in the development of ambulance stations in our country was the creation of specialized teams, primarily cardiological. The idea was expressed by Professor B.P. Kushelevsky at the XIV Congress of Therapists in 1956. A pioneer of anticoagulant therapy in our country, he, like no one else, understood that the time factor (as they now say - “golden hour”) plays a decisive role in acute manifestations of IHD. Therefore, he turned specifically to the ambulance, as the most mobile link in our healthcare. Boris Pavlovich believed in the potential of ambulances. And he turned out to be right.

The creation of cadiology teams in Leningrad - 1958, in Sverdlovsk - 1960, then in Moscow, Kyiv, and other cities of the Soviet Union - marked the transition of emergency care to a new, higher level - a level close to clinical. Specialized brigades became a kind of laboratories for the introduction of new methods of providing assistance, new forms of organization, tactics with the subsequent transfer of this new line brigades. Thanks to the activities of special teams, mortality from myocardial infarction, acute cerebrovascular accidents, acute poisoning, and injuries has significantly decreased. Therefore, it is surprising (to say the least) that periodically heard “smart thoughts” about the inexpediency and high cost of emergency medical teams, and even more so, specialized ones. At the same time, they point to “abroad” in particular, to the USA, where paramedics do the job. Their task is to take the patient to the emergency department, which they call (note!) - not an “emergency room”, like ours, but an emergency room - ER. But, firstly, we have no data on how they manage to do this. Secondly, we see the readiness of their ER to receive the most severely ill patients, in contrast to our emergency rooms.

Finally, they have transport accessibility, where the 911 car (and not just the presidential motorcade) enjoys unimpeded right of passage. Cost. You can compare the “costs” “with them,” where a paramedic receives 10–12 dollars per hour, and a doctor who does not work in an ambulance receives 100!

In our country, a doctor with no experience can earn less than a paramedic with experience and a category. Where are the savings? No matter how much we respect our paramedic, we cannot demand from him the same return as from a doctor, because he was trained as a paramedic. By the way, in European ambulance much is taken from ours, in particular, specialized teams. Now we are being asked to abandon what was born to us. Well, isn't it a paradox?

Improving the medical level involves analyzing the work done, which ultimately results in the defense of dissertations. Thus, two doctoral and 26 candidate dissertations were defended at the Moscow Ambulance Station. The first doctor of medical sciences was the chief physician of the station, A. S. Puchkov, whose name the station now bears; V. S. Belkin, E. A. Luzhnikov, V. D. Topolyansky and many others defended their first dissertations at the station. 13 candidate's theses were defended based on the material of his work in Sverdlovsk (Ekaterinburg). Doctors in other cities can be proud of similar achievements. For more information about the ambulance station in Yekaterinburg, see the next article).

Figure 1. Interior view of an ambulance with two stretchers.

Providing relevant certificates. S.'s stations are headed by a station doctor-director, and in large cities an assistant-senior station doctor is assigned. Usually, responsible senior doctors on duty (in Leningrad, an instructor on duty) are appointed from medical doctors who have administrative experience in evacuation, and they themselves answer all calls by telephone. At the S.P. station, doctors and nursing staff are on duty all the time, assigned to travel. Typically, S. station stations organize telephone and signaling communications between the senior doctor on duty who receives calls and the medical officer intended for departure. staff, a garage where S.P. cars are kept ready, a driver’s room, that from the moment a call is received from outside until the car leaves the S.P. station yard, several minutes pass, in Moscow no more than 3 minutes. In Moscow and Leningrad, staff departure occurs 1 minute after receiving a call from the doctor on duty. The corresponding alarm makes it possible for the senior doctor on duty to check whether the doctor and driver have already reached the car and when the car left the station yard. To avoid false calls, the senior doctor on duty, after transmitting the order with the call, if a false call is suspected, checks this call to the phone, whether a call was actually made to this phone. When the doctor on duty is talking on the phone about a call, there are nurses in the next room. the nurse or paramedic picks up the extension telephone from the telephone set, through which the senior doctor on duty receives the call, and writes down the address and reason for the call, usually on a special note. ambulance call card. Having received an order from the doctor receiving the call, the nurse or paramedic goes to the car, where the departing doctor and the driver are already located, who received the signal to leave in their rooms already at the moment when the call was received by the senior doctor on duty (while talking on the phone, the latter presses to the corresponding electrical alarm button). When the car leaves the yard, the gatekeeper also lets the senior doctor on duty know about it via an electric alarm. The latter has the ability to signal to the gatekeeper that a car is detained at the gate; The gatekeeper signals the senior doctor on duty about returning cars. The senior doctor on duty has a secretary who helps him in keeping records, telephone conversations regarding calls, receives signals from the gatekeeper, etc. In order to know in which area of ​​the city the S.P.’s car is currently located, the senior doctor on duty marks their location with chips on the city map. This is especially important for very large cities where there are S. p. parking points at medical institutions, hospitals, and in different areas; a car that has left for a remote area of ​​the city drives into the nearest parking lot at the hospital, where it waits for the next one call from the station of the S. p. In some large cities (for example, Leningrad), almost all the offices are connected by direct telephone wires to the central station of the S. p. The regional points of the S. p. also have at their disposal visiting doctors, average med. personnel, cars S. p. Usually central

