We often see them on city streets. Disaster medicine cars or simply ambulances. Few have seen them from the inside, as a rule, they are doctors and patients themselves. But the patient in the ambulance usually has no time for interiors and equipment, I would live, and doctors are also reluctant to expose pictures from the inside. But it’s interesting.
So let's go inside as a reader. Better to look now than on occasion.
Here's a car for the resuscitation teams. Further equipment. 
Lots of light, lots of space. If desired, two victims can be serviced in a car along the way.
WITH rear doors patients get into the car, so let's go from the side. 
The left side of the ambulance is completely occupied with medical equipment, equipment and medicines. 
All the free space is used, for example, there are catches on the neck on the handrail, an electric blanket hangs on the right. 
The resuscitation monitor connects to the patient and displays information, pulse, heart rate, temperature and a few more parameters. Have you seen in the movies? The cap is put on the finger and the patient is under control. 
An artificial lung ventilation device, it is like an onboard one, but it can also be used autonomously, there are cases when a person who is locked in a car has to be ventilated.
And at the bottom right is a syringe dispenser. Not all medications can be injected in a stream and quickly or drip.
Then a syringe is inserted and the medicine enters the body at a certain speed. The doctors are busy with the patient at this time. 
Defibrillator monitor. Well, everyone saw him in the movies. With the help of a defibrillator, you can also take a cardiogram. 
Anesthetic and respiratory apparatus. It's also portable. 
Doctors call this apparatus "one-room apartment" - it costs the same.
Artificial ventilation device LTV-1200. It can work completely autonomously, does not depend on a compressed oxygen cylinder, like the ventilator above.
The LTV-1200 produces breathing air immediately. 
There is one more interesting thing, a pain stress detector, which is rarely found in Russia so far.
The device can determine whether a person is in pain, even if he is under anesthesia, or unconscious. You can connect and see if the anesthesia is intensified.
Exhaled air analyzer. Almost a chemical laboratory. You can determine what a person has been poisoned with and what kind of help to provide.
Intraosseous access system. It is not always possible to give an injection into a vein. Veins can hide at low pressure, the patient can also be pinched somewhere.
To do this, you can quickly and reliably inject drugs directly into the bone. 
Red resuscitation case, there are a lot of things. 
Everything for injections, everything at hand. 
There is also an obstetric kit, the guys are free to give birth. There are toxicological kits, in case of poisoning, rinse the stomach and so on.
Surgical instruments. Sew up, cut, mend quickly. Sets for tracheostomy and pleural puncture 
And besides, tires, blankets, cylinders with oxygen, nitrogen and other things, a couple of shelves with medicines, several suitcases of things that were not shown. In general, there is a lot of everything, but I just do not advise you to use it all! Take care of yourself!
What happens when you dial 03 on your phone? Your call automatically goes to the central dispatch center of the city or district center. A paramedic on reception and transmission of calls picks up the receiver. In front of him is a monitor, where the algorithm by which he asks questions is displayed. Everything you say is put into the computer by the paramedic. The data is processed and, depending on your location, the call goes to the regional paramedic. The region has several substations at its disposal - the call gets to the one that is closer to the victim. The whole process takes about three minutes.
Not too long ago Ambulance went to all calls without exception.
If a person has typed "03", then he is already sick, - says Irina, a paramedic in the Moscow ambulance with thirty years of experience. - It's just that no one will call, right? Previously, doctors from all over the world came to see us to see how our system worked. Our system - it was like an exhibition of the achievements of the national economy.
Since January 2013, a radical reconstruction began at the "Exhibition of Achievements".
Technical re-equipment: two sticks with a tarp stretched between them
But you need to start one step earlier. At the beginning of 2013, the vice-mayor of Moscow, Leonid Pechatnikov, said that in two years the death rate in Moscow had decreased by almost 18%. It's almost a miracle. High mortality is the pain and shame of our country. It seemed that such things were changing slowly along with the general social and economic situation - and here is a tremendous decline in a short time. Now, according to this indicator, the capital is at the level of many European countries and is 36% better than the rest of Russia.
