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Including specialized emergency services. On approval of the Procedure for providing emergency, including specialized emergency medical care. About the activities of an emergency medical doctor

According to Part 2 of Art. 32 Federal Law dated November 21, 2011 No. 323-FZ “On the basics of protecting the health of citizens in Russian Federation"(hereinafter referred to as Federal Law No. 323) one of the types medical care is an ambulance, including specialized emergency medical care.

The procedure for providing emergency medical care, including emergency specialized medical care, was approved by Order of the Ministry of Health of Russia dated June 20, 2013 No. 388n (hereinafter referred to as the Procedure for the provision of emergency medical care). But specified order will be changed in the near future. Namely, Order of the Ministry of Health of Russia dated January 22, 2016 No. 33n “On amendments to the Procedure for the provision of emergency, including specialized emergency medical care, approved by Order of the Ministry of Health of the Russian Federation dated June 20, 2013 No. 388n” takes effect July 1, 2016, accordingly, the amended Procedure for the provision of emergency, including specialized emergency medical care will come into effect from the same date.

General changes to the Procedure for the provision of emergency medical services

Enough changes are planned in the order of the Russian Ministry of Health dated June 20, 2013 No. 388n a large number of, let us note the most significant of them:

  • Ambulance, including specialized emergency medical care, will be provided not only on the basis of medical care standards, but and taking into account clinical recommendations (treatment protocols)(Clause 3 of the Procedure for the provision of emergency medical services). More information about clinical recommendations (treatment protocols) can be found on our website at the link.
  • An emergency medical service (hereinafter referred to as EMS) will be additionally called upon admission to a medical organization providing emergency medical care, filled in in electronic format emergency call cards for emergency medical services from information systems emergency services(Clause 9 of the Procedure for the provision of emergency medical services).
  • Reasons for calling an ambulance in an emergency from July 1, 2016 will not appear duty in the event of a threat of an emergency, provision of emergency medical care and medical evacuation during the liquidation of the medical and sanitary consequences of an emergency (clause 11 of the Procedure for the provision of emergency medical services). WITH specified date in case of such a threat, as well as in places of mass events, duty of mobile ambulance teams will have to be organized (clause 18), which seems, in our opinion, more logical in this situation.

    • A rule has been introduced that when declaring death in an ambulance car the visiting EMS team is obliged to immediately notify the paramedic for receiving EMS calls and transferring them to visiting EMS teams or the nurse for receiving EMS calls and transferring them to visiting EMS teams to call employees of the territorial bodies of the Ministry of Internal Affairs of the Russian Federation or obtain permission to transport the body of a deceased patient to a medical organization performing forensic medical examination.

    If signs of death are detected in a deceased patient violent death or if it is suspected, as well as if it is impossible to identify the identity of the deceased (deceased), when making an EMS call, the medical worker of the visiting EMS team, appointed senior, is obliged to notify the paramedic for receiving EMS calls and transferring them to the visiting EMS teams or the reception nurse about this EMS calls and transferring them to field EMS teams for immediate notification territorial body Ministry of Internal Affairs of the Russian Federation. (clause 15 of the Procedure for the provision of emergency medical services).

  • When a patient enters a medical organization for the provision of emergency medical services in a hospital setting, the diagnosis is clarified, diagnostics, dynamic observation and therapeutic and diagnostic measures are carried out in emergency medical services beds for daily stay and, if there are medical indications, short-term treatment lasting no more than three days per day. emergency room beds short stay(clause 16).
  • If there are medical indications, patients are sent from the inpatient ambulance department to specialized departments medical organization, within which an inpatient ambulance department has been created, or to other medical organizations to provide specialized, including high-tech, medical care (clause 17).

Change and rules for medical evacuation during emergency medical services(Appendix No. 1 to the Procedure for the provision of emergency medical services). For example, the rule that medical evacuation in case of road traffic accidents is carried out to medical organizations that provide medical care to victims with combined, multiple and isolated injuries accompanied by shock will cease to apply(clause 10).

Rules for organizing the activities of the EMS mobile team will also not remain unchanged, namely:

  • Mobile EMS teams according to their profile will be divided into general and specialized (currently into general, specialized, emergency advisory, obstetric, and aeromedical).

    • Specialized mobile ambulance teams are divided into teams:

    • a) anesthesiology and resuscitation, including pediatric;
    • b) pediatric;
    • c) psychiatric;
    • d) emergency advisory;
    • e) aeromedical

    (currently there are teams of anesthesiology-resuscitation, pediatric, pediatric anesthesiology-resuscitation, psychiatric, obstetrics and gynecology).