1-*is. 2. Interior view of the ambulance station.

The S. p. station is connected by a direct wire to the peripheral regional S. p. stations, and a call from the corresponding region received by the central station of the S. p. is also transmitted. Transfer of a call from the duty doctor of the district station to the traveling staff also b. h. radioified. The time for receiving and transmitting a call to the district station is immediately shown on a special automatic clock. If there are regional emergency stations, assistance is provided within 2-15 minutes. The regional station of S. p. has the following. premises: room for the senior doctor on duty, dressing room (Fig. 2), room for the nursing assistant on duty. staff and drivers, a room for the doctor on duty, a dining room, a bathroom and a kitchen. Doctors going to the scene of an accident must be qualified doctors who can provide emergency medical services. assistance, quickly navigate the situation and resolve the issue of necessary further medical care. intervention. Usually, doctors with at least 5 years of sick leave, mainly surgical experience, are allowed to occupy the positions of visiting doctors of the S.P. Having delivered the patient or the victim to the hospital, the doctor fills out an accompanying sheet, in which he notes the disease or the nature of the traumatic injury and the assistance provided to him. These sheets are sewn to the patient’s history and upon the patient’s discharge or death they are returned to the S. station with an indication of the patient’s diagnosis. If a visiting doctor, who has visited a patient about a sudden illness, finds it necessary to send him to a hospital, then he takes care of the patient’s transportation, writing out an order to the patient transportation department at the S. p. station. To provide assistance in case of sudden illnesses In large cities, visiting medical doctors do not have the right to issue sick leave certificates, certificates, and they are prohibited from prescribing prescriptions, since they must take everything necessary to provide medical treatment with them When leaving, the doctor S.P. takes with him a bag or box, which contains the medications necessary for emergency care, instruments, a rubber tourniquet, a gastric tube, a set of splints and, if necessary, a device for artificial respiration. The arriving doctor, having provided emergency assistance, is obliged to request by telephone the S. station where he should go next. In the same way, S. p. cars, having arrived at the hospital, immediately report their location to the S. p. station by telephone. If a doctor makes a false call to S.P., a report is drawn up and the perpetrators are brought to justice. In Leningrad, the number of incorrect calls reaches on average about 2% per year of all calls; the number of victims or victims left at home after first aid was provided to them is 15-20% of the total number of calls. Hospitals are obliged to reliably accept patients and victims brought to them by S. p., regardless of the availability of free places. According to Moscow, S.'s arrival at the scene occurs on average 10-12 minutes after the call. In large cities, emergency psychiatric care is also included in the emergency services. Psychiatrists on duty are assigned to S.P. stations, who go out on call from S.P. to provide assistance to the mentally ill and suffering acute psychoses or who, due to their condition, are dangerous to others, as well as; alcoholics in a state of acute alcoholic psychosis. If necessary, the psychiatrist on duty sends the patient by car to a psychiatric hospital. / According to data on the work of the Moscow and Leningrad stations of the S. P. in recent years, the average number of visits per year regarding accidents in large centers can be taken as equal approximately C-8 trips per 1,000 population, and for sudden life-threatening illnesses, 10-13 trips per 1,000 population. The average number of used items (including used items transported to hospitals by the department of transportation of used items of S.p., see below) and victims of accidents, which are transported per 1 rank. car per year is 7,000-7,200 people. These data make it possible to calculate the approximate number of dignity required for large centers. cars.