This achievement was discussed at many seminars - including we tried to understand how this is possible. It turned out that, most likely, the reason is not only an improvement in the general level of health, but also in very specific and seemingly simple things: ambulances received equipment and medicines that allow them to quickly begin therapy - primarily cardiovascular diseases, which make the greatest contribution to mortality. The second simple thing: ambulances must bring an acute patient to the very clinic where they can quickly provide assistance - and here it is important to manage the system of clinics wisely (hence the idea of enlarging them and increasing the level of personnel and equipment). That is, the situation with mortality is influenced by the re-equipment and change in the organization of the admission rooms of hospitals.
We still call it an emergency room, - says Alexander, a resuscitator from Chelyabinsk. - Have you seen, at least in the TV series, how American clinics work? There is no peace, everyone is running! Several specialists begin to work with the patient at once, the time from arrival to the start of therapy is minimal.
With this, let’s say, not all is well in the capital. There are cases when a person, for example, after a stroke, is quickly taken to the hospital by an ambulance, but it is Saturday, and there is no doctor on the spot who could make the right decision within three hours, when effective therapy is still possible. Nevertheless, the ambulances in Moscow are well equipped, and this probably proves that it is possible to drastically reduce the death rate in the country. If it worked out in Moscow, why not everywhere?
We have everything in the carriages, ”says Irina from the Moscow ambulance. - They are fully equipped. Breathing apparatus - two. There are plenty of medicines. If a qualified health worker arrives, then he has everything to provide assistance in the required amount. But in the regions, the situation is far from so pleasant.
About sixty cars with one hundred percent wear and tear, - complains Tamara, an ambulance doctor from Ufa, - forty cars are more or less normal. Well, God bless him. The wheels are spinning - people are driving. However, the Chamber of Control and Accounts found that our equipment was outdated. Cardiology and resuscitation are well equipped, and in ordinary machines the equipment is old - you have to work with rare ventilators.
To all appearances, the modernization of medicine has not reached some regions.
I don’t know what kind of reform you have there, but I’m even ashamed to pull out our stretchers in front of the sick. Two sticks, and between them a tarpaulin is pulled, - says the paramedic of the district ambulance from the Vladimir region Dmitry. - We still have a gazelle car, I myself replenished it with more or less everything that was needed, but once I was put on a UAZ on someone else's shift, it was so scary. While he was “pumping” the patient, the lights went out, the battery went out - the person had to be taken to the hospital, but the car would not start. The driver and I start the car from the pusher, and the patient dies. The machines for severe patients are not equipped at all. We make diagnoses by cardiogram, but it is so difficult to see a microinfarction. For the diagnosis of a microinfarction, for example, there is a troponin test, which after twenty minutes shows an accurate result, but we do not have it. There are no defibrillators, there is not even an "Ambu" bag for mechanical ventilation.
In such a situation, you do not need to be a Nobel laureate in economics and an outstanding manager to significantly reduce mortality. An increase in funding for refurbishment and refurbishment would have had an effect in any case - just as it seems to have had an effect in Moscow. Of course, it would be nice to have ways to properly manage finances, an official is not always able and motivated to distribute money wisely. But spending on medicine will definitely reduce mortality. The problem is that the reform is taking place against the background of a general reduction in spending on medicine, which will decrease by 17.8% by 2015, so reformers are hoping for "efficiency gains" rather than additional funding.
Three magic letters OMC: everyone was reduced
The reform-revolution consists primarily in the fact that the state stopped direct financing of the ambulance service from the budget. The ambulance was included in the basic compulsory health insurance program.
What has this changed for physicians and patients? Today in Russia there is one-channel financing of medicine - all the money allocated by the state for these purposes goes to the CHI fund. This fund is the buyer of the medical care, which is provided to citizens free of charge.
The OMS is a huge organization, but it is unlikely to be able to fully service such a structure as an ambulance, says Irina from a Moscow ambulance. - It was very expensive for the state, but we had many specialized teams - cardiologists, toxicologists, traumatologists. This system has been built over the years. Now they have all been laid off.
After being included in the compulsory medical insurance system, payment for the work of ambulance employees began to be made on the basis of invoices presented for payment to the insurance company. The unit of measurement was a call by a citizen of an ambulance brigade, for which there is a fixed cost. The call is paid from the funds of the CHI fund. The invoices are checked for consistency with the volume, quality and cost of the assistance provided. Based on the results of the check, the money is transferred to the doctors. Patients were not supposed to be affected by the new funding rules. Even if the person who called the ambulance, for some reason, cannot present the compulsory medical insurance policy, the doctors have no right to refuse him assistance.