  • The medical composition of mobile ambulance teams will change. A obstetric visiting team The NSR will cease to exist altogether, because... the norm about it is excluded from new edition The procedure for providing emergency medical services.
  • Maximum defined valid time getting to the patient Teams when providing emergency medical services in an emergency - 20 minutes from the moment of the call(at the same time, it has been established that in territorial programs, the travel time of the Brigades can be reasonably adjusted taking into account transport accessibility, population density, as well as climatic and geographical features of the regions in accordance with the State Guarantees Program free provision medical assistance to citizens)
  • The responsibilities of the driver of an SMP vehicle will be set forth in clause 16 of this Application (for example, obey the doctor or EMS paramedic of the visiting EMS team and follow his orders; ensure the immediate departure of the EMS vehicle to the call and the movement of the EMS vehicle along the shortest route; monitor technical condition of the SMP vehicle, timely refill it with fuels and lubricants, wet clean the interior of the SMP vehicle as necessary, and maintain order and cleanliness in it). It is worth noting that the driver’s responsibilities are currently not fixed in the procedure for providing emergency medical services.

Since July 2016, the list of recommended departments, premises, offices and other objects for the structures of stations and EMS departments has been expanded (accounting, disinfection and sterilization department (office) and others have been added), as well as for stations and EMS departments (department (office) premises have been added) disinfection and sterilization, pre-trip and post-trip room medical examinations drivers of SMP vehicles and others).

Appendix No. 4 to the considered Procedure for the provision of emergency medical services ( recommended staffing standards for EMS station, EMS department) will also be in effect with changes from July 1.

Firstly, will reduce the number of positions, so, if today the number of recommended positions is 42 positions, then from July 1, 2016 their number will be reduced to 29. For example, the Procedure for the provision of emergency, including specialized emergency medical care in the new edition does not provide for positions such as:

  • Deputy Chief Physician for Hospitalization(currently one such position is being created if there are at least 10 medical organizations in the serviced area providing medical care in inpatient settings);
  • Deputy head of substation (department) of emergency medical service - emergency medical service doctor(1 position is now provided if the EMS substation (department) has at least 40 medical and paramedic positions on staff, including the position of manager);
  • Medical psychologist(currently 1 position is provided when there are 100 positions of medical workers in the state);
  • Obstetrician (currently 5.25 is provided to ensure round-the-clock work of the obstetric emergency medical team), etc.

Regarding the position obstetrician-gynecologist, then this position is also excluded from the recommended staffing standards for the Emergency Medical Service Station, emergency medical service department of the clinic (hospital, emergency medical service hospital) (Appendix No. 4). It is clear that the positions of obstetrician and obstetrician-gynecologist have been abolished, along with obstetric and gynecological teams. However, the position of an obstetrician-gynecologist is, as before, recommended for emergency consultative ambulance departments (emergency hospital, disaster medicine center) (Appendix No. 13) and the number of positions remains unchanged for this department - 5.25 (to ensure round-the-clock work of a mobile emergency advisory ambulance team).

Secondly, the conditions under which a particular position is introduced will change:

  • One position Deputy Chief Physician for Medical Affairs will be created at an emergency medical service station if the emergency medical service station has at least 100 medical and paramedic positions on its staff, including the position of chief physician ( today - to a medical organization, which has created an EMS department and at least 40 medical positions, including the position of head of the EMS department);
  • Pharmacist-technologist will be recommended at the rate of 1 position per emergency medical service station if there is a pharmacy in its structure; 1 additional position at an emergency medical service station if there is a pharmacy in its structure for every 300 thousand trips performed per year (if more than 300 thousand trips are performed per year) ( Currently, 1 position is recommended for an emergency medical service station if there is a pharmacy in its structure).

Car equipment various classes EMS will not be regulated for obstetric visiting teams due to the disappearance of the obstetric visiting teams themselves from July 1, 2016.

There will be lists of equipment for equipping emergency vehicles have been reduced. More precisely, due to the fact that from July 1, 2016, new requirements for the configuration of equipment and kits for the provision of emergency medical services will come into force ( more about this on our Facebook page https://goo.gl/ajc9XK and on our website), cars SMPs of various classes will not be equipped toxicological, anti-burn kit, for catheterization of central veins, for drainage of the pleural cavity, for cannulation of the cancellous bones of the cavity for the provision of emergency medical care.

Class “B” EMS vehicles for paramedics and medical general field EMS teams and specialized pediatric mobile EMS teams will be equipped in the same way, in contrast to the vehicle equipment standard in force today.