-In the composition of S. p. in a number major cities night honey included. help, previously called emergency medical care. help; it appears in cases where patients do not need immediate assistance in the next few minutes, but at the same time, for health reasons, cannot wait until the morning for a doctor to arrive for home care. Such cases include various painful conditions with a significant and rapid weakening of cardiac activity, severe and repeated vomiting and diarrhea, attacks of various colics, etc. Night medical stations. assistance workers working at S. p. stations usually receive calls independently via landline phones or from persons who come to the point to call night medical services. help. Doctors on duty night medical. assistance do not have the right to issue sick leave certificates. At the night medical point. There is a senior doctor on duty, to whom the night medical doctors report. help. These doctors are supplied with special medical bags with the necessary medications and instruments. Range of action of points 2-3 km; According to Leningrad, on average there are 25-28 visits to the night medical center per year. assistance per 1,000 population per year. IN largest cities At S.P. stations there is a special department for the transportation of b-ts, accounting and distribution of free places in b-tsakh. This department is served by tow truck specialists. All highly infectious drugs (except measles) are transported to hospitals in special vehicles, which undergo thorough disinfection each time after transportation. Accompanying personnel are required to comply with the established requirements for personal hygiene - showering, disinfection of clothing if necessary, etc. Heavy non-infectious items are also transported to special facilities. cars. To facilitate the promotion of dignity. cars they have special identification marks (special coloring, red cross) and special horns, sirens. Sanitary maintenance Transport of the working population is carried out free of charge in the USSR, in contrast to capitalist countries, where transportation of goods to hospitals is carried out for a fee. The department for the transportation of patients at S.P. transports patients to medical institutions that do not need immediate assistance, according to orders from outpatient clinics, clinics, dispensaries, and home care doctors. Hospitals are required to report information on the number of free beds to the department for transportation of patients and registration of free beds in hospitals 2 times a day. Summaries of this data, broken down by specialty and by medical institution, are transmitted to district health departments, in which requests for hospitalization are received from attending physicians. District health departments call for dignity. transport through the department for the transportation of goods at S. p. This department is served by a special staff. In Moscow and Leningrad, S. p. is closely connected with in-tami S. p., specially created to provide highly qualified emergency medical care. assistance and wedge, studying accidents. In Moscow-In-t S. l. them. Sklifosovsky, in Leningrad such an institute was created on the basis of certain medical institutions and research institutes. These institutes pay special attention to research work on the study of methods of “treatment and prevention in case of accidents. The institutes have emergency surgery departments with a trauma department, therapeutic departments, mainly studying poisoning, pathology, and forensic medicine. In Leningrad The Institute of S. P. also has a department of social pathology and prevention with rooms for industrial and domestic injuries, educational statistics and a museum. In recent years, in a number of countries, airplanes have begun to be used to provide S. P., especially in cases where assistance should be provided to victims of accidents or seriously ill people located in remote, inaccessible areas.Australia was the first country that began to widely use medical aircraft in the last decade not only to provide emergency care, but also for regular medical services in remote, sparsely populated areas regions.And in the USSR, the provision of S. p. and the referral of patients to treatment begins to be widely practiced. establishments with the help of special dignity. airplanes. San. Airplanes can be widely used in servicing rural areas and the Red Army. In large cities, the organization of water rescue also belongs to the S.P. In this case, in a number of places on the banks of rivers and canals, in addition to lifebuoys, there are motor boats for rescuing drowning people. Particularly large tasks fall on the servicing of coal mines. Rescue stations serving mines are called mountain rescue stations (see. Mining engineering, mountain rescue business). To provide S. p. on railway, on trains and at stations there are special first aid kits. On some trains and especially