It was assumed that the quality of the provision of services would even improve, because the assessment of the work of doctors from now on was undertaken by insurance companies, which theoretically could refuse to pay for an ambulance call if a patient turned to them with a complaint. But in reality, there is nowhere to get additional money - with or without the compulsory medical insurance system, but the doctors got into a complex system of monetary motivations. Moreover, these motivations require new formalities, and not better work.
Paperwork: a mistake in the number - and the call will not be paid
When an ambulance was included in the compulsory medical insurance system, it was assumed that the cost of medical care for patients not included in this system would be borne by the regions. But regional budgets, as you know, are not rubber. Therefore, this rule does not work in most cases.
If the patient did not find the policy when he called, it means that the call will not be paid, - says the doctor of the Tula ambulance Yulia. - Our salary depends on the number of calls. No policy - no challenge.
Returning to the base, doctors fill out patient cards - this is now fundamentally important for their salaries. An error in the letter of the surname or in the number of the compulsory medical insurance policy - and the call will also not be paid. A familiar picture - near the senior doctor's office, someone always writes in the number and name of drugs, there is not enough time for everything on the spot.
We have a lot of medical documentation, - says the resuscitator of the Tula ambulance substation, - and this takes a huge amount of time. The nonsense of the situation is that we can bring an agonizing patient - and they tell us: “Where are the accompanying documents? And how did you take him without documents? " And we all the way - one rocked, the other breathed!
The fact that doctors are regularly underpaid due to errors in document flow is in the order of things. The bosses explain this by negligence in filling out the cards - they say, doctors will not get used to the scrupulousness of the insurance system, and the insurance company finds fault with every little detail so as not to pay.
Increased workload: you can't survive without part-time
The reform ideologists promised three years ago that the salaries of doctors would increase by 60-70% and they would not have to engage in part-time jobs, which had a bad effect on the quality of medical services. In fact, the basic salaries of doctors and ambulance paramedics in the regions are still humiliatingly small, and they still cannot survive without part-time jobs.
The norm is in three days, - says the doctor of the Tula ambulance Yulia, - but many go out in a day after a day, or even for two days in a row.
Everything is now combined: in the ambulance and in the control room, in the state ambulance and in the private, in the ambulance and in hospitals. For example, a surgeon operates in a hospital five days a week, works in an ambulance for two or three nights in the middle of the week, and takes another day on weekends. Someone here selects patients for private practice.
And young doctors never leave here, she continues, to earn money. They gain experience and leave for Moscow. There, the salary is three times higher in the ambulance, but the work is the same. It’s hard, of course, to go there: three hours on the road, a day in the ambulance and another three hours home. Doctors there are not only from Tula - from Ryazan, Kaluga, Vladimir, Tver.
Mikhail is one of those young doctors who leave to work in Moscow. Only he has already run over. I got up at five, got behind the wheel, at nine I was at work. And so for four years. I'm tired of it.
I'm the wrong doctor, he says. - I am a psychiatrist-narcologist, retrained in an intensive care specialist. My mother is a narcologist, she dissuaded me, but I went anyway.
Well, why?
Vocation.
Paramedic Lena from Tula says that today she went to work for two days, and will work the next shift in a paid ambulance.
I used to work in a hospital, it’s even harder. Here you can at least lie down and eat, but there the whole shift is at the post, and I have 23 children - everyone needs to be given a pill at the right time, to check that everyone has eaten. On a paid ambulance, I take calls, there I can answer calls even while lying down. I also combine it with the function of a deputy director and, when necessary, I go out on calls.
How long have you been working in this mode?
Since 2005.
What if you only leave one job?
I myself raise my daughter, I also help my parents. If I left only one job, that's 15 thousand. You can hardly live on 15 thousand. And so I will work until my daughter graduates from college. Until I have enough strength.