With regard to the Rules for the organization of activities, recommended staffing standards and equipment standards for the department of an emergency consultative ambulance hospital (emergency hospital, medical disaster center) (hereinafter referred to as the Department), the following main amendments have been introduced:

  • In addition to those specified in the previous edition of the Procedure for the premises of the post of the responsible doctor on duty and the room for preparing for the work of medical facilities and equipment of emergency medical services teams It is recommended that the Department also provide offices for consultant doctors, an office for the head of the department, a room for nursing staff and a room for junior medical staff.
  • Some changes have been made to the recommended staffing standards of the Department (in particular, the following positions are included: toxicologist, neonatologist, hematologist(in the amount of 5.25 (to ensure the round-the-clock work of the mobile emergency advisory team of EMS) and infectious disease physician(in the amount of 6.0 (to ensure the round-the-clock work of the mobile emergency advisory team of the EMS)). We also note that changes in the staffing standards of the Departments did not affect obstetricians and gynecologists;
  • Minor adjustments have also been made to the Branch's equipment standards (in particular resuscitation kit in a case or backpack were reduced or a roll-up for children weighing no more than 35 kg, a resuscitation kit in a case or backpack or a roll-up for children weighing no less than 35 kg).

About the activities of an emergency medical doctor

The rules for organizing the activities of an EMS doctor at an EMS station, EMS department of a polyclinic (hospital, EMS hospital, inpatient department of an EMS hospital (EMS hospital), emergency advisory EMS department of a hospital (EMS hospital, disaster medicine center) have changed only in terms of requirements for a specialist appointed to the position emergency medicine doctor, qualification requirements. According to the previous edition, a specialist was appointed to the position of emergency medicine doctor who meets the requirements set by the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by Order of the Ministry of Health and Social Development of the Russian Federation dated July 7, 2009 No. 415n, according to specialty "emergency medical care", which became invalid on November 6, 2015. Currently, a specialist who meets the requirements of the Qualification Requirements for medical and pharmaceutical workers is appointed to this position. higher education in the field of training “Healthcare and Medical Sciences”, approved by order of the Ministry of Health of the Russian Federation dated October 8, 2015 No. 707n.

* - this is a regular selection of the most important regulatory documents And judicial practice in the healthcare sector

1. Ambulance, including specialized emergency medical care, is provided to citizens in case of illnesses, accidents, injuries, poisoning and other conditions requiring urgent medical intervention. Ambulance, including specialized ambulance, medical care provided by medical organizations of the state and municipal systems healthcare is provided to citizens free of charge.

2. Ambulance, including specialized emergency medical care, is provided in an emergency or emergency form outside a medical organization, as well as in outpatient and inpatient settings.

3. On the territory of the Russian Federation, for the purpose of providing emergency medical care, a system of a single number for calling emergency medical care operates in the manner established by the Government of the Russian Federation.

4. When providing emergency medical care, if necessary, medical evacuation is carried out, which is the transportation of citizens in order to save lives and preserve health (including persons being treated in medical organizations that do not have the ability to provide the necessary medical care for life-threatening conditions , women during pregnancy, childbirth, the postpartum period and newborns, persons injured as a result emergency situations And natural Disasters).

5. Medical evacuation includes:

1) sanitary aviation evacuation carried out by aircraft;

2) sanitary evacuation carried out by land, water and other modes of transport.

6. Medical evacuation is carried out by mobile emergency medical teams, carrying out measures to provide medical care during transportation, including the use of medical equipment.

7. Medical organizations subordinate to federal authorities executive power has the right to carry out medical evacuation in the manner and under the conditions established by the authorized federal body executive power. The list of specified medical organizations subordinate to federal executive authorities is approved by the authorized federal executive authority.

Advertisement organizing necessary medical care.

Organizing the work of an ambulance and emergency aid station

Ambulance and emergency aid stations are designed to provide emergency medical care. Ambulance stations do not provide systematic treatment; they are intended to provide emergency care at the prehospital stage (see order of the Ministry of Health of the Russian Federation dated March 26, 2000 No. 100). At ambulance stations, sick leave certificates, certificates and other written documents are not issued to patients or their relatives.

Hospitalization of patients is carried out by emergency hospitals and emergency hospitalization departments of the general network of hospital institutions.

Ambulance stations are equipped with specialized ambulance transport, equipped with equipment for urgent diagnosis and treatment of life-threatening conditions. The work of ambulance stations is organized in teams. There are linear teams (a doctor and a paramedic), specialized (a doctor and two paramedics), and linear paramedics (usually used for the targeted transportation of patients). IN major cities Usually the following specialized teams operate: resuscitation, neurological, infectious diseases, pediatric intensive care, psychiatric, etc. All work of the teams is documented, the team doctor fills out call cards, which after duty are handed over to the senior shift doctor for control, and then for storage and statistical processing in organizational and methodological department. If necessary (at the request of doctors of the general network, investigative authorities etc.) you can always find the call card and find out the circumstances of the call. If the patient is hospitalized, the doctor or paramedic fills out an accompanying sheet, which remains in the medical history until the patient is discharged from the hospital or until the patient’s death. The hospital returns the tear-off coupon of the accompanying sheet to the station, which makes it possible to keep a record of the ambulance crew's errors, thereby improving the quality of work of the ambulance crews.