on railways. stations have the tools necessary to free passengers pinched between cars and trapped under cars during railway travel. disasters. At large stations there are so-called. auxiliary trains, consisting of a car with devices for providing technical assistance to railways. wrecks, carriage for workers and dignity. carriage with an operating room, a dressing room, and provided with the necessary medical treatment. instruments, dressings, medicines, stretchers, tires, etc. The operation of these auxiliary trains is regulated by special rules. In rural areas, S. p. turns out to be the nearest local precincts to treat. institutions. With the increase in the number of cars on state and collective farms and the improvement of roads, the village will become accessible and rural population. To facilitate the provision of emergency services, especially during mass gatherings of people, they are involved in duty at special temporary emergency centers, in addition to medical services. personnel members of the ROKK, workers trained in first aid. In many countries there are branched Red Cross organizations that form special orders. columns, whose responsibilities also include the provision of emergency services. An interesting innovation in the field of organizing emergency services can be found in Berlin, where, in addition to the service centers scattered throughout the city (which usually have 3 rooms, of which one - operating room), special S. p. cabinets were installed on many of the busiest streets in the form of round columns, 3V 2 in height m and a width of 1.1 m. In the upper part of these cabinets there are instruments, medicines and dressings for providing first aid in case of accidents on the streets; in the lower part there are movable (on wheels) stretchers, which are easily removed and can quickly be used to transport victims to the nearest emergency station or to the nearest medical institution. The S. station monitors the good condition of the stretcher and the replenishment of dressings. The equipment of such a cabinet costs 3,500 marks. S. p. must participate in the conduct preventive measures combating accidents, often taking the initiative in drawing attention to issues of prevention, since S. p. has the necessary data on the causes of accidents and their nature. To reduce the number of calls to emergency services, i.e. to reduce the number of accidents, it is necessary to carry out a number of preventive measures: establishment of correct street traffic (regulation) and monitoring compliance with established rules, proper consideration of the prospects for the development of street traffic when planning and redeveloping cities, laying new and expanding old streets; training the population in traffic rules (use of cinema, radio, schools, lectures, clubs, posters, etc.); monitoring the correct functioning of all safety devices (supervision of engines, operation of brakes, etc.); explaining to the population the dangers of improper use of gas and electricity; bringing to justice all those who violate safety rules; compulsory swimming training for schoolchildren, publication of popular brochures on the issue of first aid, etc. All activities of emergency rescue stations are regulated by special regulations, which cover issues of organizing emergency response in single and large-scale accidents, transportation of waste victims and victims, treatment tasks. institutions in the provision of medical care, medical duties. and technical personnel servicing S. p. stations. There are special instructions for S. p. doctors, S. p. paramedics, for psychiatrists on duty on the procedure for servicing infectious patients, on the disinfection of vehicles, etc. (see. Health station, First aid). Lit.: Puchkov A., Moscow ambulance station (Combating industrial injuries and its consequences, collection, published by NKZdraa, M., 1927); aka, Moscow Ambulance Station, Moscow. honey. zh., 1927, No. 6; Messel M., Basic principles of organization and work of ambulance and dignity. Transport, L., 1932; Pranck E., Entwicklung und gegenwartiger Stand des Rettuius- und Krankentransportwesens in Deut-schl.md, Veroff. a. d. Geb. d. Medizin.lverw., B. XXI, V., 1925; Franck G., Das Berliner ofientliche Rettungs-wesen, seine Entwicklung und seine jetzige Gestolt, V., 19 27; Gottstein A., Rettungswesen (Hndb. d. sozia-len Hygiene und Gesundheitsfursorge, hrsg v. A. Gottstein, A. Schlossmann u. L. Teleky, B. VI, V., 1927, lit.); Grundziige fur die Ordnung des Rettungs- und Kranken-beiorderungswesen, Verofientl. d. Kais. Gesundheits antes, 1912, № 52.D. Gorfin.