Separating ambulances and emergency services: double work
As a result of the reform, citizens' calls on "03" are divided into an ambulance and an emergency. An ambulance goes to acute conditions when the patient needs urgent hospitalization and the count goes on for minutes - this includes acute abdominal pain, heart attack, trauma, accidents. From the moment of the call to the arrival of the ambulance, it should take about twenty minutes. Emergency care is distinguished by the fact that one doctor works here and he mainly goes to the so-called home calls - for example, hypertension, chronic diseases. The time it takes for the ambulance to reach the patient is two hours on average.
What are the disadvantages? If the patient's condition is more severe than expected, then you have to call the ambulance again and wait again, because the ambulance has no right to hospitalize. In addition, it is a double job for doctors.
Now the system is arranged in such a way that the ambulance stops its work at 20.00, - says Svetlana, a nurse of the cardiological ambulance team of the city of Ufa, - and the whole load falls on the ambulance. There are patients who, in principle, should call an ambulance, but they specifically wait until the evening so that the call will automatically fall on us - because we have more qualified doctors.
The separation system is, in theory, needed in order to remove the extra load from the ambulances, social challenges, challenges without risking their lives. It is reasonable. But in practice, experienced patients already know what to say in order for the ambulance to arrive: to “make a mistake” in the age of decreasing, to hide the chronic nature of the disease, to aggravate the symptoms. The word “dying” works best.
Reduction of specialized teams: keeping up with calls is unrealistic
Before the reform, there were cardiological, toxicological, trauma and neurological teams in the ambulance system. For example, in Moscow there were five specialized toxicological teams on special vehicles equipped with a chemical laboratory. Now there is only one such brigade, and it was also converted into a general brigade, which is obliged to go to all calls. Everything here, it seems, rests on the compulsory medical insurance system, because the savings for the state are obvious. The cost of calling a specialized toxicological team under a tariff agreement between doctors and insurers is 8 thousand rubles, and calling a regular team is only 3 thousand.
But what is the impact of such savings on critically ill patients?
If earlier, for example, there was a call with an acute violation of cerebral circulation, the neurological team had a Doppler, and the neurologist could immediately determine the focus of the hemorrhage, - explains the Moscow paramedic Irina. - Now the equipment remains, but the specialists who used to work in these teams have become simple line doctors.
Most alarming is the trend towards a reduction in cardiac teams.
We have six large substations and two small ones in Ufa, ”says doctor Tamara,“ and if earlier there were two cardio teams at each substation, now there is one car at four substations. In order to improve efficiency, specialized teams have to go to calls from other substations - on average, three calls per night. If we only went to our profile calls, I think we would have coped. But, for example, recently we went to a call to a child who swallowed silicone balls - only because there were no other cars. In the nearest children's hospital there was no doctor who does fibrogastroscopy, and we had to take the child to another hospital. As cardiologists, we dropped out of the process for an hour and a half. Moreover, in the future, cardiology teams are going to be reduced altogether, while coronary artery disease is recognized worldwide as a disease that is in first place in terms of mortality.
In Tula, an ambulance was subordinated to the city hospital. Here, too, from the cardiological and resuscitation teams, they made universal, cardiac resuscitation teams.
Is it better this way?
Uh-huh, - paramedic Alexei covers his mouth with his hand, so as not to say too much.
Optimization?
Has long been.
As a result of optimization, one children's team remained for the entire substation in Tula. Now she is sent only to the smallest, up to a year. And at the same time, now the children's team, led by an elderly experienced doctor, is on calls for six hours in a row.
Over the past six months, two out of four teams have been reduced, - says Dmitry, a paramedic of the district ambulance from the Vladimir region. - We serve our village and 88 villages. When I take a patient to Vladimir, it’s 70 kilometers back and forth, I’m gone for two hours. And if the second team leaves, the call goes to the substation in Petushki - if there is a free car, they go from there. On average, this is thirty to forty minutes, and there are states when the count goes for seconds. If four cars were returned to us and equipped more or less decently, I think we would have done it. And so, most likely, they will simply close us soon and hand over the substation to Petushki. Driving from there and keeping up with the calls when the journey takes forty minutes will be unrealistic.
Reduction of the composition of teams: paramedics will take the place of doctors
A couple of years ago, a doctor always came to the ambulance team and qualified medical assistance was provided to people at the pre-hospital stage.