At the scene of the call, the ambulance team provides the necessary treatment to the maximum extent available (as well as on the way when transporting the patient). In providing assistance to the sick and injured, the main responsibility rests with the team doctor, who supervises the actions of the team. IN difficult cases the doctor consults with the senior shift doctor by telephone. Most often, the senior shift doctor, at the request of the line team doctor, sends a specialized team to the place of call. Patients in need of emergency care are transported over long distances by air ambulances and helicopters.

41. Maternal and child health care system.

OcherAon the materAndnstva and detstva- a system of state and public measures aimed at ensuring the health of mother and child, strengthening the family, creating the most favorable conditions for raising children, their physical, intellectual and moral development.

WHO programs events according to OMID as the main ones; The WHO program states that by 2005, sustainable and continuous improvement in the health of children and women should be achieved.

Characteristics of the health status of women and children currently (in Russia). 1. More than 40 thousand babies die annually 2. 30 thousand children are born premature or sick 3. among all children, 14% belong to the group of healthy and practically healthy 4. Every year, teenage girls under 17 years old have about 20 thousand abortions. 5. Every year about 5 million births occur in the country, at the same time about 6 million abortions are carried out annually, and about 600 of them end fatally 6. Our infant mortality rate is 17, and in developed countries it is 10, in Germany

7. Infant mortality represents 1/3 of total mortality, thus is an indicator general health population also affects average life expectancy. 8. Children get sick 3 times more often than adults; The overall incidence rate in the country is about 1000 per 1000 population, while the incidence rate in children under 1 year of age is 3000 per 1000 population. 9. Structure of diseases of children in the 1st year of life: first place - pneumonia, second place - nutritional disorders, third place - birth injuries and hemolytic diseases. In the second year of life: first place - respiratory diseases (70%), second place - infections, third place - metabolic diseases, allergies. The health of mother and child must be considered as the health of the future society. In the country, about 90 medical institutes have a pediatric department and 2 institutes are pediatric.

WHO has defined 6 groups for monitoring the health of children: 1 group of child health care - before conception. This includes measures to protect women's health in general and the development of medical genetic centers. Group 2 - the period from conception to childbirth. The most active activities are carried out in the first months of pregnancy. Group 3 - the period of childbirth, includes measures for the safety of obstetric care and the prevention of complications during childbirth. Group 4 - the period of early childhood (up to 1 year) or infancy. Activities to promote breastfeeding and immunization. Group 5 - preschool age) 1-7 years). Objectives: rational nutrition and physical development. 6 group - school age. objectives are to accustom children to health procedures, conduct sanitary and hygienic training, and promote a healthy lifestyle.

Principles of organizing medical care for mothers and children. 1. The principle of a single pediatrician - that is, one doctor serves children from 0 to 14 years 11 months. 29 days. Since 1993, the child population can be served by two pediatricians under a contract.

2. The principle of locality. Pediatric area size 800 children. The central figure of the outpatient clinic network is the local pediatrician; Now the responsibility of the local pediatrician is increasing within the framework of compulsory health insurance (CHI) and criteria for individual responsibility (or personification) are being sought.

3. Dispensary method of work. All children, regardless of age, health status, place of residence and attendance at organized preschool and school institutions, must be examined as part of preventive examinations, which, like vaccination, is carried out free of charge. 4. The principle of unification, that is, antenatal clinics are united with maternity hospitals, children's clinics are united with hospitals. 5. The principle of alternating medical care: at home, in a clinic, in a day hospital. Only healthy children or convalescents come to the clinic for outpatient appointments; patients are served at home.

6. The principle of continuity. Carried out between the antenatal clinic, maternity hospital and children's clinic in the form of prenatal care, visits to the newborn within 3 days after discharge from the maternity hospital, monthly examinations of the baby in the children's clinic for 1 year of life 6. for the antenatal clinic - the principle of early registration at the dispensary (up to 12 months .)

7. the principle of social and legal assistance, that is, there is a lawyer’s office in the children’s clinic and antenatal clinic.

OMID Institutions.

Child welfare institutions.

1. Outpatient clinics: children's clinic, children's dental clinic, children's consultation 2. Inpatient: children's hospital, somatic children's infectious diseases hospital, children's department in the structure of general somatic adult hospitals 3. Specialized children's homes, children's sanatoriums, nurseries, children's dairy kitchens for developmentally retarded children Maternity protection: antenatal clinics, maternity hospitals, obstetric and gynecological departments of somatic hospitals, departments of pathology of pregnant women

general somatic hospitals.