The field of emergency medical care is perhaps the most critical branch of medicine. For an emergency physician, it is important not only to correctly diagnose a patient’s life-threatening condition, but also to respond very quickly, select the necessary resuscitation measures or emergency therapy to remove an acute threat to life, and all this so that the affected person can survive or survive the process of transportation to medical institution - after all, the ambulance team works on the road, in the absence of the necessary set of medications and medical devices. From how fast and correct curative measures What the doctor does will directly affect the patient’s life.

Paramedic and emergency doctor - what's the difference?

Many ordinary people, without going into the subtleties of the differences in medical professions, believe that paramedics work in the ambulance, and it is they who provide medical care to the victims. In fact, a paramedic can work in an ambulance, but this is not the only possible job for him.

Emergency doctor - a doctor with a special higher education, who provides qualified medical care and consultation, has the right to decide on emergency resuscitation measures.

A paramedic, like an emergency doctor, can diagnose a patient, determine the diagnosis and prescribe treatment. However, unlike a doctor, a paramedic has an average special education– this could be a diploma from a medical college or technical school. Most often, he provides first aid.

This specialist can work not only in an ambulance brigade, but also in military units, at an ambulance substation, on a river or sea vessel, at a medical center at a railway station or at an air terminal, as well as in towns and villages at a paramedic and obstetric station.

In places where access to qualified medical care is difficult for the population, the skills and knowledge of a paramedic should be sufficient to perform the functions of a doctor. For example, he participates in the medical examination of patients, in the absence of an obstetrician on staff, observes pregnant women and participates in childbirth, observes children under 2 years of age, conducts physical therapy according to the doctor’s indications, and monitors the timeliness of vaccinations and immunizations.

If an ambulance team has one doctor, it is called linear. A specialized team is one that specializes in working with a specific pathology, for example, cardiological or psychiatric. A team where a doctor is not included in the staffing table is called a paramedic.

In the absence of a doctor, a paramedic can, if necessary, carry out:

• cardiac defibrillation;
• tracheotomy;
• cardiopulmonary resuscitation;
• birth reception.

Thus, the difference between a paramedic and an emergency physician is mainly one of skill level.

What does an emergency doctor do?

The doctor’s scope of competence includes providing emergency qualified medical care to victims who urgently need it.

The first task this specialist faces is making a diagnosis, correctly identifying a disease or condition requiring medical intervention. In this case, it is necessary to take into account, firstly, time constraints, and secondly, the lack of many necessary equipment and devices that are available in a hospital medical institution.

It depends on the ambulance team whether the victim will reach the hospital, whether he will survive to the intensive care unit, and whether the doctors will have time to provide him with full assistance. Therefore, it would not be entirely correct to say that emergency doctors treat diseases. If the patient has a condition where his life is in danger, the emergency doctor is obliged to take all measures aimed at reducing it or completely eliminating it, so in this case we are talking, rather, about the treatment of dangerous symptoms and manifestations.

Doctors of this specialty are the first to deal with victims of disasters and road accidents; they respond to calls if a person’s condition does not leave him the opportunity to get to a medical facility on his own.

In addition, the doctor provides symptomatic therapy, for example, assistance to cancer patients who are tormented by severe pain attacks (special pain-killing injections), patients with blood pressure disorders, they are called to children if there are signs of fever, acute infectious lesions.

The responsibilities of an emergency doctor are:

• provision of qualified medical care to patients;
• transportation of victims to a hospital medical facility;
• grade general condition the patient and the choice of the most suitable method of transportation and transfer of the affected person;
• if the patient refuses hospitalization, if necessary, take all possible measures in relation to the patient himself and his relatives in order to convince him;
• while on the road, if you encounter an accident or breakdown, inform the dispatcher and begin providing assistance to the victims.

The doctor must have good physical and mental health, medical logic, observation, quick reaction and the ability to make quick decisions, knowledge about the main pathological conditions and skills in providing pre-hospital care when they occur, the skills and experience of a diagnostic specialist.

Organs, organ systems and mental phenomena with which the emergency doctor works

The doctor on duty working in the ambulance team must understand such branches of medicine as gynecology, pediatrics, surgery, obstetrics, neurology, general therapy, rheumatology, resuscitation, traumatology, ophthalmology, otolaryngology. In the course of his medical practice, an emergency doctor encounters disruptions in his work:

• heart, blood vessels;
• brain;
• organs of the gastrointestinal tract;
• organs of the genitourinary system;
• eye;
• nervous system;
• spine, joints, bones;
• body parts: head, torso, limbs;
• ENT organs.