Now, due to low salaries and high workload, doctors are not very willing to take this job.
There are only a few medical teams left, we have mostly paramedics, - says doctor Tamara from Ufa. - With our salaries, doctors do not come to us. If a doctor works at a headquarters and sits in a clinic, he does not run around the floors and does not listen to rudeness, and in our country every fifth patient considers it his duty to indicate how bad we are.
The reality is that doctors are being replaced by paramedics in all regions, and, according to doctors, everything goes to the fact that doctors will be excluded from this link altogether.
How can this affect patients?
Now, in almost all large cities of Russia there are well-equipped cardiology and neurosurgical centers, where they can save a patient from a heart attack, stroke or the consequences of trauma, if the ambulance staff make the correct diagnosis and take the patient on time. In particular, due to the timely delivery of patients to such specialized centers, it was possible to reduce mortality from heart attacks and strokes in Moscow to the level of Eastern Europe. But this is in the capital, where the salaries of doctors are sometimes three times higher than the salaries of their colleagues in the regions and the number of doctors is higher, including due to the influx of personnel from the regions.
Will it be possible to achieve a reduction in mortality from heart attacks and strokes in Russia as a whole, when, in addition to the reduction of specialized teams, paramedics will take the place of doctors? After all, a paramedic is not a doctor, he can incorrectly assess the situation and, instead of a specialized center, take the patient to a regular hospital - and then the outcome will be completely different. Moreover, the system is designed in such a way that when a paramedic starts work, he is obliged to go to a call of any complexity, regardless of experience and length of service. At the same time, there are manipulations that only a doctor has the right to carry out. For example, when the patient does not have peripheral vessels and the drug needs to be injected under the collarbone.
According to the physicians interviewed by "RR", the problem would not be so acute if the system of training and advanced training of medical personnel was debugged.
I believe that a good doctor and a good paramedic are equal, - says Irina from the Moscow ambulance. - Some paramedic knows more than a doctor and better diagnoses. It all depends on the person - if he wants, he will ask, be interested and quickly learn. Alas, now the majority of people come who are not interested in advanced training. For example, a challenge: a patient has abdominal pain, and this is an abdominal form of a heart attack. If a paramedic comes to such a call, who does not care about everything, he may simply not understand or collect the wrong anamnesis. Naturally, they call, consult, but it is one thing when a specialist sees a patient, and another when a consultation is done by correspondence. Previously, we had a school for young specialists, now it also exists, but the administration has no time to do this. When I was a senior paramedic, the head and I gathered young people, talked about the structure of the ambulance, checked how they write prescriptions, checked their knowledge of the equipment - these were kind of mini-exams. Nobody does that now. I judge by my substation. And, I must say, there is no special desire to learn from the young. You can put a young paramedic with an adult and teach, but they don't pay extra for this and few are ready for it.
The tendency to reduce the number of brigades to one (!) Physician also looks quite alarming.
Our team consists of a driver and a paramedic, - says paramedic Dmitry. - We have no choice, the paramedic is responsible for everything here. I am 21 years old, my shift worker is 24.
Today, it is common for an ambulance team to leave for one physician. But if a situation arises when the patient needs resuscitation, two hands are not enough to carry out the necessary actions.
Recently, a Muscovite rode an ATV and crashed into a tractor, - Dmitry continues. - Brain contusion, traumatic coma. I put it on a stretcher - it causes cardiac arrest. At this point, two medics are needed. One starts cardiac massage, the second - artificial ventilation. Even if I had an “Ambu” bag for artificial ventilation, it would be physically impossible to carry out a full-fledged resuscitation alone. That patient eventually died.
Consequences of hospital enlargement: an ambulance plugs all holes
The general reduction in hospitals, which has been taking place in Russia for several years, is explained by the fact that many hospitals, in addition to treatment, also perform social functions, for example, the function of care. Now the beds of intensive treatment, which are paid for from the compulsory medical insurance, are exempted from these social functions. In addition, in order to improve the quality of services, not district, but regional hospitals should become treatment centers. In the place of closed hospitals in the village, paramedic points, offices of general practitioners and in best case several beds of the day hospital.