"

Registered with the Ministry of Justice of Russia on August 16, 2013 N 29422
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
ORDER

MEDICAL CARE
In accordance with Part 2 of Article 37 of the Federal Law of November 21, 2011 N 323-FZ “On the protection of the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2012, N 26, Art. 3442, 3446) I order:

1. Approve the attached Procedure for the provision of emergency, including specialized emergency medical care.

2. To recognize as invalid:

order of the Ministry of Health and social development Russian Federation dated November 1, 2004 N 179 “On approval of the Procedure for providing emergency medical care” (registered by the Ministry of Justice of the Russian Federation on November 23, 2004, registration N 6136);

order of the Ministry of Health and Social Development of the Russian Federation dated August 2, 2010 N 586n "On amendments to the Procedure for the provision of emergency medical care, approved by order of the Ministry of Health and Social Development of the Russian Federation dated November 1, 2004 N 179" (registered by the Ministry of Justice of the Russian Federation August 30, 2010, registration N 18289);

order of the Ministry of Health and Social Development of the Russian Federation dated March 15, 2011 N 202n “On amending Appendix No. 3 to the Procedure for the provision of emergency medical care, approved by order of the Ministry of Health and Social Development of the Russian Federation dated November 1, 2004 N 179” ( registered by the Ministry of Justice of the Russian Federation on April 4, 2011, registration N 20390);

order of the Ministry of Health and Social Development of the Russian Federation dated January 30, 2012 N 65n "On introducing changes to the Procedure for providing emergency medical care, approved by order of the Ministry of Health and Social Development of the Russian Federation dated November 1, 2004 N 179" (registered by the Ministry of Justice of the Russian Federation March 14, 2012, registration N 23472).

V.I.SKVORTSOVA
Approved

by order of the Ministry of Health

Russian Federation

AMBULANCE SERVICES, INCLUDING EMERGENCY SPECIALIZED,

MEDICAL CARE
1. Present Order establishes the rules for the provision of emergency, including specialized emergency medical care on the territory of the Russian Federation.

2. Ambulance, including specialized emergency medical care, is provided in case of illnesses, accidents, injuries, poisoning and other conditions requiring urgent medical intervention.

3. Ambulance, including specialized emergency medical care, is provided on the basis of medical care standards.

4. Ambulance, including specialized emergency medical care, is provided in the following conditions:

a) outside a medical organization - at the place where the ambulance team is called, including specialized emergency medical care, as well as in vehicle during medical evacuation;

b) outpatient (in conditions that do not provide round-the-clock medical supervision and treatment);

c) inpatient (in conditions that provide round-the-clock medical supervision and treatment).

5. Ambulance, including specialized emergency medical care, is provided in the following forms:

a) emergency - in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life;

b) emergency - for sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs threats to the patient's life.

6. Ambulance, including specialized ambulance, medical care outside a medical organization is provided by medical workers of mobile ambulance teams.

7. Mobile emergency medical teams are dispatched to a call by a paramedic to receive emergency medical calls and transfer them to mobile emergency medical teams or by a nurse to receive emergency medical calls and transfer them to mobile emergency medical teams, taking into account the profile of the mobile emergency medical team and forms of medical care.

8. Ambulance, including specialized emergency medical care in outpatient and inpatient settings is provided by medical workers of medical organizations providing medical care in outpatient and inpatient settings.

9. Emergency medical assistance is called:

a) by telephone by dialing numbers “03”, “103”, “112” and (or) telephone numbers of a medical organization providing emergency medical care;

b) using short text messages (SMS);

c) when directly contacting a medical organization providing emergency medical care.

10. If an emergency medical call is received, the nearest available general-purpose mobile ambulance team or specialized mobile ambulance team is dispatched to the call.

11. The reasons for calling an ambulance in an emergency are:

a) disturbances of consciousness that pose a threat to life;

b) breathing problems that pose a threat to life;

c) disorders of the circulatory system that pose a threat to life;

d) mental disorders accompanied by the patient’s actions that pose an immediate danger to him or other persons;

e) sudden pain that poses a threat to life;

f) sudden dysfunction of any organ or organ system that poses a threat to life;

g) injuries of any etiology that pose a threat to life;

h) thermal and chemical burns that pose a threat to life;

i) sudden bleeding that poses a threat to life;

j) childbirth, threat of termination of pregnancy;

k) duty in the event of a threat of an emergency, provision of emergency medical care and medical evacuation in the event of liquidation of the health consequences of an emergency.

12. In the event of an urgent medical emergency call, the nearest available general-profile mobile ambulance team is dispatched to the call in the absence of emergency emergency medical calls.

13. The reasons for calling an ambulance in an emergency are:

a) sudden acute diseases (conditions) without obvious signs of a threat to life, requiring urgent medical intervention;

b) sudden exacerbations of chronic diseases without obvious signs of a threat to life, requiring urgent medical intervention;

c) declaration of death (except for the opening hours of medical organizations providing medical care on an outpatient basis).

14. When providing emergency, including specialized emergency medical care, medical evacuation is carried out if necessary.

15. Ambulance, including specialized emergency, medical care in inpatient conditions is provided by medical workers of the inpatient emergency department.

16. When a patient enters a medical organization to provide emergency medical care in a hospital setting, the diagnosis is clarified, diagnostics, dynamic observation and therapeutic and diagnostic measures are carried out in emergency medical care beds for a daily stay and, if there are medical indications, short-term treatment lasting no more than three days in short-stay emergency medical beds.