A specialized psychiatric ambulance team is called in the following cases:

• psychotic or acute psychomotor agitation(hallucinations, delusions, pathological impulsivity);
• depression, which is accompanied by suicidal behavior;
• socially dangerous behavior of a mentally ill person (aggression, death threats);
• manic states with gross violation of public order and socially dangerous behavior;
• acute affective reactions accompanied by aggression, agitation;
• acute alcoholic psychoses;
• suicide attempts in persons who were not previously registered as psychiatric patients.

Diseases and injuries treated by emergency physicians

This specialist provides assistance to patients in any difficult situations that threaten life and health.

According to the nature of the diseases, and, accordingly, medical events services that ambulance teams can provide, they are all divided into:

• intensive care (they work, most often, with victims of road accidents and disasters, specializing in the most severe cases of damage to the human body);
• pediatric (it employs specialists with specialized education in pediatrics who provide emergency care to the youngest patients, for example, in acute febrile conditions, pain attacks, burn injuries);
• cardiological (these doctors are sent to save people with such dangerous conditions as attacks of acute heart failure or heart attack);
• traumatological (specialize in providing assistance and transporting victims with injuries and polytraumas of any nature);
• psychiatric (engaged in emergency treatment and transportation to appropriate medical institutions of patients with acute mental disorders, people who, due to their illness, can threaten themselves and others with their behavior);
• general qualification teams (teams working with various injuries, burns, diseases, feverish conditions).

When to contact emergency doctors

The reason for calling an ambulance is the patient’s condition in which he needs urgent medical care, otherwise his life and health are in serious danger. There are a number of so-called threatening conditions in which it is necessary to contact ambulance teams:

• electric shock, significant burn injuries, poisoning;
• Road accidents and disasters in which victims suffered fractures, ruptures, bleeding and other life-threatening injuries;
• difficulty breathing (regardless of the etiology, this condition can lead to suffocation and death);
• symptoms acute fever: severe fever that is not relieved by antipyretics, convulsions, suffocation, headaches;
• sharp pain in abdominal cavity which literally deprive a person of the ability to move (these may be signs of peritonitis, appendicitis, acute pancreatitis, ulcerative lesions stomach and intestines);
• sharp pain in the chest, which can radiate to the shoulder, back, neck, jaw, arm;
• in the presence of signs of stroke and heart attack (numbness of the limbs, dizziness, loss of consciousness, temporary loss of vision, numbness of half the face, nausea and vomiting, strong pain in the chest, lack of air, weakness, sudden causeless increase in temperature).

There are cases when calling an emergency doctor is not necessary. The ambulance does not handle calls to carry out the doctor’s orders (injections, IVs, dressings), to issue sick leave certificates and certificates, to provide dental care, to provide assistance with exacerbations of chronic diseases, if the patient’s condition does not require emergency medical intervention, as well as for transporting the deceased to the morgue.

Today, you can get emergency medical care from both ambulance teams and public hospitals, and from private clinics.

Examination and treatment methods used by emergency physicians

The specificity of this doctor’s work is that he is very limited in time and in the means of diagnostics. The main methods he uses to determine the causes of a patient’s lesion are external examination, palpation of the abdomen (palpation and pressure in the abdominal area), listening to the heart and lungs using a stethoscope, measuring blood pressure and body temperature, and conducting electrocardiography. If the patient is conscious, the doctor questions him.

After checking the body’s vital signs and analyzing the information received, the physician decides on the need for emergency resuscitation measures or urgent transportation of the victim to a medical facility. If the doctor determines that breathing and cardiac function have stopped, he begins defibrillation of the heart, artificial respiration and pumping of the heart.

If the victim is diagnosed with injuries (fractures, ruptures, dislocations), the doctor takes measures to immobilize him and transport him to the hospital.

The doctor uses medicinal methods of assistance (injections, droppers, sprays, tablets), in some cases he can carry out surgical intervention eg tracheotomy.

The medical team doctor must be a qualified specialist with lightning-fast acumen, the ability to quickly respond and make decisions. His competence includes providing assistance to patients with an immediate threat to life. It is this specialist who is the first to arrive at the scene of an accident, catastrophe, electric shock, or poisoning. All these threatening conditions, in the absence of quick and adequate medical intervention, can cause disability or death, so emergency doctors bear a huge responsibility.