I am against the closure of small hospitals, - says the doctor of the Tula ambulance Yulia. - Of course, a big center has better equipment and better doctors. But the grandmother herself will not go even a few kilometers away. That's all the ambulance rushes in. How many chronic patients are now calling us! They say that if they call the local doctor, he will not help. And you will give an injection and talk. We do not have psychological assistance to the population - we provide this too. Now even cardio teams, as usual, go not only for arrhythmias, but also for purely outpatient calls. It turns out that holes have been made in health care, and the ambulance is now plugging them up. We are both for the clinic and for the hospital. Because in the polyclinic, patients will first be covered with a three-story mat. If an ECG is needed, they will record it in a month. And we arrived - and did the cardiogram, and measured the sugar.
Formalism instead of humanity: a step to the right - explanatory
Once I came to a call, a woman complained of shortness of breath, - says Dmitry, a paramedic of the district ambulance from the Vladimir region. - I made a cardiogram, and she has a massive myocardial infarction with pulmonary edema. I'm taking her to the intensive care unit. It was evident that the patient was grave. The resuscitator comes out, asks what the pressure is, and says: "The pressure allows - take it to Vladimir." I say: "She will die in the car." "No, take it." Drove her to Vladimir, the doctor comes out and says: “Are you a fool? To take on such a responsibility - if only ten minutes more, and she would have died with you. " With a heart attack, 7, 14 and 21 days are indicative. The woman I brought to Vladimir was alive, from the intensive care unit she was transferred to a regular ward, she went on the mend, but died on day 21 - because a complication began. If we had taken her to the hospital on time, perhaps a heart attack could have been prevented, but since we were skating, the result is the following. Recently I bring a patient with asthma - a doctor comes out: "Take me to Petushki." I have already learned, I say: "Only with your accompaniment." I put the patient to bed, the doctor heard that he was again complaining of shortness of breath. "No," he says, "then we won't go." Dumped the patient back, spent three hours on the call in total. Doctors are afraid to take responsibility and hang it on us.
The financial incentives that are implemented through compulsory medical insurance often work well - it is beneficial for a doctor and a hospital to “provide a medical service,” especially a simple one. But in cases of responsibility and risk, small salaries, which still need to be fought for with accountability, kill the most important thing in doctors, which should be - the desire to save lives.
Paramedic Irina from the Moscow ambulance says that in the old days the human factor was in the first place for doctors. The doctor himself chose how much time to spend on the patient. Now, according to the new standards, the ambulance must reach the patient in twenty minutes. Thirty minutes are allotted to provide assistance on a call. During this time, the doctor must write down the patient's data, collect anamnesis, listen, look, make a cardiogram, measure sugar.
Of course, we stay on the call as long as necessary, - says Irina. - But if you mess around for more than half an hour, you have to call back, tell me what you are doing. Let's take a situation: you come to a call and work alone, treating a patient, giving an intravenous injection. The medicine is injected slowly, and they start calling you: "What are you doing there?" This control is distracting. You have to think not about the patient, but about not forgetting to call back. There are a lot of frameworks, and doctors are in such stress all day long. I departed from the algorithm, a step to the right is explanatory. The constant struggle for indicators, all the time you think about how to meet the deadline. If a person has enough moral and spiritual reserves, then, of course, in such a situation he will be able to do his job and will try to do it efficiently, without prejudice to patients. But the conditions are really quite difficult, many doctors are now embittered, they say: "How can we take care of the sick if no one is taking care of us?"
For repeated calls we no longer get paid, and then everyone decides for himself, - continues Irina. - And in any area there are patients who, for some reason, call an ambulance more often than others and repeatedly. In our district, for example, there are only two of them, and we know them by their last names - Zayats and Zaleshchanskaya, both, by the way, are former doctors. They lived to be ninety years old, and they had no friends or relatives left. They call an ambulance so that someone just came to talk to them. Sometimes you come to see such a grandmother, and she says: "I only call for the second time." “Really? - I answer. “Tatyana Leonidovna, I’m here for the fourth time in a day.” So what? I'll go and talk. It will not decrease. People go to medicine from a great love for people and for their neighbors. And if this is not the case, it is better to immediately choose another profession.
What are medical unions striving for?