17. If there are medical indications, patients are sent from the inpatient emergency department to the specialized departments of the medical organization within which the inpatient emergency department has been created, or to other medical organizations to provide specialized, including high-tech, medical care.

18. In remote or hard-to-reach settlements (areas settlements), along highways To provide emergency, including emergency specialized medical care, branches (posts, route points) of emergency medical care can be organized, which are structural divisions a medical organization providing emergency medical care outside a medical organization.

19. Ambulance, including specialized emergency medical care, is provided in accordance with Appendices No. 1 - 15 to this Procedure.
Appendix No. 1

to the Procedure for providing

ambulance, including

emergency specialized

medical care,

approved by order

Ministry of Health

Russian Federation

IMPLEMENTATION OF MEDICAL EVACUATION WHEN PROVIDING AN AMBULANCE

MEDICAL CARE
1. These Rules determine the procedure for carrying out medical evacuation when providing emergency medical care (hereinafter referred to as medical evacuation).

2. These Rules do not apply to relations involving medical evacuation by federal government agencies.

3. Medical evacuation includes:

a) sanitary aviation evacuation carried out by air transport;

b) sanitary evacuation carried out by land, water and other modes of transport.

4. Medical evacuation is carried out by mobile emergency medical teams.

5. Medical evacuation can be carried out from the scene of the incident or the location of the patient (outside the medical organization), as well as from a medical organization that does not have the ability to provide the necessary medical care for life-threatening conditions, women during pregnancy, childbirth, the postpartum period and newborns, persons affected by emergencies and natural disasters (hereinafter referred to as a medical organization that does not have the ability to provide the necessary medical care).

6. The choice of a medical organization to deliver a patient during medical evacuation is made based on the severity of the patient’s condition, minimum transport accessibility to the location of the medical organization and the profile of the medical organization where the patient will be delivered.

7. The decision on the need for medical evacuation is made by:

a) from the scene of the incident or the location of the patient (outside the medical organization) - a medical worker of the mobile emergency medical team, appointed by the head of the specified team;

b) from a medical organization in which there is no possibility of providing the necessary medical care - the head (deputy head for medical work) or the doctor on duty (except for the working hours of the head (deputy head for medical work)) of a medical organization in which there is no possibility of providing the necessary medical care assistance, upon the recommendation of the attending physician and the head of the department or the responsible medical worker of the shift (except for the working hours of the attending physician and the head of the department).

8. Preparation of a patient being treated in a medical organization that does not have the ability to provide the necessary medical care for medical evacuation is carried out by medical workers of the specified medical organization and includes all the necessary measures to ensure the stable condition of the patient during medical evacuation in accordance with the profile and severity disease (condition), expected duration of medical evacuation.

During medical evacuation, medical workers of the mobile ambulance team monitor the state of the patient’s body functions and provide him with the necessary medical care.

9. Upon completion of the medical evacuation, the medical worker of the mobile emergency medical team, appointed by the head of the specified team, transfers the patient and the corresponding medical documentation to the doctor of the reception department of the medical organization and informs the paramedic for receiving emergency medical calls and transferring them to visiting ambulance teams or the nurse for receiving emergency medical calls and transferring them to visiting emergency medical teams about the completion of the medical evacuation of the patient, indicating the last name, first name and patronymic name of the doctor in the emergency department of a medical organization.

10. Medical evacuation in case of road traffic accidents is carried out to medical organizations that provide medical care to victims with combined, multiple and isolated injuries accompanied by shock.

11. Sanitary aviation evacuation is carried out in the following cases:

a) the severity of the patient’s condition, requiring his prompt delivery to a medical organization, if available technical feasibility the use of air transport and the inability to provide sanitary evacuation in the optimal time frame by other modes of transport;

b) the presence of contraindications to medical evacuation of the victim by ground transport;

c) the location of the incident is remote from the nearest medical organization at a distance that does not allow the patient to be delivered to the medical organization as quickly as possible;

d) climatic and geographical features of the incident site and lack of transport accessibility;

e) the scale of the incident does not allow mobile emergency medical teams to carry out medical evacuation by other means of transport.
Appendix No. 2

to the Procedure for providing

ambulance, including

emergency specialized

medical care,

approved by order

Ministry of Health

Russian Federation

ORGANIZATION OF THE ACTIVITIES OF THE AMBULANCE Crew

MEDICAL CARE
1. These Rules determine the procedure for organizing the activities of a mobile ambulance team.

2. The main purpose of the mobile ambulance team is to provide emergency medical care, including at the scene of an emergency call during medical evacuation.

3. Based on their profile, mobile emergency medical teams are divided into general, specialized, emergency advisory, obstetric, and aeromedical.

4. Based on their composition, mobile emergency medical teams are divided into medical and paramedic teams.

5. Specialized mobile emergency medical teams are divided into anesthesiology-resuscitation, pediatric, pediatric anesthesiology-resuscitation, psychiatric, and obstetrics-gynecology teams.

6. Mobile emergency medical teams include medical workers from medical organizations providing emergency medical care.

7. Mobile emergency medical teams are created taking into account the need to ensure round-the-clock shift work, the population size, the average radius of the service area, the average load per ambulance team per day, and the load factor of emergency medical teams.

8. A paramedic general-profile mobile ambulance team includes either one emergency medical paramedic and one paramedic-driver of an ambulance, or two paramedics of an emergency medical service and one paramedic-driver, or two paramedics of an emergency medical service and one driver, or two paramedics - ambulance drivers (using a class "A" or "B" ambulance).

9. A medical general-profile mobile emergency medical team includes either one emergency medical technician and one paramedic-emergency medical driver, or one emergency medical technician, one emergency medical assistant and one paramedic-driver, or one emergency medical technician, one emergency medical technician and one driver (using a class "B" ambulance).

10. A specialized mobile emergency medical team of anesthesiology-resuscitation, a pediatric specialized mobile emergency medical team of anesthesiology-resuscitation includes either one emergency medical doctor (a specialist doctor in a specialty corresponding to the profile of the mobile emergency medical team), two specialists with secondary medical education (emergency medical assistant or nurse anesthetist) and one orderly-driver, or one emergency medical doctor (specialist doctor in a specialty corresponding to the profile of the mobile emergency medical team), two specialists with secondary medical education (emergency medical assistant aid or nurse anesthetist) and one driver, or one emergency medical technician (specialist doctor in a specialty corresponding to the profile of the mobile emergency medical team), one specialist with secondary medical education (emergency medical assistant or nurse anesthetist) and one paramedic-driver of an ambulance (using a class "C" ambulance of the appropriate profile).

11. A psychiatric specialized mobile emergency medical team, a pediatric specialized mobile emergency medical team, an obstetric-gynecological specialized mobile emergency medical team include either one emergency medical doctor (a specialist doctor in a specialty corresponding to the profile of the mobile emergency medical team), two emergency medical assistants and one paramedic-driver, or one emergency medical doctor (specialist doctor in a specialty corresponding to the profile of the mobile emergency medical team), two emergency medical assistants and one driver, or one emergency medical doctor (doctor - a specialist in a specialty corresponding to the profile of the mobile emergency medical team), one emergency medical assistant and one emergency medical assistant driver (using a class "C" ambulance of the appropriate profile).

12. An obstetric emergency medical team includes either one obstetrician and one nurse-driver, or one obstetrician and one driver (using a class “A” or “B” ambulance).

13. A traveling emergency advisory ambulance team includes either a specialist doctor (consultant) of the emergency advisory emergency medical care department of a medical organization, two specialists with secondary medical education (an emergency medical assistant or a nurse anesthetist) and one orderly driver, or a specialist doctor (consultant) of the emergency advisory ambulance department of a medical organization, two specialists with secondary medical education (an emergency medical assistant or nurse anesthetist) and one driver, or a specialist doctor (consultant) of the emergency advisory ambulance department of a medical organization organization, one specialist with secondary medical education (emergency medical assistant or nurse anesthetist) and one paramedic-emergency medical driver (using a class "C" ambulance of the appropriate profile).

14. The aeromedical emergency medical team includes at least one emergency medical technician or anesthesiologist-resuscitator and at least one specialist with secondary medical education (emergency medical assistant or nurse anesthetist).

15. The mobile ambulance team is operationally subordinate to the senior doctor (senior paramedic) of the operational department of the medical organization providing emergency medical care, the shift supervisor of the medical organization providing emergency medical care, the paramedic for receiving emergency medical calls and transferring them to mobile ambulance teams medical assistance (a nurse who receives emergency medical calls and transfers them to visiting emergency medical teams).

16. The mobile emergency medical team performs the following functions:

a) carries out immediate departure (departure, departure) to the place where emergency medical assistance is called;

b) provides emergency medical care based on the standards of medical care, including establishing the leading syndrome and preliminary diagnosis of the disease (condition), implementing measures to help stabilize or improve the patient’s condition;

c) determines a medical organization to provide medical care to the patient;

d) carries out medical evacuation of the patient if there are medical indications;

e) immediately transfers the patient and the corresponding medical documentation to the doctor of the admission department of the medical organization with a note in the emergency medical care call card of the time and date of admission, the name and signature of the person receiving it;

f) immediately informs the paramedic for receiving emergency medical calls and transferring them to emergency medical teams (the nurse for receiving emergency calls and transferring them to emergency medical teams) about the end of the call and its result;

g) ensures the triage of patients (victims) and establishes the sequence of medical care in case of mass diseases, injuries or other conditions.