On November 30, a procession of doctors against health care reform organized by trade unions will take place in Moscow
Trade unions consider it a mistake to introduce single-channel financing and the principle of cost accounting in the work of state and municipal medical institutions. After all, now the salaries of doctors have ceased to be a protected item in the structure of health care expenditures. And the regional authorities are trying to reduce their participation in the financing of territorial compulsory medical insurance programs and approve deliberately reduced volumes of work of medical institutions. For example, according to the Action trade union, the tariff for the services of the ambulance station in the city of Ufa for 2014 was reduced by 5%, which led to a decrease in funding by 70.2 million rubles. As a result, the salaries of ordinary employees fell by about 20% in June.
In this regard, the trade union leaders propose to abandon insurance medicine for state and municipal institutions and return to the budgetary model for organizing health care, which will allow tight control of costs and limit the arbitrariness of employers in the distribution of salary funds. In addition, it is proposed to deprive insurance companies of the function of monitoring the work of medical institutions, since in reality they control not the quality of medical services, but the correctness of the documentation. As a result, healthcare providers are wasting time not on treating patients, but on increasingly rigorous paperwork.
Do you know what happens when you dial 03 on your phone? Your call automatically goes to the central dispatch center of the republic. A specialist in reception and transmission of calls picks up the phone ...
1. Almost all outgoing calls to numbers "03", "103" are received by the unified dispatching service of the Republican ambulance station. The station serves more than 75 percent of the republic's residents: about a hundred service brigades make calls more than a thousand times a day. They work here around the clock.
2. When you ask for help on the phone, the first person you hear is the voice of the dispatcher. The doctor on duty will start asking you specific questions. Unfortunately, false calls happen quite often.
3. It may seem that he is showing indifference, but with the help of clarifying questions, the patient's condition is determined and which team to send to help (calls from citizens are divided into an ambulance and an ambulance).
4. The senior doctor coordinates the work of the duty shift. Meet Irina Serova, Senior Emergency Physician.
5. Before her eyes there are two monitors on which incoming calls are displayed, ranked by priority. In practice, experienced patients already know what to say in order for the ambulance to arrive: “make a mistake” in the age of decreasing, hide the chronic nature of the disease, aggravate the symptoms. The word “dying” works best.
6. Everything you say is logged into the computer, all calls are recorded. Technical innovations made it possible to reduce to a minimum the number of missed and unhandled calls, optimally allocate resources for servicing calls
7. The whole process takes about two to three minutes. The data is processed and, depending on your location, the call goes to the ambulance substation, usually to the one closest to the victim.
8. With the help of the Glonass system, the movement of ambulance crews is monitored in real time: location, time spent at the address and even speed in the process of movement.
9. Each parameter is recorded, analyzed, which helps in further work, for example, in controversial situations, if any.
10. From the moment of the call to the arrival of the ambulance, it should take about twenty minutes. With the help of dispatching services, ambulances bring an acute patient to the very clinic where they can quickly provide assistance.
11. The building of the Republican Ambulance Station has its own ambulance substation, which mainly serves city calls. There are no holidays or weekends for doctors working on emergency calls.
12. All conditions for work have been created at the substation. The work schedule is three days later. There is a rest room here, where, in your free time from calls, you can relax a little.
13. Dining room. Here you can warm up food and eat during a break from the trip.
14. Medicines in sufficient quantities are stored in special cabinets at a certain temperature.
16. In addition to analgin, nitroglycerin and validol, ambulance teams have the most modern drugs that can help in a matter of minutes with heart attacks and strokes.
17. This is how the ambulance emergency medical bag looks like. It weighs about 5 kilograms and contains not only a sufficient amount of painkillers, but also narcotic ones.
18. The peak of calls to numbers "103" or "03" occurs at 10-11 am and from 5 pm to 11 pm. Calls are provided with ambulances equipped with everything necessary.
19. And there is also a simulation center, equipped with special mannequins that maximally imitate the vital functions of the human body. Thanks to the conditions created, future doctors and ambulance paramedics hone their skills in first aid.
The work of doctors is not the easiest, try to help the ambulance staff as best you can: do not terrorize with false and trifling calls, give way on the highway, behave adequately upon the arrival of the ambulance team.
An ambulance is an excellent school, which is desirable for any future doctor to go through. She teaches you to make decisions quickly, to fight disgust, gives you invaluable experience of behavior in non-standard situations.
Special medical ambulances are used for urgent transportation of patients or providing them with emergency at home. Vehicles of this category, when entering a call, have an advantage on the road, they can pass a red light or move in the oncoming lane, necessarily turning on special sound and warning beacons.
Linear category
This is the most common variation of ambulance vehicles. In our country, for line brigades, modifications of ambulance carriages based on the Gazelle, Sobol with a low roof, UAZ and VAZ-2131 SP (oriented to the countryside) are most often provided.
In accordance with international standards, these machines, due to the insufficient dimensions of the cabin, can only be used for transporting people who do not require immediate medical attention. According to European requirements, transport for basic treatment, monitoring and transportation of patients requiring emergency intervention must have an increased working part.
Reanimobiles
According to GOST, ambulances for resuscitation, cardiology, toxicology teams and intensive care physicians must correspond to a certain category. As a rule, this is a transport with a high roof, equipped with devices for carrying out intensive events, monitoring the condition and transporting the patient. In addition to the standard set of drugs and special devices for linear analogs, they must have a pulse oximeter, perfusers and some other equipment, which we will discuss in more detail below.
In fact, the appointment of the brigade is determined not so much by the equipment of the reanimobile, but by the qualifications of the personnel and the profile of the disease for which it is used. There are special analogues of resuscitation machines for children, which are very rare in our country. As far as we know, even in Moscow there is only one such brigade - in the Filatov Children's City Clinical Hospital.
Neonatal model for newborns
The main difference between this type of ambulance vehicle is the presence of a special compartment for a newborn patient (incubator type incubator incubator). It is a rather complex device in the form of a box with transparent plastic opening walls. It maintains an optimal stable temperature and humidity level. The doctor can monitor the condition of the baby, the work of vital organs. If necessary, he connects an artificial respirator, oxygen and other devices that ensure the survival of a small patient. This is especially important for premature babies.
Neonatal ambulances are assigned to special nursing centers. For example, in Moscow it is GKB No. 13, 7, 8, in St. Petersburg - a specialized consulting center.
Other modifications
Among other things, medical transport, the following options can be noted:
Ambulance car classes
Depending on the dimensions, equipment and technical parameters, there are three categories of ambulances:
Below is a table showing the drugs and equipment on board the ambulances, depending on their category.
| Arrangement of ambulance brigades | Class "A" | Class "B" | Class "C" |
| Infusion set NISP-05 | |||
| Traumatological set NIT-01 | |||
| Obstetric set IISP-06 and resuscitation IISP | |||
| Paramedic kit NISP-08 | |||
| Cloak stretcher NP | |||
| Gurney and longitudinal folding stretcher | |||
| Defibrillator | |||
| Ventilator TM-T | |||
| Inhalation anesthesia device | |||
| Pulse Oximeter | |||
| Nebulizer, glucometer, peak flow meter | |||
| Sets of splints for fixing the thigh, neck | |||
| Reduced-type cylinder for medical gases | |||
| Injection stand |
In history and the modern era, there are cases when unconventional vehicles, sometimes very original. For example, during the Second World War in large cities, trams often acted as ambulances. This was due to the fact that almost all automobile transport, not to mention specialized medical vehicles, was mobilized to the front lines.
Along the demarcation line, also during the Second World War, ambulance trains ran, which can be classified as emergency aid rather conditionally. They were responsible for the urgent delivery of the wounded and sick from the frontline zone to hospitals.
In the remote territories of modern Russia (in the taiga regions of Siberia and the Far East), snowmobiles or all-terrain vehicles serve as emergency vehicles. The peoples of Chukotka and other regions of the Far North often use reindeer harness to deliver patients. In some regions, both now and in the past, the fastest way to get to the hospital is by water. There are used "floating" hospitals (boats with motors, boats, motor ships).
In conclusion
In most domestic cities, the most popular ambulance car is GAZ-32214 or 221172. It is these cars that most often go to standard calls, have minimal equipment, and save many lives.
I would like to hope that this industry will develop, especially since its financing has been carried out for several years at the expense of receipts from compulsory medical insurance.