17. The mobile ambulance team calls a specialized mobile ambulance team (if they are available in the service area) in cases where the patient’s condition requires the use of special methods and complex medical technologies, performing the maximum possible amount of medical care on site before its arrival using its own resources and resources.
Appendix No. 3

to the Procedure for providing

ambulance, including

emergency specialized

medical care,

approved by order

Ministry of Health

Russian Federation

2. Ambulance, including specialized emergency medical care, is provided in case of illnesses, accidents, injuries, poisoning and other conditions requiring urgent medical intervention.

3. Emergency, including specialized emergency medical care is provided on the basis of standards of medical care and taking into account clinical recommendations (treatment protocols).

4. Ambulance, including specialized emergency medical care, is provided in the following conditions:

A) outside a medical organization - at the place where the ambulance team is called, including specialized emergency medical care, as well as in a vehicle during medical evacuation;

B) outpatient (in conditions that do not provide round-the-clock medical supervision and treatment);

C) inpatient (in conditions that provide round-the-clock medical supervision and treatment).

5. Ambulance, including specialized emergency medical care, is provided in the following forms:

A) emergency - in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life;

B) emergency - in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient’s life.

6. Ambulance, including specialized ambulance, medical care outside a medical organization is provided by medical workers of mobile ambulance teams.

7. Mobile emergency medical teams are dispatched to a call by a paramedic to receive emergency medical calls and transfer them to mobile emergency medical teams or by a nurse to receive emergency medical calls and transfer them to mobile emergency medical teams, taking into account the profile of the mobile emergency medical team and forms of medical care.

8. Ambulance, including specialized emergency medical care in outpatient and inpatient settings is provided by medical workers of medical organizations providing medical care in outpatient and inpatient settings.

9. Emergency medical assistance is called:

A) by telephone by dialing numbers “03”, “103”, “112” and (or) telephone numbers of a medical organization providing emergency medical care;

B) using short text messages (SMS) if technically possible;

C) when directly contacting a medical organization providing emergency medical care;

D) upon admission to a medical organization providing emergency medical care, an electronically filled out emergency medical care call card from the information systems of emergency operational services.

10. If an emergency medical call is received, the nearest available general-purpose mobile ambulance team or specialized mobile ambulance team is dispatched to the call.

11. The reasons for calling an ambulance in an emergency are sudden acute diseases, conditions, exacerbations of chronic diseases that pose a threat to the patient’s life, including:

A) disturbances of consciousness;

B) breathing problems;

B) disorders of the circulatory system;

D) mental disorders accompanied by the patient’s actions that pose an immediate danger to him or other persons;

D) pain syndrome;

E) injuries of any etiology, poisoning, wounds (accompanied by life-threatening bleeding or damage to internal organs);

G) thermal and chemical burns;

H) bleeding of any etiology;

I) childbirth, threat of termination of pregnancy.

12. In the event of an urgent medical emergency call, the nearest available general-profile mobile ambulance team is dispatched to the call in the absence of emergency emergency medical calls.

13. The reasons for calling an ambulance in an emergency are:

A) sudden acute diseases, conditions, exacerbations of chronic diseases requiring urgent medical intervention, without obvious signs of a threat to life specified in paragraph 11 of this Procedure;

B) declaration of death (except for the opening hours of medical organizations providing medical care on an outpatient basis).

14. When providing emergency, including specialized emergency medical care, medical evacuation is carried out if necessary.

15. When a death is ascertained in an ambulance, the visiting ambulance team is obliged to immediately notify the paramedic for receiving emergency medical calls and transferring them to visiting ambulance teams or the nurse for receiving emergency medical calls and transferring them to visiting ambulance teams. medical assistance to call employees of the territorial bodies of the Ministry of Internal Affairs of the Russian Federation or obtain permission to transport the body of a deceased patient to a medical organization performing a forensic medical examination.

If signs of violent death are detected in a deceased (deceased) patient or if it is suspected, as well as if it is impossible to identify the identity of the deceased (deceased), when making an emergency medical call, the medical worker of the mobile emergency medical team, appointed by the senior, is obliged to notify about this a paramedic to receive emergency medical calls and transfer them to visiting emergency medical teams or a nurse to receive emergency medical calls and transfer them to mobile emergency medical teams for immediate notification of the territorial body of the Ministry of Internal Affairs of the Russian Federation.

16 - 17. Lost power. - Order of the Ministry of Health of Russia dated January 22, 2016 N 33n.

18. In remote or hard-to-reach settlements (sections of settlements), along highways, to provide emergency, including specialized emergency medical care, branches (posts, route points) of emergency medical care can be organized, which are structural divisions of a medical organization providing ambulance , including specialized emergency medical care.

In the event of a threat of emergency situations, including in places of mass events, mobile ambulance teams are on duty.

19. Ambulance, including specialized emergency medical care, is provided in accordance with Appendices No. 1 to this Procedure.